Minority primary care physicians' knowledge, attitudes, and practices on eye health and preferred sources of information.
ABSTRACT Racial and ethnic disparities exist in the prevalence of certain eye diseases. Minority primary care physicians are in a unique position to help prevent vision loss and blindness, especially among minority populations.
To measure physicians' knowledge and attitudes regarding eye health and to better understand the facts regarding patient information and counseling concerning eye health and disease, the National Eye Institute included key eye health knowledge, attitude, and practice questions in the 2007 DocStyles Survey, a Web-based survey of primary care physicians about physician perceptions and attitudes concerning communication with patients.
A total of 428 minority primary care physicians responded to the survey. Results indicate that minority primary care physicians have favorable attitudes regarding eye health and the role they should play in talking with patients about eye health. Approximately 60% indicated that they could identify patients at higher risk for eye disease; however, only 52% of physicians indicated that they have adequate knowledge to advise their patients on vision health. Regarding information sources, most minority physicians prefer to obtain information about vision and eye health from professional journals, medical Web sites, and continuing medical education.
Findings from this research reveal both a need and an opportunity with regard to increasing physician confidence in identifying patients at higher risk for eye disease and advising their patients on eye health.
- SourceAvailable from: Bei Wu[Show abstract] [Hide abstract]
ABSTRACT: INTRODUCTION: Limited research has examined primary care providers' communication with patients about maintaining cognitive functioning. Our study's objective was to compare the perceptions of consumers and primary care providers related to beliefs and communication practices about lifestyle behaviors beneficial for overall health and for maintaining cognitive functioning. METHODS: In 2009, we submitted 10 questions to Porter Novelli's HealthStyles survey and 6 questions to their DocStyles survey. We compared consumers' (n = 4,728) and providers' (n = 1,250) beliefs, practices, and information sources related to maintaining health and cognitive functioning. We made comparisons using nonparametric statistics. RESULTS: Approximately 76% of consumers considered their health to be good or very good; 73.4% were concerned or very concerned about the possibility that their memory may worsen with age. Women were significantly more concerned than men, and white consumers were more concerned than black and Hispanic consumers. Consumers reported they believed that intellectual stimulation (86.6%), physical activity (82.6%), and healthful diet (82.5%) prevented or delayed cognitive impairment. Providers reported advising patients to reduce cognitive impairment risk through physical activity (85.9%), intellectual stimulation (80.3%), and social involvement (67.4%). Few consumers (7.8%) reported receiving this information from providers but reported learning about strategies to maintain memory, primarily from television (50.1%), magazines (44.1%), and newspapers (33.7%). CONCLUSION: Providers reported advising patients about how to reduce risks of cognitive impairment. Consumers reported receiving this information from other sources. Findings suggest a need to examine and assess media messages and to better understand patient-provider communication about cognitive functioning.Preventing chronic disease 04/2013; 10:E58. · 1.96 Impact Factor
- Medical Education 05/2012; 46(5):517-8. · 3.62 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: This paper presents a Web Information Retrieval System (WebIRS), which is designed to assist the healthcare professionals to obtain up-to-date medical knowledge and information via the World Wide Web (WWW). The system leverages the document classification and text summarization techniques to deliver the highly correlated medical information to the physicians. The system architecture of the proposed WebIRS is first discussed, and then a case study on an application of the proposed system in a Hong Kong medical organization is presented to illustrate the adoption process and a questionnaire is administrated to collect feedback on the operation and performance of WebIRS in comparison with conventional information retrieval in the WWW. A prototype system has been constructed and implemented on a trial basis in a medical organization. It has proven to be of benefit to healthcare professionals through its automatic functions in classification and summarizing the medical information that the physicians needed and interested. The results of the case study show that with the use of the proposed WebIRS, significant reduction of searching time and effort, with retrieval of highly relevant materials can be attained.Journal of Medical Systems 06/2013; 37(3):9946. · 1.37 Impact Factor
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATIONVOL. 101, NO. 12, DECEMBER 2009 1247
of many eye diseases in minority populations is a major
public health problem that can lead to loss of productiv-
ity and reduced quality of life. Racial/ethnic disparities
exist in the prevalence of certain eye diseases.1-3 Data
from the Los Angeles Latino Eye Study suggest that the
