Previous Studies

Public health programs need to be based on sound public health science and evidence based practice. CDC conducts and supports research to strengthen the public health science base and to guide public health practice. In 2008 the Vision Health Initiative developed a cooperative agreement with Prevent Blindness AmericaExternal to develop a multi-component project to strengthen interventions and science.

In addition, VHI supported cost studies to estimate the economic impact of vision loss as well as initiated a series of projection studies to estimate increases among various eye conditions. These major initiatives and key highlights are listed below.

Cooperative Agreement

In 2003 and 2008 CDC established cooperative agreements (CA) with the Prevent Blindness America (PBA), to reduce the burden of vision loss and eye diseases. More

Expert Panel Meeting

The Vision Health Initiative convened an expert panel on the CDC campus in Atlanta in April 2006. This panel laid the framework for the development of the comprehensive and coordinated public health action plan for eye health and vision loss prevention. The panel members assisted in identifying gaps and possible solutions that will serve to guide future actions and expand opportunities for ongoing collaborative efforts among all sectors of the vision community. The panel discussions and recommendations resulted in the release of a report titled Improving the Nation’s Vision Health: A Coordinated Public Health Approach Cdc-pdf[PDF–1.9 MB]. The objectives of the meeting were to

  • Define a strategic vision and eye health agenda that fills knowledge gaps in surveillance and applied public health research in order to address the burden of eye disease, access to care, quality of care and quality of life
  • Examine the efficacy and cost effectiveness of current and future interventions in vision and eye health
  • Explore public, private, and government models for comprehensive and effective programs for the adaptation, replication, and expansion of vision and eye health interventions
  • Examine opportunities to assure the best possible use of available resources while achieving the greatest returns in vision and eye health.

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Economic and Projection Studies

Cost-effectiveness Model for Age-Related Macular Degeneration

This study simulated the incidence and natural history of age-related macular degeneration (AMD) with and without the use of prophylactic antioxidant vitamin plus zinc supplements to prevent advanced vision threatening disease. The study found that the universal use of vitamin therapy would reduce the percentage of patients with early AMD who ever developed visual impairment in the better-seeing eye to 5.6% compared to 7.0% without such therapy. Compared to no therapy, vitamin therapy cost approximately $21,000 per Quality adjusted life (QALY) gained, in 2003 dollars, a cost that was favorable compared to other ocular health interventions.


Rein DB, Saaddine JB, Wittenborn JS, et al. Cost-effectiveness of vitamin therapy for age-related macular degeneration. Ophthalmology 2007;114(7):1319–1326.
Summary | AbstractExternal

The Economic Impact of Vision Problems Report

This report combined the work of two teams of prominent health economists. David B. Rein, PhD, of RTI International led one team, and Kevin D. Frick, PhD, of Johns Hopkins Bloomberg School of Public Health, led the other team. Rein’s research was funded by the Vision Health Initiative of the Centers for Disease Control and Prevention (CDC); Frick’s research was funded by Prevent Blindness America. They delved into public sources of data, teasing out the impact of vision problems on federal and state budgets, personal expenditures and health-related quality of life. Impact_of_Vision_Problems.pdf Cdc-pdf[PDF–197KB]External

Cost-effectiveness Model for Glaucoma

Using a computer model, this study simulated glaucoma incidence, natural progression, diagnosis, and treatment. The study evaluates whether routine assessment and treatment of glaucoma enhances quality of life at a reasonable cost.


Rein DB, Wittenborn JS, Lee PP, Wirth KE, Sorensen SW, Hoerger TJ, Saaddine JB. The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open-angle glaucoma in the United States. Ophthalmology 2009;116(5):823–832.
Summary | AbstractExternal

Rein DB, Wirth KE, Johnson CA, Lee PP. Estimating quality-adjusted life year losses associated with visual field deficits using methodological approaches. Ophthalmic Epidemiol 2007;14(4):258–264.
Summary | AbstractExternal

Projecting the Numbers of People with Eye Diseases in the United States through 2050

The purpose of the project is to develop a model which projects the numbers of people with eye diseases (i.e., diabetic retinopathy, glaucoma, cataract, and macular degeneration) among those with and without diabetes in the United States. The model also projects costs associated with these eye diseases.

Diabetes is a major cause of morbidity and premature mortality in the United States, and is the leading cause of blindness among working-age adults. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year, and among an estimated 10 million U.S. adults aged 40 years and older known to have diabetes, prevalence rates for retinopathy and vision threatening retinopathy are 40% and 8%, respectively. Furthermore, diabetes disproportionately affects minority populations and the elderly, and the disease burden and associated costs of diabetes is likely to increase as minority populations grow and the total population becomes older. When changes in past determinates of disease are expected, public health policy is best informed by projections which report plausible scenarios reflecting the anticipated changes.

In 2001 RTI developed a static projection model of the prevalence and numbers of people with diagnosed diabetes in the United States by year, age group, race and sex through 2050. This follow-up project updated these projections and used the results, along with historical prevalence of eye diseases, to project the number of people with eye diseases (diabetic retinopathy, glaucoma, cataract, and macular degeneration) among those with and without diabetes by year, age group, race, and sex through 2050.


Saaddine JB, Honeycutt AA, Narayan KM, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005–2050. Arch Ophthalmol 2008;126(12):1740–1747.
Summary | AbstractExternal

Rein DB, Wittenborn JS, Zhang X, Honeycutt AA, Lesesne SB, Saaddine J. Forecasting are-related macular degeneration through the year 2050: the potential impact of new treatments. Arch Ophthalmol 2009;127(4):533–540.

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