Doctor of Philosophy, Case Western Reserve University, 2024, Sociology

Despite the availability of many preventive measures, there are a vast number of people with vision loss. The World Health Organization (2022) estimated that there are 2.2 billion people who are visually impaired, with 43 million being blind. In the United States, 32.2 million adults have vision loss. It is estimated that 90% of vision loss could be prevented or treated. Sociological inquiry on vision impairment provides a deeper understanding of the vision loss experience by examining both micro and macro consequences of vision loss, such as economic strains, depression, decreased ability to perform daily activities, and decreased quality of life. Few studies analyze social barriers to accessing vision care. This research advances and expands research on vision impairment through analysis of the social barriers to preventive vision exams that can prevent or impede vision loss. It employs linear and logistic regression as well as descriptive statistics to provide a better understanding of the vision loss experience. It examines how social categories (age, gender, race, and ethnicity), human capital, and social and emotional support affect access to preventive eye exams. Second, it evaluates how general health and vision health affect access to preventive eye exams. Third, an evaluation of which factors affect general health and vision health. This work provides findings that can help opticians, optometrists, and ophthalmologists understand the needs of their patients and the unique barriers patients may have to access care. It can also be used by organizations and policymakers to recognize important current and future changes that are needed in organization structure.

Committee: Brian Gran Phd (Committee Chair) Subjects: Sociology

Master of Science, The Ohio State University, 2021, Vision Science

Vision impairment is a public health problem currently affecting over 10 million people in the United States. Established vision health surveillance mechanisms individually fail to capture the complexities of vision impairment at a granular level. The purpose of this study is to develop a county-level needs assessment for primary vision care services by assessing the relationship between vision impairment prevalence, unmet vision care need prevalence, and the distribution of optometrists in Ohio using multiple publicly available databases. Data from the 2017 American Community Survey were used to determine county-level prevalence estimates for vision impairment. Data from the 2017 Ohio Medicaid Assessment Survey were used to estimate unmet vision care needs in each county. State licensure records were obtained from the Ohio Vision Professionals Board and used to determine the geographic distribution of optometrists. US Census Bureau data were used to determine county population estimates. Correlations between vision impairment prevalence and unmet vision care need prevalence were assessed using linear regression. Vision impairment and unmet need prevalence differences between visually impaired and non-visually impaired cohorts were stratified by age, sex, and Medicaid eligibility (<138% Federal Poverty Limit, FPL) and compared using ANOVA and paired t-test analyses. Correlations between vision impairment prevalence and unmet vision care need prevalence with available optometrists per 10,000 residents in each county were assessed using linear regression. County-level vision impairment prevalence ranged from 1.1% to 5.2% and unmet vision care need prevalence ranged from 6.2% to 15.5%. Vision impairment and unmet vision need were positively correlated (R2 = 0.32, p < 0.001). Adults at or below 138% FPL were significantly more likely to report unmet vision care needs than those above 138% FPL (p < 0.001). Women were more likely than men to be visually impaired (open full item for complete abstract)

Committee: Dean VanNasdale OD, PhD (Advisor); John Crews DPA (Committee Member); Jacqueline Davis OD, MPH (Committee Member); Bradley Dougherty OD, PhD (Committee Member); Andy Wapner DO, MPH (Committee Member) Subjects: Ophthalmology; Public Health

Doctor of Philosophy, The Ohio State University, 2013, Vision Science

Bioptic telescopic spectacles (BTS) allow people with vision impairment to obtain driving licensure even when their visual acuity does not meet normal state standards. BTS are spectacles with a small telescope implanted in one or both of the lenses. The telescope is used for brief periods during driving to spot distant targets such as road signs and traffic signals. The study described in this dissertation examines visual and demographic associations among obtaining a bioptic driving license, training and road testing results, and motor vehicle collisions in patients with low vision. The study also compares the collision rate of bioptic drivers to that of a control group of non-bioptic drivers matched on age and sex. A retrospective study of medical records was completed for patients examined for entry into the Ohio bioptic driving program at the College of Optometry at The Ohio State University over a five year period. Data were collected on visual factors, documented driver training, licensure testing results, and post-licensure driving record. No significant associations were found among visual and demographic factors and obtaining licensure after an initial vision examination. Several factors were significantly associated with the amount of training documented for candidates for licensure, including age and previous non-bioptic driving experience. The amount of training documented was associated with road testing results, but not with driving safety after licensure. Previous driving experience was also significantly associated with occurrence of motor vehicle collisions (MVC) in bioptic drivers, with drivers without previous experience having approximately 2.5 times as many collisions per year of licensure than those with previous experience. Other significant associations with MVC in bioptic drivers included age and the number of non-collision related convictions. Nystagmus was independently associated with MVC, but no other patient visual factors w (open full item for complete abstract)

Committee: Thomas Raasch (Advisor) Subjects: Biomedical Research; Health Sciences; Ophthalmology; Optics; Public Health; Public Policy; Transportation

Master of Sciences, Case Western Reserve University, 2018, Clinical Research

Background: Vision impairment (VI) and cataract are common causes of disability in U.S. adults age 65 and older, but are especially, highly prevalent in institutionalized elderly. Objective: To estimate prevalence of VI and cataract in both populations and compare prevalence trends since 1985. Method: A meta-analysis included studies containing both nursing home and community elderly populations. A secondary (synthetic) meta-analysis also included studies containing only one of the two populations, pooled by 10-year cohorts. Results: The meta-analytic pooled prevalence estimates for VI and cataract in nursing home elderly are .50 and .48. In community elderly, these estimates are .04 and .17 respectively. Both meta-analyses indicate significantly higher odds (p<.001) of VI in nursing home elderly (OR1=26.123, OR2=31.097) and cataract (OR1=8.868, OR2=6.378). VI trends in both groups are remaining stable. While community studies are showing a rise in cataract prevalence, nursing home studies indicate a declining trend since mid-1990's.

Committee: Sara Debanne PhD (Advisor); Douglas Rowland PhD (Committee Member); James Spilsbury PhD (Committee Member); Jonathan Lass MD (Committee Member) Subjects: Aging; Epidemiology; Ophthalmology