prevalence of diabetic retinopathy is high among Lati-
nos, primarily those of Mexican ancestry. Research-
ers found that Latinos appear to have a higher rate of
severe vision-threatening diabetic retinopathy than non-
Hispanic whites.4 Glaucoma disproportionately affects
specific racial and ethnic groups. African Americans
have almost 3 times the prevalence of primary open-
angle glaucoma (POAG) than whites.5 The prevalence of
POAG is also high among Latinos of Mexican ancestry.6
Cataract causes about 50% of the cases of vision loss
among whites, African Americans, and Latinos in the
United States. African-American men are more likely
to be visually impaired from cataract than white men.7
Cataract occurs in 20% of the Latino population.8
Given the significant prevalence of eye disease, it is
important to identify strategies to reduce this burden of
disease in the community. Primary care physicians are a
critical source for health information and can play a sig-
nificant role in preventing vision loss and blindness. Fur-
ther, minority physicians, who are more likely than other
physicians to see minority patients, can be integral in
improved health communication with racial/ethnic con-
cordant patients. Racial and ethnic concordance (between
patient and physician) is an important factor in patient-
physician communication—the fundamental value being
improved communication.9 The idea is that when physi-
cians and patients share culture and/or language, patients
and physicians communicate more effectively and with
n the United States, minorities are at higher risk of
developing eye diseases such as diabetic retinopa-
thy, glaucoma, and cataract. The growing prevalence
Author Affiliations: National Eye Health Education Program, National Eye
Institute, National Institutes of Health, Bethesda, MD (Ms Ammary-Risch,
deputy director); ICF Macro, Rockville, Maryland (Dr Kwon and Ms Heath-
Watson, technical directors; Dr Scarbrough, senior technical director);
Morehouse School of Medicine, Atlanta, Georgia (Dr Higginbotham, dean).
Corresponding Author: William Scarbrough, PhD, ICF Macro, 11420 Rockville
Pike, Rockville, MD 20852 (firstname.lastname@example.org).
Funding/Support: This paper was written with the support of the
National Eye Institute under contract 263-01-D-0174 NICS 39.
Background: Racial and ethnic disparities exist in the preva-
lence of certain eye diseases. Minority primary care physi-
cians are in a unique position to help prevent vision loss and
blindness, especially among minority populations.
Methods: To measure physicians’ knowledge and attitudes
regarding eye health and to better understand the facts
regarding patient information and counseling concerning
eye health and disease, the National Eye Institute included
key eye health knowledge, attitude, and practice questions
in the 2007 DocStyles Survey, a Web-based survey of primary
care physicians about physician perceptions and attitudes
concerning communication with patients.
Results: A total of 428 minority primary care physicians
responded to the survey. Results indicate that minority pri-
mary care physicians have favorable attitudes regard-
ing eye health and the role they should play in talking with
patients about eye health. Approximately 60% indicated
that they could identify patients at higher risk for eye dis-
ease; however, only 52% of physicians indicated that they
have adequate knowledge to advise their patients on vision
health. Regarding information sources, most minority phy-
sicians prefer to obtain information about vision and eye
health from professional journals, medical Web sites, and
continuing medical education.
Conclusions: Findings from this research reveal both a need
and an opportunity with regard to increasing physician con-
fidence in identifying patients at higher risk for eye disease
and advising their patients on eye health.
Keywords: ophthalmic n primary care n minority health n
J Natl Med Assoc. 2009;101:1247-1253
Minority Primary Care Physicians’ Knowledge,
Attitudes, and Practices on Eye Health and
Preferred Sources of Information
Neyal Ammary-Risch, MPH, CHES; Harry T. Kwon, PhD, MPH, CHES; William Scarbrough, PhD;
Eve Higginbotham, MD; Shelly Heath-Watson, MA
1248 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATIONVOL. 101, NO. 12, DECEMBER 2009
MINORITy PHySICIANS AND EyE HEALTH
greater confidence in the interaction. Minority patients
may also make additional efforts to receive care from
racially concordant providers.10 Further, language discor-
dance between patients and providers was associated
with less health education, decreased health quality, and
low ratings of the provider.11 Research has shown that
white, African American, Asian, and Hispanic patients in
racially and language-concordant relationships with their
physicians were more likely to use needed services,
receive preventive screenings, have prescriptions filled,
adopt physician-recommended health behaviors, and
were less likely to postpone seeking care and miss
appointments.12-15 Furthermore, because primary care
physicians commonly see their patients more frequently
than specialists, they are in a unique position to help pre-
vent or minimize vision loss and blindness. The purpose
of this paper is to more systematically examine what
minority primary care physicians report knowing, believ-
ing, and practicing with their patients with regard to
vision and eye health.
