Building a basis for action: Enhancing public health surveillance of vision impairment and eye health in the United States

Purpose: To examine the ability of current surveillance systems to assess and monitor disparities in: (1) vision impairment, (2) eye disease, (3) vision-related functioning, (4) access to vision and eye care, and (5) access to supports and services for those needing vision rehabilitation. Design: Review of surveillance systems and instruments. Methods: We defined surveys and surveillance systems as data collection systems that used an active survey or data abstraction instrument, regardless of the sampling unit, and excluded strictly administrative data sources. We assessed 8 surveys against key surveillance attributes of representativeness, flexibility, and timeliness, as well as their contribution to establishing a national vision surveillance system. Results: The key challenges facing a national vision surveillance system are: (1) the lack of consistent outcome data with adequate sample size and coverage to enable identification and tracking of vision health disparities, (2) lack of standardized data elements, and (3) a paucity of data that influence disability such as behavioral and environmental data. Conclusions: Current systems for assessing and monitoring vision health in the United States are limited and do not provide adequate information to guide interventions and policy decisions. Vision surveillance can help to document the burden of the condition, to identify high-risk populations, to develop strategies to reduce the individual and societal burden, and to guide public health programs and policies. Existing surveillance systems could be enhanced by integrating data and by periodically including patient-reported outcomes measurements including, but not limited to, specific barriers for people with vision impairment and related disabilities.