0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Socioeconomics and Health Services |

Economic Cost of Visual Impairment in Japan FREE

Chris B. Roberts, BA, BEc; Yoshimune Hiratsuka, MD, MPH; Masakazu Yamada, MD; M. Lynne Pezzullo, BEc; Katie Yates, BSc, BComm; Shigeru Takano, MD; Kensaku Miyake, MD; Hugh R. Taylor, MD
[+] Author Affiliations

Author Affiliations: Access Economics Pty Limited, Barton, Australia (Mr Roberts and Mss Pezzullo and Yates); Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan (Dr Hiratsuka); National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo (Dr Yamada); Takano Eye Clinic, Kawasaki, Japan (Dr Takano); Shozan-kai Miyake Eye Hospital, Nagoya, Japan (Dr Miyake); and Melbourne School of Population Health, University of Melbourne, Melbourne, Australia (Dr Taylor).


Section Editor: Paul P. Lee, MD

More Author Information
Arch Ophthalmol. 2010;128(6):766-771. doi:10.1001/archophthalmol.2010.86.
Text Size: A A A
Published online

Objective  To quantify the total economic cost of visual impairment in Japan.

Methods  A prevalence-based approach was adopted using data on visual impairment, the national health system, and indirect costs to capture the economic impact of visual impairment in 2007.

Results  In 2007, visual impairment affected more than 1.64 million people in Japan and cost around ¥8785.4 billion (US $72.8 billion) across the economy, equivalent to 1.7% of Japan's gross domestic product. The loss of well-being (years of life lost from disability and premature mortality) cost ¥5863.6 billion (US $48.6 billion). Direct health system costs were ¥1338.2 billion (US $11.1 billion). Other financial costs were ¥1583.5 billion (US $13.1 billion), including productivity losses, care takers' costs, and efficiency losses from welfare payments and taxes. Community care was the largest component of other financial costs and was composed of paid and unpaid services that provide home and personal care to people with visual impairment. The findings of this study are in line with those of similar studies in Australia and the United States.

Conclusions  Visual impairment imposes substantial costs on society, particularly to individuals with visual impairment and their families. Eliminating or reducing disabilities from visual impairment through public awareness of preventive care, early diagnosis, more intensive disease treatment, and new medical technologies could significantly improve the quality of life for people with visual impairment and their families, while also potentially reducing national health care expenditure and increasing productivity in Japan. The results of this study should provide a first step in helping policymakers evaluate policy effects and to prioritize research expenditures.

The costs of visual impairment have been characterized in the United States, Australia, and some European countries, including the United Kingdom.14 Although direct comparison of results is difficult because of differing methodologies, these reports show that visual impairment places a heavy burden on individuals, families, and society.

Increasing eye disease and vision loss is often driven by an aging population and social and environmental changes. Population-based studies from Australia, Europe, and the United States have demonstrated that the prevalence of visual impairment approximately triples with each decade of life beyond the age of 40 years.5,6

The Organization for Economic Cooperation and Development reported that in 2006, health expenditures in Japan accounted for 8.1% of the country's gross domestic product. Although Japanese health expenditure was lower than the Organization for Economic Cooperation and Development average of 8.9%, Japan has one of the world's oldest and longest living populations. Measuring the cost of health care is essential for designing future health financing.

Rapid economic development, growing public awareness of treatable eye diseases, and the national medical insurance system have enhanced prevention and treatment of visually impairing conditions in Japan. However, the economic consequences of visual impairment have not been documented, apart from some top-down estimates based on national statistics. This is a timely first study to assess the economic impact of visual impairment in Japan.

This study adopts the prevalence-based costing method used in similar studies for Australia1 and the United States (unpublished data, Access Economics, 2006), measuring the number of people with visual impairment in 2007 and the cost of treating their conditions plus other financial and nonfinancial costs from their vision loss in that year. Understanding cost components is crucial for appropriate allocation of health care resources.4

All costs were originally calculated in Japanese yen (¥) and are presented with United States dollar equivalents based on the Organization for Economic Cooperation and Development's purchasing parity 2007 rate of ¥120.66 per US dollar.