In July/August 2007, Porter Novellia,1 conducted Doc-
Styles, a national Web-based survey with primary care
physicians. The sample was drawn from the Epocrates
Honors Panel (EHP), an opt-in, verified panel of 142 000
physicians.b,2 A random sample of eligible physicians
was selected from the EHP database to be used in the sur-
vey invitation database. This sample was drawn to match
the American Medical Association’s master data file pro-
portions for age, gender, and region. Electronic invita-
tions included a link to the Web-based survey, which was
hosted by OpenVenue (Toronto, Ontario, Canada).3 Quo-
tas were set to reach 1000 primary care physicians, 250
pediatricians, and 250 obstetricians and gynecologists.
Physicians were screened to include only those who
practice in the United States, actively see patients; work
in an individual, group, or hospital practice; and who
have been practicing medicine for at least 3 years. Physi-
cians were provided an honorarium of $45 to $55 for
completing the survey. Respondents were not required to
participate and could exit the survey at any time.
The DocStyles survey was comprised of 69 questions,
some with multiple subparts, designed to provide insight
into physicians’ attitudes and counseling behaviors on a
variety of health issues and to assess their use of health
information sources. The eye health component of this
survey consisted of 17 questions assessing physician atti-
tudes and opinions, patient information and counseling,
and sources of information followed by 8 demographic
questions. Data were analyzed using SPSS version 15.0
(SPSS Inc, Chicago, Illinois). Descriptive statistics were
computed and differences between nonminority and
minority physicians were examined using contingency
tables and Pearson c2 tests. “Minority” physicians were
defined as physicians who self-report their race and eth-
nicity in response to the survey question as African Amer-
ican, Asian, Hispanic, Native Hawaiian or other Pacific
Islander, and American Indian or Alaskan Native. Nonmi-
nority physicians were defined as Caucasian.
Of the 3115 physicians invited to participate in the
DocStyles survey, 1502 completed the entire survey (2
survey responses were unusable for an effective sample
of 1500 and a response rate of 48%). Forty respondents
Table 1. Characteristics of Responding Minority
Primary Care Physicians (n = 428)
Average years, range
American Indian/Alaskan Native
Native Hawaiian/other Pacific Islander
Income of patient population served
Very poor to poor
Poor to lower middle class
Lower middle class to middle class
Middle class to upper middle class
Upper middle class to affluent
Type of practice
Hospital or clinic
Obstetricians and gynecologists
years practicing medicine
a Selected Hispanic as ethnicity.
a Porter Novelli is a public relations firm that has a specialty practice in health and social marketing. 1909 K St NW, Suite 400, Washington, DC, 20006.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATIONVOL. 101, NO. 12, DECEMBER 2009 1249
MINORITy PHySICIANS AND EyE HEALTH
did not complete the entire survey, 32 were disqualified
based on the screener questions, 528 logged in to take the
survey but were terminated due to filled quotas, and 1013
did not respond to the invitation. Four hundred twenty-
eight physicians reported that they were Hispanic or of a
minority group (28.5% of the sample that completed the
entire survey). Table 1 displays the demographic charac-
teristics of the minority physician sample.
Minority Primary Care Physicians’
Knowledge of Vision and Eye Health
A total of 78% of minority physicians reported know-
ing that many eye diseases (such as diabetic eye disease,
glaucoma, and age-related macular degeneration) do not
have early warning signs or symptoms. However, fewer
(60%) minority physicians reported that they could
identify patients at higher risk for eye disease. Relative
to nonminority physicians, a statistically significantly
larger proportion of minority physicians agreed with the
statement, “I can identify patients at higher risk for eye
disease.” Further, just more than half (52%) of the sur-
veyed minority physicians believed they had adequate
knowledge to advise their patients on eye health. Table 2
presents minority physicians’ responses to selected
knowledge, attitudes, and practices questions.
Minority Primary Care Physicians’
Attitudes and Practices Regarding
Patient Vision and Eye Health
Many minority physicians reported counseling their
patients about vision and eye health, but relatively few
reported performing eye screenings or referring patients
for dilated eye exams. More than 6 of every 10 minority
physicians (62%) felt that talking with patients about
vision and eye health was their responsibility and not the
responsibility of the optometrist or ophthalmologist. Rela-
Table 2. Percentage of Nonminority (n = 887) and Minority (n = 363) Primary Care Physicians’ Responses
to Questions About Knowledge, Attitudes, and Practices About Vision and Eye Healtha
Knowledge and beliefs about vision and eye health
Many eye diseases have no symptoms.
