Lawmakers recently discussed options that could help improve access to eye care for older patients in Minnesota.
Dr. Amy Maltry, president of the Minnesota Academy of Ophthalmology (MAO)—which represents over 300 eye physicians and surgeons throughout the state—discussed challenges the elderly face in accessing eye care during a Legislative Task Force on Aging meeting on July 25.
The prevalence of common age-related diseases like cataracts, glaucoma, and macular degeneration is expected to double between 2010 and 2050, according to the American Academy of Ophthalmology (AAO) and the National Eye Institute, Maltry said.
“Ophthalmologists are second only to geriatricians in the number of patients over 65 that we care for,” Maltry said. “And proactive intervention for eye disease can significantly enhance the health of older adults. Eye diseases are largely diseases of aging.”
A JAMA Network study published in December 2021 found that cataract removal is associated with a 30 percent lower risk of developing dementia among older adults, Maltry said.
“This means considerable improvement in the quality of life for affected individuals and their families with benefits that last beyond 10 years,” she said. “So this long-term benefit underscores the importance of eye care and timely intervention for vision-threatening conditions. Even simple interventions can make a difference.”
Maltry discussed several MAO-supported initiatives that could help elderly Minnesotans with their eye care. The mechanics for eye drop administration can be challenging for many elderly patients, she said—noting that eye drop bottles are very small; difficult to squeeze; and hard to aim at the eye, especially for people with limited dexterity—and the AAO developed a policy on color coding eye drop bottle caps.
“There are eye drop helpers,” Maltry said. “These are small devices; they fit around the eye drop bottle. They aid in squeezing the bottle and guiding the drop to the eye. This system has been widely adopted, and helps patients easily identify medications. This color coding has significantly improved medication safety and ease of use. Insurance coverage for these inexpensive devices would help make them accessible and improve medication adherence for some of our most vulnerable patients.”
Transportation barriers present even greater challenges for older patients than eye drop administration, Maltry said.
“When my patients express concerns about their vision, one of their greatest fears is losing their ability to drive, and consequently their independence. Every state sets visual acuity standards for driver’s licenses, and most require 20/40 acuity for an unrestricted license. However, there is significant variability among states regarding peripheral vision requirements and restrictions for those who have worse than 20/40 vision.”
— Maltry
The task force could recommend that the Department of Public Safety review Minnesota’s current driver’s license vision requirements to make sure the state is safely allowing maximal independence for moderately visually-impaired drivers, Maltry said.
Transportation to medical appointments and other necessary activities remains a significant challenge for older Minnesotans who cannot drive safely, Maltry added. Many cannot easily navigate public transportation, and rideshare apps are often impractical for the demographic.
“Even if they can use them, rideshare drivers are not trained in assisting the elderly,” she said. “So providing safe transportation options would improve patient adherence with follow-up care, create independence, and improve quality of life. So options to help facilitate trips—say from rural Minnesota to our regional medical centers of excellence—as well as state support for non-emergency medical transportation services would be very helpful.”
Rep. Natalie Zeleznikar (R-Duluth) agreed that transportation is a significant barrier for seniors in accessing their healthcare appointments, especially for those living in rural areas.
“Because we have rural hospitals that are not doing the specialties. Whether it’s (obstetrics), all the way to caring for eyes for seniors. There is a distance to travel, and we have snow and ice where I live. Seniors struggle with that too. And many of them need to have care from the moment they get dressed in the morning to leave home. It is not a simple thing to get people in greater Minnesota the necessary care. And that after-care is critical.”
— Zeleznikar
Another challenge Maltry sees at her practice relates to post-surgical care. After sedation for all patient procedures—like cataract surgery—ambulatory surgery centers require that a responsible adult accompany the patient and stay with them for several hours for surgery, she said. And if a responsible adult is not present, their surgery is canceled.
“Many seniors live alone,” Maltry said. “They might not have family nearby, they may not have much in the way of friends or community support, (and) they might not meet requirements for personal care assistance or hospital administration after an outpatient surgery. So state support for a program that would provide transportation, aid, and companionship after surgery would alleviate this burden and allow patient access to get these procedures to improve their function and maintain their health.”
Rep. Ginny Klevorn (DFL-Plymouth) asked Maltry to supply the legislature with some information about what the necessary requirements for a post-surgical position would include.
“Because it seems to me that could be a low-cost or no-cost option for us to help people get the services they need when they need them,” Klevorn said. “And I think it would also be an equity issue for individuals who have family members who can’t afford to take off work. It would be very helpful there as well.”
Those interested in learning more about elderly care in Minnesota can register to attend the 2024 Minnesota State of Reform Health Policy Conference, which will be held on Sept. 5 at the Hyatt Regency Bloomington in Minneapolis. A “Transforming Aging in Minnesota” panel will be held at 1 p.m.
“Addressing the needs of our aging population requires thoughtful and proactive measures by encouraging coverage for eye drop medication, administration aids, reviewing driver’s license requirements, improving transportation options, and expanding post-surgical support,” Maltry said. “We can significantly enhance the quality of life for elderly patients who face visual impairment.”