PREVALENCE

Prevalence of visual impairment (best-corrected visual acuity <6/12) was calculated as the sum of low vision (best-corrected visual acuity between 6/12 and 6/60) and blindness (best-corrected visual acuity <6/60). Visual impairment was defined as <6/12 (<20/40) because this is a well-accepted international definition,6 thus enabling cross-country comparisons, and because these data were available in Japan.

Prevalence rates by age were based on data from the Japanese Ministry of Health, Labour and Welfare, presented by the National Committee of Welfare for the Blind in Japan,7 and a major epidemiological study.8 Sex and severity splits were based on epidemiological data sets by cause of visual impairment.919 Prevalence rates were multiplied by Japanese census data to estimate the number of people with visual impairment.

DIRECT HEALTH COSTS

Health costs were based on Japanese health expenditure data,20 which concord with the World Health Organization's International Statistical Classification of Diseases, 10th Revision (ICD-10). In the absence of more granular data, the ICD-10 code VII for “diseases of the eye and adnexa” was used. These expenditures were related to all eye health costs and may include some conditions that are not potentially visually impairing. However, these are likely to be small relative to the total, as in other studies in which data do not support separation of visually impairing conditions.1 Health expenditures were converted to 2007 values using official health inflation data.

OTHER FINANCIAL COSTS

Other financial costs are composed of productivity losses, costs of care outside the health system, vision aids, and efficiency losses from government transfers and expenditure. People with visual impairment may work less than otherwise, retire early, or die prematurely, representing real productivity losses to the economy. A human capital approach was used to measure productivity losses, as is appropriate in countries with low unemployment like Japan.21 Age- and sex-standardized employment rates, absenteeism, and mortality rates were estimated for people with visual impairment using official estimates and government survey data.7,22 Productivity costs were estimated, assuming that in the absence of visual impairment, people would have worked at the same rate as the general population. Productivity costs from increased absenteeism were calculated as the average number of days absent per year owing to visual impairment × the total number of people employed with visual impairment × average annual wages. Production losses arising from premature mortality from falls and depression associated with visual impairment were calculated as a net present value using World Health Organization data for Japan on retirement age, average life expectancy, average age of death, and an estimated discount rate of 1.5%, calculated as long-term nominal bond rates minus expected inflation and growth in productivity.

Additionally, any taxation foregone requires equivalent revenue raising, imposing real efficiency costs on the economy, known as deadweight losses (DWLs). Internationally, DWLs are estimated to be in the range of 9, 16, and 50 cents (9%, 16%, and 50%, respectively)23 for every additional tax dollar raised by the government. The parameter estimate of 16% was used, since no Japanese studies were found to provide a local estimate.

To estimate the cost of community care services, an opportunity cost method valued time devoted to care giving responsibilities that cannot be spent in the paid workforce. This was calculated as the estimated number of people with visual impairment who require some level of care × the average number of hours of care required20 × by an average hourly rate for the wage forgone by the caregiver,21 and weighted by age, sex, and the probability of alternative employment.22

LOSS OF WELL-BEING

Loss of well-being from visual impairment was measured in disability-adjusted life years (DALYs). Disability-adjusted life years have 2 components: the years of life lost as a result of premature death (the mortality burden) and the years of healthy life lost as a result of disability (the morbidity burden).

Years of healthy life lost as a result of disability from visual impairment were calculated by multiplying prevalent cases by disability weights for mild, moderate, and severe visual impairment (0.02, 0.17, and 0.43, respectively) based on the global burden of disease study.24 These disability weights represent losing 2%, 17%, and 43%, respectively, of a year of healthy life. Years of life lost were calculated from the age when a person dies from comorbid conditions attributable to visual impairment and the life expectancy for people of that age and sex. To calculate the burden of disease, Japanese prevalence rates for low vision were subdivided into mild and moderate visual impairment using weights from Australian prevalence data.25

The loss of well-being in DALYs was converted into a monetary value using an estimate of the value of a statistical life. The value of a statistical life in Japan has been valued between ¥675.9 million (US $5.6 million) and ¥1783.5 billion (US $14.8 million).26 The lower bound of US $5.6 million was used with a discount rate of 3.0% during 40 years to generate an estimate for the value of a statistical life year (VSLY) of ¥28.3 million (US $234 552).