Can identify patients at higher risk for eye disease.b
I have adequate knowledge to advise my patients
on vision health.
Attitudes and practices regarding patient vision and eye health
It is the optometrist’s or ophthalmologist’s
responsibility to talk to patients about eye health, not
the physician’s responsibility.b
I only talk to my patients about their vision or eye
health if they bring it up.
Encouraging patients to get a dilated eye exam is
Patients are asked if they have a family history of
any eye disease when they complete their medical
Vision and eye health attitudes and practices with patients with diabetes
I often talk to patients with diabetes about their
Patients with diabetes should have their eyes
examined every year.b
I only talk with my patients with diabetes about
diabetic eye disease, such as diabetic retinopathy,
if they bring it up.b
I am likely to talk to patients I see with diabetes
about diabetic eye disease.c
576027 3015 10
50 5230 29 2019
8 11 21277162
18 201819 64 61
45 4216 203937
9 14 8172
916 53 3
Abbreviations: M, minority; NM, nonminority.
a The 250 pediatricians in the total sample were not asked these questions.
b Statistically significant difference (p <. 05).
c Responses were reported on likelihood scale (92% likely/very likely, 5% unlikely, 3% very unlikely).
1250 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 12, DECEMBER 2009
MINORITy PHySICIANS AND EyE HEALTH
tive to nonminority physicians, a statistically significantly
smaller portion of minority physicians disagreed with the
statement, “It is the optometrist’s or ophthalmologist’s
responsibility to talk to patients about eye health, not the
physician’s responsibility.” Further, minority physicians
(64%) reported that encouraging patients to get a dilated
eye exam was their responsibility. However, only 61% of
minority physicians reported to talking with patients about
their vision and eye health even when patients do not bring
it up themselves. When completing medical history forms,
only 42% of the minority physicians asked their patient
about family history of eye disease.
Minority Primary Care Physicians’
Practices Regarding Patients
Many minority physicians counseled their patients
with diabetes regarding vision and eye health. With
regard to patients that have diabetes, among the sur-
veyed primary care physicians, 84% of minority physi-
cians reported talking with their patients about eye
health and 92% of minority physicians reported that
they were likely to talk with their patients with diabetes
about diabetic eye disease. However, only 72% of minor-
ity physicians reported that they discussed with patients
their vision and eye health even when patients did not
bring it up themselves. Relative to nonminority physi-
cians, a statistically significantly larger proportion of
minority physicians agreed with the statement, “I only
talk to my patients with diabetes about diabetic eye dis-
ease, such as diabetic retinopathy, if they bring it up.”
Most minority physicians (94%) reported that patients
with diabetes should have their eyes examined every
year. Relative to nonminority physicians, a statistically
significantly smaller proportion of minority physicians
agreed with the statement, “Patients with diabetes
should have their eye examined every year.”
Minority Primary Care Physicians’
Practices Regarding Referral and
A total of 75% of minority physicians reported that
they were more likely to recommend that their patients
see an eye care professional for an eye exam whether or
not they had any vision problems. However, only 31% of
minority physicians surveyed indicated that, in the past
12 months, they performed a basic eye screen with fewer
than 10% of their patients, or none at all, while conduct-
ing a routine general physical examination. Further-
more, 25% of minority physicians surveyed reported
that, in the past 12 months, they referred fewer than 10%
of their patients, or none at all, for a dilated eye exam.
Table 3 presents responses to selected referral and exam-
Minority Primary Care Physicians’
Medical Information Sources
Most minority physicians receive their medical infor-
mation from professional sources. More than half of
minority physicians report getting their medical infor-
mation most frequently from professional journals
(74%), medical Web sites (67%), continuing medical
education (61%), professional medical societies (53%),
and scientific meetings (52%). In contrast, most Ameri-
can adults get their medical information from television,
radio, and their doctor’s office.16 Table 4 presents
responses to questions regarding sources for minority
physicians’ medical information.
