Bill Harvey: Global economics
Author: Bill Harvey
Socioeconomic status is a risk factor for eye disease.
The major causes of sight loss in the UK have a wide range of risk factors. An understanding of these should inform any adaptations to an eye examination you may need, for example using a full threshold fields program for someone with a family history of glaucoma, or perhaps using autofluorescence on a middle-aged heavy smoker.
The major risk factors (age, family history, ethnicity, refractive error) are considered non-modifiable – that is cannot be influenced by intervention (until, at least, progress is made with gene therapy or myopia management). Most conditions do have modifiable risk factors. Those that have a direct influence on disease likelihood and progression, such as intraocular pressure in glaucoma, may be influenced directly and help the prognosis.
Many of the known modifiable risk factors are less direct so their influence varies due to their impact relying on intermediary processes between the initial insult and the final ocular consequence. That said, the influence of some is still significant, such as the case with smoking for AMD, while others are sometimes considered to be putative and less easily to quantify.
A recent study in last month’s Ophthalmology Journal joins a long line of research highlighting the role of socioeconomic status in the prevalence of eye diseases, in this case an increased prevalence in indigenous people in Australia. Except for in a very few cases, for example the spike in microbial keratitis in wealthy young male contact lens wearers, the association usually is a higher likelihood of disease in lower socioeconomic patient base environments, often because of poorer awareness of health care services, poor nutrition, poor compliance with health measures, increased smoking patterns and so on.
So why is poverty so rarely cited as a modifiable risk factor?