SENSITIVITY ANALYSIS

The effects of 20% changes in health care costs, the number of people requiring informal care, and earnings for men and women were examined. The effect of reducing the DWL parameter estimate to the lower bound of 9% was tested. We also assessed the effects of a 20% change in the value of a statistical life used for Japan and in the distribution of low-vision severity.

PREVALENCE

There were 1.64 million people with visual impairment in Japan in 2007; almost 188 000 were blind. Of those with visual impairment, 93.2% were aged 40 years or older, 61.2% were aged 65 years or older, and 33.5% were aged 75 years or older (Table 1).

Table Graphic Jump LocationTable 1. Prevalence of Visual Impairment in Japan by Age, Sex, and Severity
DIRECT HEALTH COSTS

The direct financial costs in Japan for the treatment of all disorders of the eye and adnexa were estimated to total ¥1338.2 billion (US $11.1 billion) in 2007 (Table 2) and may include some conditions that are not visually impairing. However, the cost overestimation is expected to be slight as a result of this data constraint and is countered in that costs of screening programs and eye health promotion are not included, so health cost coverage was not exhaustive. The largest component of health costs for visual impairment related to general medical expenditure (¥977.5 billion [US $8.1 billion]), of which outpatients represented 77.7% (¥759.4 billion [US $6.3 billion]).

Table Graphic Jump LocationTable 2. Summary of Health Care Costs for Visual Impairment in Japan
OTHER FINANCIAL COSTS

Other financial costs of visual impairment were estimated as ¥1583.5 billion (US $13.1 billion) in 2007 (Table 3). Productivity losses from visual impairment (¥563.1 billion [US $4.7 billion]) reflected the lost earnings from lower employment participation (¥510.4 billion [US $4.2 billion]) and worker absenteeism costs (¥46.4 billion [US $384 million]). There are also additional costs totaling ¥6.4 billion (US $53.0 million) associated with premature mortality due to comorbid consequences.

Table Graphic Jump LocationTable 3. Summary of Other Financial Costs for Visual Impairment in Japan

As a substantial component of overall costs, the cost of community care represented both unpaid and paid home care for people with visual impairment. Using the opportunity cost method, the cost of community care in 2007 was estimated as ¥797.3 billion (US $6.6 billion).

The DWL resulting from raising additional taxation revenue to pay for costs borne by the government in relation to visual impairment was composed of losses from health care costs (¥130.9 billion [US $1.1 billion]), lost taxation (¥33.8 billion [US $280 million]), welfare payments (¥24.8 billion [US $205 million]), and other costs associated with providing institutional care and vision aids (¥4.6 billion [US $38.4 million]).

Expenditure on other institutional care and rehabilitation for people with visual impairment in Japan was based on the average cost of institutional care per person per year (derived from long-term care insurance facilities, estimated at ¥7 445 863 [US $61 711.63]) and multiplied by the number of people admitted (3857 people, minus the adjustment to account for the 30% overlap in the data with long-term care insurance facilities). In total, it was estimated that expenditure for institutional services (over and above that provided by long-term care insurance facilities) for the visually impaired was ¥28.7 billion (US $238 million) in 2007.

LOSS OF WELL-BEING

In 2007, the years of healthy life lost as a result of disability and years of life lost attributable to visual impairment in Japan were estimated as 220 022 DALYs and 9063 DALYs, respectively. In total, the burden of disease was 229 085 DALYs.