Physicians are viewed as credible leaders within
many communities, and their opinions and recommenda-
tions are widely respected. Involvement in promoting eye
health and the appropriate receipt of eye care and exami-
nations is likely to be equally effective. Adults express a
great deal of confidence in their primary care provider to
assist them with their health care issues, including eye
care.16 Many minority physicians responding to this Web-
based survey demonstrated favorable attitudes and opin-
ions regarding eye health and the role they should play in
talking with patients about it. Approximately 60% indi-
cated that they could identify patients at higher risk for
eye disease; however, only 52% of physicians indicated
that they had adequate knowledge to advise their patients
Table 3. Minority Primary Care Physicians’ Practices Regarding Referral and Examination (n = 363)a
I am likely to recommend that my patients see an eye
care professional (optometrist or ophthalmologist) for an
eye exam, regardless of whether they have any vision
problems or not.
Very Likely or Likely Unlikely Very Unlikely
75% 21% 4%
Practices in past 12 months 0%-10% 10%-50% >50%
Proportion of patients that received a basic eye exam
as part of general physical examination 31% 42% 26%
Proportion of patients referred to get a dilated eye exam 25% 54% 21%
a The 65 pediatricians in the minority physician sample were not asked these questions.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATIONVOL. 101, NO. 12, DECEMBER 2009 1251
MINORITy PHySICIANS AND EyE HEALTH
on vision health. There appears to be an opportunity for
improvement among physicians with regard to advising
patients about eye health and their confidence in identify-
ing patients at higher risk for eye disease.
Minority physicians in this study reported favorable
attitudes towards physician responsibility, recommenda-
tions, and practices as they relate to vision and eye
health. One study examining vision care access among
low-income minorities found that physician advice was
significantly associated with receipt of vision care.17
With regard to patients who have diabetes, minority phy-
sicians in this study inquired often about their patients’
eye health and reported positive attitudes and opinions
regarding eye health. To examine factors related to why
people with diabetes may not get dilated eye exams,
Phillips18 examined predictors of failing to receive
dilated eye exams using data from the 2001 Behavioral
Risk Factor Surveillance Survey and found that being a
minority and having fewer physician-involved preven-
tive care practices (among additional variables) were
related to not getting a dilated eye exam. In addition,
many minority physicians reported counseling their
patients with diabetes about eye health, indicating that
physicians may be more aware of vision complications
related to chronic disease.
There are several limitations in the present study that
can be addressed in future surveys on this topic. First, the
sampling methodology that was used for the survey may
not have produced a truly random national sample. Thus,
the findings from this study may not be representative of
the entire population of all physicians in the United States.
Second, a number of eye health questions were not asked
of pediatricians. Given the importance of eye screenings
and recommendations from pediatricians to eye care pro-
fessionals for the vision health of children, not asking
these types of questions of pediatricians leaves a gap in
our knowledge regarding what pediatricians know and
practice concerning vision health among children in the
United States. In a related issue, the validity of the survey
questions has not been fully assessed, and some residual
confusion over the survey questions may exist.
Findings from the DocStyles survey reveal an oppor-
tunity with regard to increasing minority physician
knowledge of eye disease and confidence in identifying
patients at higher risk for eye disease. Additional minor-
ity physician education is needed to raise awareness of
the risk factors of eye diseases and conditions in order to
better identify patients at higher risk for eye disease,
advise their patients on eye health, perform basic eye
screenings, and make referrals for dilated eye examina-
tions. Minority physicians responding to the survey
indicated that their preferred sources of information
were professional journals, medical Web sites, and con-
tinuing medical education. As such, the fact sheets
(Boxes 1 and 2) in this article are designed to provide
physicians with key eye care information.
We would like to thank Robert Alexander, PhD,
MPH, CHES, for his early contributions to this study.
1. Higginbotham EJ, Gordon MO, Beiser JA, et al. The Ocular Hypertension
Treatment Study: Topical medication delays or prevents primary open-
angle glaucoma in African-American individuals. Arch Ophthalmol.
2. Kempen JH, O’Colmain BJ, Leske MC, et al. The prevalence of dia-
betic retinopathy among adults in the United States. Arch Ophthalmol.
3. Varma R, ying-Lai M, Klein R, et al. Prevalence and risk indicators of visu-
al impairment and blindness in Latinos. The Los Angeles Latino Eye Study.
4. Varma R, Torres M, Peña F, et al. The prevalence of diabetic retinopa-
thy in adult Latinos: The Los Angeles Latino Eye Study. Ophthalmology.
