Our eyes are the points of primary access to the world around us. They allow us to interact with it and facilitate physical, emotional, and mental well-being. Blindness and visual impairments are serious impediments to the same. Vision needs to be recognized as a key part of overall health. There is mounting evidence indicating that vision loss affects more than how people see, and has implications for physical, cognitive, and mental health, and can exacerbate inequities in employment, healthcare access, and income.
Visual Impairment and Medical Expenditure
A paper titled Economic impact of visual impairment and blindness in the United States by Frick KD, Gower EW, Kempen JH, Wolff JL assessed the economic impact of excess medical and informal care and the health utility loss associated with visual impairment and blindness in adults aged 40 years and older in the United States. Medical Expenditure Panel Survey data from 1996 to 2002 were pooled to estimate the relationship of visual impairment and blindness with total medical expenditures, components of expenditures, days of informal care received, and health utility.
Estimates accounting for the complex sampling design were based on regressions including confounders such as comorbidities and demographics. The aggregate economic impact was estimated by projecting average individual effects to the population of individuals with blindness and visual impairment.
The results of the experiment showed how blindness and visual impairment were significantly associated with higher medical care expenditures, a greater number of informal care days, and a decrease in health utility. The home care component of expenditures was most affected by blindness. The aggregate annual economic impact included $5.5 billion spent for medical care and the value of informal care as well as a loss of more than 209,000 quality-adjusted life years.
It concluded that visual impairment has a large effect on home care. Any economic analysis of prevention, treatment, and rehabilitation should account for the fraction of the annual economic cost and loss of quality-adjusted life-years that can be averted.
Implications for the Economy
The Economic Impact of Blindness in Europe was a research paper worked upon by Chakravarthy U, Biundo E, Saka RO, Fasser C, Bourne R, Little JA to estimate the annual loss of productivity from blindness and moderate to severe visual impairment (MSVI) in the population aged >50 years in the European Union (EU). They estimated the cost of lost productivity using three simple models reported in the literature based on minimum wage (MW), gross national income (GNI), and purchasing power parity-adjusted gross domestic product (GDP-PPP) losses.
In the first two models, assumptions included that all individuals worked until 65 years of age, and that half of all visual impairment cases in the >50-year age group would be in those aged between 50 and 65 years. Loss of productivity was estimated to be 100% for blind individuals and 30% for those with MSVI. None of these models included direct medical costs related to visual impairment.
The estimated number of blind people in the EU population aged >50 years is ~1.28 million, with a further 9.99 million living with MSVI. Based on the three models, the estimated cost of blindness is €7.81 billion, €6.29 billion, and €17.29 billion and that of MSVI €18.02 billion, €24.80 billion, and €39.23 billion, with their combined costs of €25.83 billion, €31.09 billion and €56.52 billion, respectively. The estimates from the MW and adjusted GDP-PPP models were generally comparable, whereas the GNI model estimates were higher, probably reflecting the lack of adjustment for unemployment.
It concluded that the cost of blindness and MSVI in the EU is substantial. Wider use of available cost-effective treatment and prevention strategies may reduce the burden significantly.
Uncorrected distance refractive error has been estimated to result in a global loss of productivity of international dollar (I$) 269 billion (the US $202 billion) annually, which will also increase if there is a significant increase in uncorrected myopia. International dollar allows comparison of prices and currency values between countries after adjustment of the currency exchange rate. An international dollar has the same purchasing power as the U.S. dollar has in the US.
A recent meta-analysis estimated the global potential loss associated with VI in 2015 was US $244 billion/annum [95% confidence interval (CI) US $49 billion—the US $697 billion] from uncorrected myopia and the US $6 billion/annum (95% CI US $2 billion–US $17 billion) from myopic macular degeneration. The cost of care is also likely to increase significantly and will be exacerbated by an even greater increase in the prevalence of high myopia, from 2.8% (190 million people) to 9.7% (924 million people) by 2050, representing a 4.9-fold increase in high myopia.
In some populations of young adults in Asia, the prevalence of high myopia has already reached 38%. The annual direct cost of optical correction of myopia for Singaporean adults has been estimated at the US $755 million. Refractive correction comprising of optometry visits, spectacles, and/or contact lenses is the most significant cost domain and it accounts for 65.2% of the total costs. In Singapore, the estimates for an adult (SG $587 or the US $455 per patient per year) are significantly higher than a child aged 7–9 years (SG $222 or the US $175 per patient per year).
Among those above the age of 50 years, cataracts and refractive error are the major causes of visual impairment. According to a study by PricewaterhouseCoopers, an investment of USD 2.20 or INR 163.70 per person per year in low to middle-income countries between 2011-2020 could have eliminated avoidable blindness, including other grave eye defects.
The higher cost could be because of the greater likelihood that adults may undergo laser-assisted in situ keratomileusis (LASIK), wear contact lenses, or develop ocular complications due to high myopia. Furthermore, adults tend to have higher spending power compared to a child. It has been estimated that if such prevalence rates were extrapolated to all cities in Asia in which the prevalence of myopia is approximately equal to the rates in Singapore, the estimated direct cost would be the US $328 billion/annum. It is estimated that the US $8.1 billion/annum was spent on vision products including eyeglass frames, lenses, and contact lenses in the USA in 1990.
A cross-sectional study demonstrated that 110 million Americans could achieve normal vision with refractive correction and the estimated cost was US $3.8 billion/annum. Of this amount, the annual cost of providing distance vision correction for adults older than 65 years old was US $780 million. The types of refractive error included correction for myopia, hyperopia, and presbyopia. This represents approximately US $35 per person or US $13 per capita annually, based on the cost of a pair of spectacles and refractive examination.
Possible reasons for the difference in direct costs of refractive correction are the treatment costs may be borne by the individual, who may be willing to pay for other factors such as aesthetics. Whereas in some countries, some segments of the population are entitled to free eyeglasses subsidized by the government. As the prevalence of myopia increase in East Asia, the total cost of treating myopia will be high. There is likely to be an increase in the demand for optical services as the number of older people increases and if, as suggested, the number of younger people with myopia increases. It is estimated that partial sight and blindness in adults costs the UK economy around £22 billion per year.