The gross value of the burden of disease (DALYs multiplied by the VSLY) was ¥6503.1 billion (US $53.9 billion). However, the gross value includes some costs borne by the individual—notably, lost earnings and out-of-pocket health expenditures, for example, which have already been captured. As such, these costs were subtracted and the net cost of the loss of well-being in Japan was calculated as ¥5863.6 billion (US $48.6 billion) for 2007. Costs by item and bearer are summarized in Table 4.

Table Graphic Jump LocationTable 4. Cost Summary of Visual Impairment by Item and Bearer in Japan
INTERNATIONAL COMPARISONS

The cost methodology used here for Japan has also been applied in Australia in 2004 and in the United States in 2005. The estimates can be compared by inflating those costs to 2007 values using domestic inflation data and to US dollars using purchasing power parity. Table 5 shows the economic costs per person with visual impairment.

Table Graphic Jump LocationTable 5. Cost of Visual Impairment per Person With Visual Impairment by Country

The results in Table 5 show that while the costs vary across categories, it is evident that visual impairment incurs a large overall cost in each country. The differences across countries largely reflect differences in the structure of each health care system, the delivery of elderly and community care, productivity estimates, and the value of the burden of disease owing to different values of a statistical life for each country.

SENSITIVITY ANALYSIS

Varying direct health costs, the number of people requiring informal care in the community, and male and female average earnings ±20% produced a variation in the baseline of total visual impairment costs of ±2.9%, ±1.9%, and ±2.2%, respectively. Our results did not vary significantly when the assumption used for the DWL parameter estimates was dropped from 16% to 9%, resulting in a fall of total costs of 1.0%. The value of a statistical life used for Japan to estimate the burden of disease was varied by 20% resulting in changes of ±15.1% of total costs; the sensitivity of this result is discussed subsequently. The distribution of low vision (between mild and moderate vision) was altered by 20%, resulting in changes of ±1.5% of total costs.

While no single data set provided a complete picture of the prevalence of visual impairment in Japan, all surveys provided valuable input. The prevalence of visual impairment was principally based on epidemiological studies of larger sample sizes. These sources were considered representative of the rapid economic development in Japan during the past half century, public awareness of treatable ocular diseases, and the universal medical insurance system in Japan. Additionally, the smaller surveys provided valuable information on prevalence by sex and severity for low vision and blindness.

In the present study, we have shown that in 2007 visual impairment affected more than 1.64 million people in Japan, or 1.3% of the population, and cost an estimated ¥8785.4 billion [US $72.8 billion], or 1.7% of the gross domestic product of Japan. These findings are consistent with other studies that also found substantial expenditures to be associated with visual impairment.27,28

The total cost of visual impairment presented in this report captures the direct and indirect costs incurred across the economy by individuals, family and care takers, employers, society, and government. It was important to include indirect costs to gain an accurate picture of the total economic burden of visual impairment.

Our analysis suggests that community care costs account for 50% of indirect costs of visual impairment in Japan. This suggests that substantial resources are dedicated to care for individuals with visual impairment at home through informal care. Community care costs were composed of both paid and unpaid home care. Official usage data were available for paid home care20 and used as a proxy for unpaid care. Usage data ranged from all-day care to care only when required. A weighted average of 17.1 hours per week based on the percentage distribution of the usage data was applied to those with visual impairment most likely to require some form of community care. It was assumed that those with mild visual impairment would not require any form of community care and those in institutional care were accounted for in other financial costs.

The loss of well-being comprises a large part of the costs of visual impairment in Japan as well as in Australia and the United States. There has been some controversy about placing a monetary value on DALYs, and the value of the VSLY chosen has a large impact on the estimated burden of disease from visual impairment. As a conservative approach, the lower end estimate was used because the VSLY for Japan was already at the high end of estimates of that among comparable countries. Accordingly, the estimated loss of well-being from visual impairment per person per year in Japan was between that in Australia and the United States.

Even in a developed country like Japan, avoidable vision loss is now a major problem and will increase in the future in the absence of policy change. Because prevalence rates of visual impairment increase with each decade of life, the number of Japanese individuals with visual impairment is expected to increase by 23% during the next 20 years. Although specific interventions may increase health costs, they can also bring significant savings in other financial costs and loss of well-being. Taylor and associates29 have shown that many eye care interventions are cost-effective.