5. Friedman D, Wolfs RC, O’Colmain BJ, et al. Prevalence of open-
angle glaucoma among adults in the United States. Arch Ophthalmol.
6. Varma R, ying-Lai M, Francis BA, et al. Prevalence of open-angle glauco-
ma and ocular hypertension in Latinos. The Los Angeles Latino Eye Study.
7. Congdon N, O’Colmain B, Klaver CC, et al. Causes and prevalence of
visual impairment among adults in the United States. Arch Ophthalmol.
8. Varma R, Torres M. Prevalence of lens opacities in Latinos: The Los Ange-
les Latino Eye Study. Ophthalmology. 2004;111(8):1449-1456.
9. Brown TT, Scheffler RM, Tom SE, et al. Does the market value racial and
ethnic concordance in physician-patient relationships? Health Serv Res.
10. Bach PB, Pham HH, Schrag D, et al. Primary care physicians who treat
blacks and whites. N Engl J Med. 2004;351:575-584.
11. Ngo-Metzger Q, Sorkin DH, Phillips RS, et al. Providing high-quality care
for limited English proficient patients: the importance of language concor-
dance and interpreter use. J Gen Intern Med. 2007;22(S2):324-330.
12. LaVeist TA, Nuru-Jeter A, Jones KE. The Association of Doctor-Patient
Race Concordance with Health Services Utilization. J Public Health Policy.
13. Lasser KE, Mintzer IL, Lambert A, et al. Missed Appointment Rates in
Primary Care: The Importance of Site of Care. J Health Care Poor Under-
Table 4. Minority Primary Care Physicians’
Medical Information Sources (n = 363)a
Medical Web sites
Continuing medical education
Professional medical societies
Magazines or newsletters
% of Minority
a The 65 pediatricians in the minority physician sample were
not asked these questions.
1252 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 101, NO. 12, DECEMBER 2009
MINORITy PHySICIANS AND EyE HEALTH
Box 1. Eye Disease Facts for Physicians
What Should Physicians Know About Eye Health?
Physicians can help protect their patients from vision loss or blindness by recognizing risk factors
associated with common eye diseases and recommending they see an eye care professional for a
comprehensive dilated eye exam. Eye diseases often have no early warning signs or symptoms However,
with early detection, treatment and appropriate follow-up care, vision loss and blindness from eye
disease can be prevented or delayed. Talk to all your patients about their eye health, especially those
at higher risk for diabetic retinopathy, age-related macular degeneration, glaucoma and cataract.
Diabetic retinopathy is the most common diabetic eye disease. It is caused by changes in the blood
vessels of the retina. One in every 12 people with diabetes aged 40 and older has vision-threatening
• Symptoms: No signs or symptoms in its early stages.
• Risk Factors: All people with diabetes (type 1, type 2 or gestational) are at risk. The longer a person has
diabetes, the more likely he or she is to develop retinopathy. Controlling blood glucose levels, blood
pressure and cholesterol can prevent or delay the progression of diabetic retinopathy.
• Detection: Patients with diabetes should have a comprehensive dilated eye examination at least once
a year. Patients with proliferative retinopathy can reduce their risk of blindness by 95 percent with
timely treatment and appropriate follow-up care.
Age-Related Macular Degeneration
AMD is a leading cause of vision loss in Americans age 60 and older, which gradually destroys sharp,
central vision. Dry AMD occurs when the light-sensitive cells in the macula slowly break down. Wet AMD
occurs when abnormal blood vessels behind the retina start to grow under the macula.
• Symptoms: Neither dry nor wet AMD cause pain. For dry AMD, the most common early sign is blurred
vision. For wet AMD the classic early symptom is that straight lines appear wavy.
• Risk Factors: The greatest risk factor is age. Others risks include smoking, family history, and race, with
Caucasians being more likely to lose vision from AMD.
• Detection: Encourage all patients over 50 to have a comprehensive dilated eye examination every
year. In some cases, AMD advances so slowly that people notice little change in their vision. In others,
the disease progresses faster and may lead to a loss of vision in both eyes.
Glaucoma is a group of diseases, defined by damage to the optic nerve and can lead to blindness. The
intraocular pressure may or may not be elevated.
• Symptoms: There are often no early warning signs or symptoms.
• Risk Factors: African Americans over the age of 40, everyone over the age of 60 (especially Mexican
Americans), and people with a family history are at higher risk.
