Protecting vision in Native American and Alaska Native communities
Native American and Alaska Native communities in the United States have high rates of visual impairment and other eye problems. In many cases, these problems are treatable. But health disparities mean many Native communities go untreated.
A health disparity is when a certain population shows worse health outcomes than others. This is usually because of health inequities. Health inequities are when health resources aren’t fairly distributed among groups of people.
Many Native American and Alaska Native communities face health disparities. Higher levels of poverty and less access to health care, especially in remote areas, make these populations more vulnerable to poor health. This includes eye problems, like visual impairment or even blindness.
Many of these eye problems are treatable. But not having easy access to care means there’s a higher chance these conditions go untreated, leading to worse outcomes later on.
Eye problems that are more common in Native communities
Eye problems have been shown to happen more frequently in Native American and Alaska Native communities than in other populations. Although many are treatable, care isn’t always easy to get for these communities.
Diabetic eye disease
North American Native communities have the highest rates of diabetes compared to other groups in the U.S. They also have higher rates of diabetic eye disease. Diabetic eye disease refers to any eye problem resulting from diabetes.
In diabetes, high glucose (blood sugar) levels can damage the blood vessels in your eyes. Diabetic eye diseases can include:
- Diabetic retinopathy – Damage to the retina, the layer of tissue at the back of your eye that senses light. This damage could cause loss of vision over time.
- Macular edema – When fluid leaks into the macula, the center part of the retina that helps you see clearly. Damage to the macula or when the macula deteriorates over time (called macular degeneration) can affect how clearly you’re able to see things.
- Cataracts – When the lens of your eye becomes “cloudy.” This can make your vision worse over time.
- Glaucoma – A group of eye diseases caused by damage to the optic nerve (the connection between the eyes and the brain). Damage over time can make your vision worse or it can happen suddenly. This can lead to blindness if untreated.
Sometimes, there are no symptoms of any of these diseases early on in diabetes. Getting regular eye exams is a key way to catch any issues and prevent further damage.
READ MORE: Diabetic eye problems: How diabetes affects the eyes
Cataracts
Cataracts can happen naturally as you age. The proteins in your eye break down over time, forming “clouds” in your eye. But other factors (environmental, medication or genetic) can increase their likelihood. For instance, having diabetes or high blood sugar raises the risk.
Cataracts are present more often in Native populations. This is likely because of a lack of access to specialized eye care and made worse due to the higher rate of diabetes. Not having transportation or not being able to afford care may mean the disease gets worse. This can lead to poorer vision over time or more intensive care that is needed later.
READ MORE: Cataract surgery
Uncorrected refractive errors
Refractive errors occur when light can’t focus on your retina because of the shape of your eye. Common refractive errors include nearsightedness (myopia), farsightedness (hyperopia) and astigmatism.
Refractive errors can be treated with glasses or contacts. The rate of untreated refractive errors in Native populations has been increasing, but a significant proportion of these communities still go without glasses. This is likely due to a lack of access to screenings and exams.
Glaucoma
Certain types of glaucoma may be more common in Native populations. Alaska Natives in particular show the highest rates of angle-closure glaucoma. This is when pressure builds up because your eye can’t drain fluid like normal.
In some cases, the higher rates may be related to eye anatomy. This can also make angle-closure glaucoma more likely to be inherited. But another chronic illness (like diabetes or high blood pressure) can also make you more at risk.
Some studies have shown that general rates of glaucoma are not higher in Native communities than in other populations. However, the rates of treatment in Native communities are lower. Treatments also show poorer outcomes.
What increases the risk for eye problems
Several factors can lead to a higher risk for eye problems. These can include:
- Not having access to healthy foods
- Environmental factors, like exposure to ultraviolet (UV) light from the sun
- Having other chronic health conditions
Native American and Alaska Native populations can be especially vulnerable to these factors. Disparities in health care, poverty and unemployment have led to a much higher rate of health problems and treatable eye diseases in these communities.
Chronic health conditions
Native communities have higher rates of chronic health conditions, like diabetes, high blood pressure and heart disease. Factors like not having regular access to healthy food can raise the risk of getting these conditions. Chronic conditions that affect your whole body can also affect your eyes (diabetes leading to diabetic retinopathy, for example).
Barriers to early diagnosis
Although eye problems are more common in Native American and Alaska Native communities, the rates of getting treatment for these problems are lower. It can be harder to access medical or eye care for these communities.
Native communities often live in rural areas, which have lower availability of eye care professionals. This may result in people waiting too long to get care or not getting their regular annual eye exams.
Warning signs that mean you should get an eye exam
It’s important to get your eyes checked yearly. It’s even more important if you’re having symptoms, like blurry vision or double vision. These are common symptoms of a refractive error but can also indicate cataracts or glaucoma.
More serious changes in sight, like losing vision, can also indicate retinopathy. In retinopathy and certain types of glaucoma, there might be no symptoms in the early stages. Seeing a doctor as soon as possible is the best way to prevent further damage or loss of vision.
SEE RELATED: What to expect during a comprehensive eye exam
Steps you can take to protect your vision
Regular eye exams are a key way to protect your vision, but there are other things you can do to keep your eyes healthy.
Eat foods that support eye health
You need a healthy diet to support healthy eyes. Make sure to eat vitamins and minerals, especially vitamin A. Not getting enough vitamin A means your retina can’t make the pigments it needs to see. It can also cause night blindness, dry eyes, and, in severe cases, permanent blindness. Leafy greens, orange vegetables (like carrots) and eggs are good sources of vitamin A.
Manage blood sugar and blood pressure
Your overall health can help your eyes stay healthy, too. Staying on top of conditions, like diabetes or hypertension, can significantly reduce the risk of losing vision.
Protect your eyes from the sun and injuries
Wearing protective eyewear and sunglasses with 100% UV protection can keep your eyes safe from injury and possible damage from the sun.
Stay on top of regular eye exams
You should get an eye exam every one to two years. Getting an annual exam is especially important if you have a condition, like diabetes or hypertension, or if you’ve been having symptoms.
If traveling to an eye care specialist is difficult, eye care via telemedicine (teleophthalmology) may be available. Telemedicine can make eye care more accessible, especially to people in rural areas.
Where to get eye care help
If you are struggling to access eye care, organizations and resources are available to help.
The Indian Health Service (IHS) is a federal agency that provides health services for Native American and Alaska Native communities. Their teleophthalmology services screen for diabetic retinopathy and are available in IHS primary care clinics nationwide. This means you don’t have to find an eye care specialist to get screened.
Regional organizations, like the Alaska Native Tribal Health Consortium (ANTHC), can also help. The Centers for Disease Control and Prevention (CDC) Tribal Affairs page has a useful resource for finding organizations dedicated to health care for tribes across the country.
Nonprofit organizations can also help you find care. For instance, the Lions Club International provides communities with vision screenings and other support. The OneSight EssilorLuxottica Foundation also helps provide eye exams and glasses to people who need them.
LEARN MORE: Where to get a free eye exam and glasses