Owing to good access to high-quality cataract surgery, the prevalence of visual impairment from cataract is low in Japan. On the other hand, glaucoma is the leading cause of visual impairment.8,19 Compared with the United States and Australia, the rate of undiagnosed glaucoma is very high in Japan,15 and this may partially explain the high prevalence of visual impairment from glaucoma in Japan. Diabetic retinopathy is the second most common cause of visual impairment. The prevalence of diabetes is relatively high in Japan and this would contribute to a high prevalence of diabetic retinopathy and visual impairment.8 Access to good medical services in Japan through its universal health care system enables people with diabetes to have better systemic control. However, the high proportion of visual impairment due to diabetic retinopathy also raises questions about the adequacy of coverage of screening and close coordination with general physicians and ophthalmologists and the use of photocoagulation and vitreous surgery, which are readily available in Japan.

Reducing the burden of visual impairment through factors such as public awareness of preventive care, early diagnosis, more intensive disease treatment, more research, and the advent of new medical technologies could significantly improve the quality of life for people with visual impairment and their families, while at the same time potentially reducing national expenditures for health care services and increasing productivity in the Japanese economy.

The comparability of epidemiological and economic estimates between illnesses is also important to inform decisions on the distribution of research effort, as suggested by Leal and colleagues.30 Japan already has good primary, secondary, and tertiary eye care services as well as good data on the distribution and impact of eye diseases. Additionally, Japan has extensive health and financial data that permit economic modeling of any related prevention or treatment. Our study is the first to quantify the burden of visual impairment in Japan. We believe that our study will be of particular interest to policymakers. It highlights, above everything else, the need for comparable and accurate information on the prevalence, severity, and resource use associated with visual impairment in Japan.

Correspondence: Yoshimune Hiratsuka, MD, MPH, Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan (yoshi-h@tkf.att.ne.jp).

Submitted for Publication: July 15, 2009; final revision received September 7, 2009; accepted September 8, 2009.

Additional Contributions: This report was commissioned by the Japan Ophthalmologists Association. Assistance was provided by Akira Murakami, MD, from the Department of Ophthalmology, Juntendo University School of Medicine, and Shunichi Fukuhara, MD, from the Department of Epidemiology and Health Care Research, Kyoto University.

Financial Disclosure: None reported.