• Detection: Patients at higher risk should have a comprehensive dilated eye examination every 1 to 2
years. Early detection and treatment is the best way to control the disease. Left untreated, glaucoma
can lead to permanent vision loss or blindness.
A cataract is a clouding of the lens in the eye. It can occur in either or both eyes. It cannot spread from
one eye to the other. By the age of 80, more than half of all Americans either have a cataract or have
had cataract surgery.
• Symptoms: Common symptoms include cloudy or blurry vision, colors seem faded, glare from lights,
poor night vision, double vision or multiple images in one eye, or frequent prescription changes to
glasses or contact lenses.
• Risk Factors: Most cataract are related to aging. Other risk factors include having diabetes, personal
behaviors such as smoking or alcohol use, or prolonged exposure to sunlight.
• Detection: Encourage all patients over 50 to have a comprehensive dilated eye examination every year.
For additional information and patient education resources, visit: National Eye Institute at
http://www.nei.nih.gov. The National Eye Institute is part of the National Institutes of Health and is the
federal government’s lead agency for vision research that leads to sight-saving treatments and plays a
key role in reducing visual impairment and blindness.
National Eye Health Education Program (NEHEP), http://www.nei.nih.gov/nehep: NEHEP is a program
established by the National Eye Institute to ensure that vision is a health priority by translating eye and
vision research into public and professional education programs.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATIONVOL. 101, NO. 12, DECEMBER 2009 1253
MINORITy PHySICIANS AND EyE HEALTH
14. Flores G. The Impact of Medical Interpreter Services on the Quality of
Health Care: A Systematic Review. Medical Care Res Rev. 2005;62(3):255-299.
15. Clark T, Sleath B, Rubin RH. Influence of Ethnicity and Language Con-
cordance on Physician-Patient Agreement About Recommended Chang-
es in Patient Health Behavior. Patient Educ Couns. 2004;53(1):87-93.
16. National Eye Institute, U.S. Department of Health and Human Services.
2005 Survey of Public Knowledge, Attitudes, and Practices Related to Eye
Health and Disease. Rockville, MD: Government Printing Office; 2007.
17. Baker RS, Bazargan N, Bazargan-Hejazi S, et al. Access to vision care
in an urban low-income multiethnic population. Ophthalmic Epidemiol.
18. Phillips MM. Targeting diabetes preventive care programs: Insights
from the 2001 behavioral risk factor surveillance survey. Prev Chronic Dis.
Box 2. Eye Disease Facts for Patients
Diabetic Eye Disease
Diabetic eye disease is a complication of diabetes that can lead to vision loss or blindness. Diabetic
eye disease has no warning signs. Finding and treating the disease early, before it causes vision loss or
blindness, is the best way to prevent vision loss or blindness. All people with diabetes, type 1 or 2, should
have a comprehensive dilated eye examination at least once a year or as suggested by their eye
care professional. The longer a person has diabetes, the greater his/her risk of developing diabetic eye
Age-Related Macular Degeneration
AMD is a disease that gradually destroys sharp, central vision. AMD does not cause pain. The greatest
risk factor is age, but other risk factors include:
• Smoking—Smoking may increase the risk of AMD.
• Race—Whites are much more likely to lose vision from AMD than African Americans.
• Family history—Those with immediate family members who have AMD are at a higher risk of
developing the disease.
Glaucoma is a group of diseases that can damage the eye’s optic nerve. Glaucoma often has no early
warning signs. Left untreated, glaucoma can lead to permanent vision loss or blindness. People at higher
risk for glaucoma include African Americans over the age of 40, everyone over the age of 60 (especially
Mexican Americans), and people with a family history of glaucoma. People at higher risk should have
a comprehensive dilated eye examination every 1 to 2 years. Early detection and treatment before it
causes vision loss, is the best way to control the disease.
A cataract is a clouding of the lens in the eye that affects vision. The most common symptoms of a
• Cloudy or blurry vision.
• Colors seem faded.
• Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
• Poor night vision.
• Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
• Frequent prescription changes in your eyeglasses or contact lenses.
The risk of cataract increases as you get older. Other risk factors for cataract include:
• Certain diseases such as diabetes.
• Personal behavior such as smoking and alcohol use.
• The environment such as prolonged exposure to sunlight.
• These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check
with your eye care professional.
For more information about diabetic eye disease, AMD, glaucoma, cataract, or other eye health
diseases and conditions, visit http://www.nei.nih.gov or call (301) 496-5248.