A public health crisis is brewing in plain sight, with vision-threatening eye disease increasing at a pace our healthcare system is not prepared to manage. America’s population is aging rapidly, and age is one of the strongest risk factors for vision loss. By 2030, every baby boomer will be at least 65 years of age, which will significantly expand the nation’s older population. Most concerning, the 85+ age group is projected to more than double, rising from 6.7 million in 2020 to 14.4 million in 2040. This demographic shift will bring many healthcare challenges, and eyesight loss for millions is among the most urgent.
The Centers for Disease Control and Prevention (CDC) projects a devastating increase in vision-threatening diseases by 2050, with annual costs reaching $373 billion—a staggering 157% increase from previous decades. Much of this burden stems from three major eye diseases, which all increase in prevalence and severity with age. Age-related macular degeneration (AMD) is expected to nearly double by the end of the decade, glaucoma cases will almost double by 2030, and diabetic retinopathy – already the most common vision-threatening disease – currently affects 7.7 million Americans and is projected to reach 11.3 million.
The impact on patients goes far beyond loss of eyesight. Visual impairment reduces patient quality of life more severely than cardiovascular disease, diabetes, or cancer. It can also increase the risks of secondary diseases, hearing loss, depression, falls, nursing home admissions, caretaker strain, and social isolation. The financial toll of vision loss is equally profound: people who experience blindness face nearly double the healthcare costs of those without vision loss.
The cruel irony is that incredibly effective treatments, such as intravitreal injections, already exist. Many people, however, cannot access them due to barriers to care. More than 90 percent of vision impairment is preventable or treatable with current interventions when patients are able to adhere to their clinician’s plan. Yet the existing model, which requires repeated in-person visits to ophthalmologists for diagnosis, monitoring, and treatment, is failing to meet the needs of many patients.
One in five people over 85 years old live with permanent vision loss, and shortages of eye-disease specialists and systemic barriers to care already delay or prevent many patients from receiving timely injections. Even brief delays in follow‑ups or treatment can lead to clinically meaningful and often irreversible declines in vision. Without changes in our eye disease care delivery model, millions of people will lose their sight unnecessarily.
Patient volume outpacing physician supply
One major issue is that the ophthalmology workforce is too small to meet current patient needs, and the gap will continue to widen in the future. Training programs are not replacing retiring clinicians quickly enough, and experts project a 30% shortfall in ophthalmologists by 2035. Rural and underserved areas face even greater shortages. Many providers already see 80 to 100 patients daily for shorter periods of time, leaving clinical staff with little to no capacity to engage patients beyond diagnosis and in-office treatments.
Consider the case of wet AMD, the most severe vision-threatening eye disease and leading cause of irreversible blindness among older adults. Vision loss from wet AMD progresses rapidly, sometimes within weeks, without swift intervention. Timely access to an ophthalmologist is critical to preserving people’s sight.
Compounding the problem, patients only accurately recall 49% of decisions and recommendations from physician visits without reinforcement. A model built around quick, in-office conversations followed by complex at-home treatment schedules and self-monitoring leaves too much room for error. Patient education, adherence support, and early detection of disease progression must modernize and expand beyond the clinic if we are serious about curbing blindness.
Treatment adherence free fall
Treatment adherence remains a challenge, as broader education, psychosocial, and financial factors often lead patients to discontinue injection therapy prematurely. Roughly 30% discontinue anti-vascular endothelial growth factor (anti-VEGF) drugs within two years, and up to 44% discontinue geographic atrophy (GA) drugs at 18 months.
Research shows that clinicians often underestimate how burdensome ongoing injections can be for patients. Barriers include gaps in disease understanding, transportation or scheduling challenges, financial constraints and psychosocial burdens, such as vision-related functional loss or caregiver strain.
At the same time, growing patient demand leaves ophthalmologists with less time to address these concerns, even as the need for education and engagement increases. Practices need added support through a modernized care model that can help meet these needs.
Innovation to combat vision loss and a better care model for patients
There is no quick fix, as training more ophthalmologists will take decades, and even then will not resolve systemic barriers that keep patients from accessing care. Patients need continuous care that can be administered outside the physician’s office, without consuming already scarce clinic time. This new care model should identify barriers each patient faces and proactively address them, whether that means improving disease understanding, coordinating transportation, managing refills, or assisting with cost concerns.
A new care model can also help people recognize vision changes they might otherwise dismiss, like wavy lines that should be straight or other visual distortions that signal disease progression requiring urgent attention. Remote patient monitoring (RPM) technologies are becoming increasingly accurate in detecting early signs of vision changes that patients might otherwise miss. Predictive analytics can also identify high-risk patients who need more support from the outset. Payers are already embracing this new care model through coverage of care management services, RPM, and telehealth.
These solutions make sense: they improve member outcomes while helping control the more than $98 billion in direct costs currently associated with vision loss. Effective tools and technologies already exist to protect aging patients from the coming surge of eye disease. The healthcare system must now move swiftly to adopt them — because millions of people stand to lose their sight if we don’t.
Photo: Jay_Zynism, Getty Images
Dr. Landon Grace is the CEO of Lumata Health, where he leads the company’s strategic vision, growth initiatives, and research and development. Dr. Grace has devoted the last 20 years to solving some of the most challenging problems in healthcare on behalf of the US Air Force, NASA, the National Science Foundation, and the National Institutes of Health. After earning his PhD while working for the US Air Force as an aerospace engineer, Dr. Grace joined the Mechanical and Aerospace Engineering department at the University of Miami and was involved in ophthalmology-focused collaborations with the world-renowned Bascom Palmer Eye Institute, including 3D printing orbital prostheses and utilizing visual evoked potentials to prevent postoperative vision loss. During the Covid-19 pandemic, he led a team of engineers to tackle health system supply chain issues through innovations in manufacturing and tool adaptation.
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