March 24, 2023
2 min read
McLeod SD. Health equity in ophthalmology: Where do we go from here? Presented at: Wills Eye Conference; March 9-11, 2023; Philadelphia.
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- Infrastructure updates are important to address health inequity.
- Community outreach, telehealth updates and a deeper understanding of root causes of inequity are needed to take effective action.
PHILADELPHIA — Mitigating disparities in health equity for eye care patients requires community outreach and improvements in health care infrastructure, as well as more understanding of the root causes, according to a speaker here.
“Formally, when we speak about inequity, we are basically saying that there is an ethical component, that there is a measured difference, the difference is avoidable, and the absence of the avoidance is unjust,” Stephen D. McLeod, MD, said during the Irving H. Leopold Lecture at the Wills Eye Conference.
According to McLeod, the conversation surrounding health equity has expanded to include factors such as insurance status and geographic location of patients, as well as socioeconomic status, race and ethnicity, gender identity and sexual orientation. In turn, the root causes of disparities have become more complex and multifactorial.
“There is a bidirectional relationship,” he said. “One’s health status is very likely going to have some impact on many things that will be social determinants of health because it’s going to affect your income, where you live, etc. And a lot of those elements are going to feed back and affect your health status.”
Finding solutions for the common health care barriers that affect a large number of the population requires an action plan. McLeod proposed starting with community outreach, telehealth in ophthalmology and expanded access to federally qualified health centers (FQHCs).
FQHCs provide federally funded health care services for underserved populations, but according to data collected in 2021, only 2% of total visits across 1,400 centers were vision-related cases. To provide a model on how to increase this number, McLeod discussed the Serve the People Community Health Center in California, which has provided free retina services since 2017 and has relied primarily on volunteer work from ophthalmologists in the area to establish an effective model for treating the uninsured.
“What you have to ask is, ‘Are there at least elements that we can try to pull from a structure like this and try to create some sort of system or network that is actually scalable?’” he said.
Additionally, 95% of cases at FQHCs are in person, despite many having telehealth options, McLeod said, suggesting the need for ophthalmologists to get creative on how to incorporate more telemedicine into their practices.
“While telehealth was used for a wide range of other health care encounters, ophthalmology never really went up the way that it could,” he said.
Growing advancements in technology have made services such as handheld fundus cameras and diabetic retinopathy screening programs that rely on AI possible and may help ophthalmology grow to allow more opportunity for virtual care.
Ultimately, the health care community should focus on collecting more data that will further highlight causes of health care discrepancies and knowledge of the communities most affected by them to gain a more solid understanding of the root causes of inequity in health care to make an action plan more effective.
“I think where we are now in the health equity discussion for ophthalmology is that as a community, we recognize both the challenge and the opportunity,” McLeod said. “It’s important for us to get a good handle on causes, and as we look at a framework like FQHCs, we certainly want to do what we can now, but we really do want to look forward and be proactive in establishing a much more robust infrastructure that will help us effect broad and lasting change.”