Vision Care from a Distance
By Hilary Gibson

We depend on it everyday. We expect it to be there for us and to respond the minute we need it. It's something that we all take for granted until it goes noticeably wrong. In fact, you're using it right now to read this's your eye sight. In the United States, an estimated 80 million people have eye diseases which can potentially cause blindness, another 3 million have low vision, 1.1 million are legally blind, and 200,000 are considered severely visually impaired. The development or disintegrate of one’s vision can forever affect the way they learn, communicate, and work, as well as influence their health and quality of life. Another sobering fact is that visual impairment is consider to be one of the ten most frequent causes of disability in the United States. Something else which may be taken for granted is the ability to easily access much needed eye care. When a caregiver and their loved one reside in a metropolitan area, the distance they may travel to get to an eye care specialist, as well as the length of time it may take to get there can be much shorter than for their rural counterparts.

Of the two types of eye care specialists - optometrists and ophthalmologists - optometrists (doctors of optometry who give specialized eye exams in order to detect and/or correct vision problems) are geographically well distributed and are located throughout many of America’s rural areas. Most of the ophthalmologists (doctors who perform eye surgery to correct or arrest particular vision disorders and impairments) are usually located in and around urban and suburban areas. The eye examinations which optometrists perform can determine if someone is exhibiting signs of a pre-existing or present condition which could cause visual impairment or possible blindness. If an optometrist finds a situation that needs more extensive and specialized medical attention, they will then refer a patient to an ophthalmologist for treatment and possible surgery. 

Dr. John Whitener, OD, MPH, an Optometrist who now worked for many years at the American Optometric Association in Washington, DC, says, “People put off eye exams until some sort of permanent damage has already been done, especially those residing in rural areas since they have the added barriers of distance and finances keeping them from receiving proper eye care and exams. Most vision problems can be prevented. In fact, 90% of diabetic blindness can be prevented by early detection and treatment.” With the knowledge of the obstacles that rural caregivers and their loved ones experience in trying to receive eye care, the Federal Government has created two programs that may help them receive much needed care. Both the and VISION USA programs hope that people in low income, rural areas will benefit from early detection of eye diseases such as diabetic retinopathy, cataract, glaucoma, and age-related macular degeneration through free eye exams.

The program came about from a 1979 Surgeon General's Report entitled “Healthy People,” as well as from the “Healthy People 2000: National Health Promotion and Disease Prevention Objectives” which was a follow-up report to the original conducted 21 years earlier. Both of these reports established health goals on a national level, and have served as the basis for the development of state and community plans. The encourages diverse community groups to combine their efforts and work as a team in order to improve the health of those around them. The program wants to achieve certain health objectives over the first decade of the new century, including for the first time vision care and preventative eye care maintenance as a part of these goals. The program now addresses visual impairment due to eye disease and refractive error and includes regular eye examinations for children and adults, vision screenings for pre-school children, injury prevention, and vision rehabilitation. Many states and communities use the framework to create guidelines for local health policies and vision programs. People who would like to find out more information regarding local chapters that provide affordable and/or free eye care, as well as locating the nearest doctor of optometry, can contact 800-262-3947 or go online to

Another vision program available to low-income, working people throughout the United States, including in rural areas, is VISION USA. The program began nationwide in 1991, and was developed by doctors of optometry and who are members of the American Optometric Association. To date, over 314,000 low-income, working Americans have benefited from the free eye exams provided by VISION USA. There are at least 40 million people in the United States who can’t afford the cost of routine eye care or the health insurance that covers it. Although they may be of low-income status, they’re considered to earn too much, disqualifying them from government aid and private health-care assistance. VISION USA is available year round, helping these people to receive basic eye health and vision care services free of charge to these people and their families who have no other means of obtaining care. The program is available to children and adults of all ages who qualify. In order to receive free eye care services, the general eligibility requirements are as follows: person must have a job or live in a household where there is only one working member; have no vision insurance; have income below an established level based on household size; and not have had an eye exam within 2 years.

When an individual or family is found to be eligible for the program, they will be matched with a volunteer optometrist who will provide a comprehensive eye exam at no charge. Eye wear may also be provided at no cost or for a small fee/donation in some states.

Dr. Whitener agrees that it is very important for eye care to be accessible for those in rural areas, not only because of the obvious diseases that can cause blindness, but because many of these people work on farms and encounter serious eye injuries due to the nature of their work. Many of them do not wear safety glasses because they can’t afford to purchase them, let alone afford the eye exam that is needed for such protective eye wear. Still, Dr. Whitener is hopeful that programs like VISION USA and will continue to expand their work further and further into the rural areas of America where preventative eye care is greatly needed. When asked, Dr. Whitener had this to say regarding the single most important thing that rural caregivers could do for their loved ones, “When caring for a loved one, there’s an entire laundry list of things that caregivers must make sure they do for them every day, however, something like eye care tends to be somewhere last on this list too often. Caregivers naturally prioritize the most immediate needs of their loved one, and although eye care may not be at the top of the list, caregivers must make sure that it does make the list somewhere. Caregivers should also remember that if their loved one is 65 or older, an annual, preventative eye exam is extremely important for them to have, because it may lead to the discovery of other problems which might be easily treated and controlled through early detection.”

If you would like to know if you are eligible for VISION USA, you can apply online at or contact VISION USA at 243 North Lindbergh Blvd., St. Louis, MO 63141, and by phone at 800-766-4466, 7 a.m.-9 p.m., CST, Monday through Friday.

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