Taylor  HRPezzullo  MLKeeffe  JE The economic impact and cost of visual impairment in Australia. Br J Ophthalmol 2006;90 (3) 272- 275
PubMed Link to Article
Frick  KDGower  EWKempen  JHWolff  JL Economic impact of visual impairment and blindness in the United States. Arch Ophthalmol 2007;125 (4) 544- 550
PubMed Link to Article
Rein  DBZhang  PWirth  KE  et al.  The economic burden of major adult visual disorders in the United States. Arch Ophthalmol 2006;124 (12) 1754- 1760
PubMed Link to Article
Lafuma  ABrezin  ALopatriello  S  et al.  Evaluation of non-medical costs associated with visual impairment in four European countries: France, Italy, Germany and the UK. Pharmacoeconomics 2006;24 (2) 193- 205
PubMed Link to Article
Taylor  HRLivingston  PMStanislavsky  YL McCarty  CA Visual impairment in Australia: distance visual acuity, near vision, and visual field findings of the Melbourne Visual Impairment Project. Am J Ophthalmol 1997;123 (3) 328- 337
PubMed
Congdon  NO’Colmain  BKlaver  CC  et al. Eye Diseases Prevalence Research Group, Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004;122 (4) 477- 485
PubMed Link to Article
National Committee of Welfare for the Blind in Japan, Persons With Visual Impairment in Japan.  Tokyo, Japan National Committee of Welfare for the Blind in Japan2005;
Iwase  AAraie  MTomidokoro  AYamamoto  TShimizu  HKitazawa  YTajimi Study Group, Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study. Ophthalmology 2006;113 (8) 1354- 1362
PubMed Link to Article
Iwano  MNomura  HAndo  FNiino  NMiyake  YShimokata  H Visual acuity in a community-dwelling Japanese population and factors associated with visual impairment. Jpn J Ophthalmol 2004;48 (1) 37- 43
PubMed Link to Article
Oshima  YIshibashi  TMurata  TTahara  YKiyohara  YKubota  T Prevalence of age related maculopathy in a representative Japanese population: the Hisayama study. Br J Ophthalmol 2001;85 (10) 1153- 1157
PubMed Link to Article
Yuzawa  MTamakoshi  AKawamura  TOhno  YUyama  MHonda  T Report on the nationwide epidemiological survey of exudative age-related macular degeneration. Int Ophthalmol 1997;21 (1) 1- 3
PubMed Link to Article
Sasaki  KOno  MAoki  K  et al.  Cataract epidemiology survey in three climatically different areas in Japan: prevalence of cataracts and types of lens opacification [in Japanese]. Nippon Ganka Gakkai Zasshi 1995;99 (2) 204- 211
PubMed
Miyazaki  MKubo  MKiyohara  Y  et al.  Comparisons of diagnostic methods for diabetes mellitus based on prevalence of retinopathy in a Japanese population: the Hisayama study. Diabetologia 2004;47 (8) 1411- 1415
PubMed Link to Article
Kuzuya  TAkanuma  YAkazawa  YUehata  T Prevalence of chronic complications in Japanese diabetic patients. Diabetes Res Clin Pract 1994;24 ((suppl)) S159- S164
PubMed Link to Article
Iwase  ASuzuki  YAraie  M  et al. Tajimi Study Group, Japan Glaucoma Society, The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study. Ophthalmology 2004;111 (9) 1641- 1648
PubMed
Yamamoto  TIwase  AAraie  M  et al. Tajimi Study Group, Japan Glaucoma Society, The Tajimi Study report 2: prevalence of primary angle closure and secondary glaucoma in a Japanese population. Ophthalmology 2005;112 (10) 1661- 1669
PubMed Link to Article
Shimizu  NNomura  HAndo  FNiino  NMiyake  YShimokata  H Refractive errors and factors associated with myopia in an adult Japanese population. Jpn J Ophthalmol 2003;47 (1) 6- 12
PubMed Link to Article
Matsumura  HHirai  H Prevalence of myopia and refractive changes in students from 3 to 17 years of age Surv Ophthalmol 1999;44 ((suppl 1)) S109- S115
PubMed Link to Article
Nakae  KMasuda  KSenoo  TSawa  MKanai  AIshibashi  T Ageing Society and Eye Disease: a recent epidemiological study on underlying diseases responsible for visual impairment [in Japanese]. Geriatr Med 2006;44 (9) 1221- 1224
Ministry of Health Labour and Welfare, Statistical Abstracts on Health and Welfare in Japan 2006.  Tokyo, Japan Statistics and Information Dept, Minister's Secretariat, Health and Welfare Statistics Association2007;
Statistics Bureau, Japan Monthly Statistics: Labour and Wages, Director General for Policy Planning (Statistical Standards) and Statistical Research and Training Institute.  Tokyo, Japan Ministry for Internal Affairs and Communications2007;
Statistics Bureau, Labour Force Survey: Director General for Policy Planning (Statistical Standards) and Statistical Research and Training Institute.  Tokyo, Japan Ministry for Internal Affairs and Communications2007;
Stuart  C Welfare costs per dollar of additional tax revenue in the United States. Am Econ Rev 1984;74 (3) 352- 362
Murray  CLopez  A The Global Burden of Disease: A Comprehensive Assessment of Mortality And Disability From Diseases, Injuries and Risk Factors in 1990 and Projected to 2020, Global Burden of Disease and Injury Series.  Boston, MA Harvard School of Public Health1996;
Centre for Eye Research Australia, Clear Insight: The Economic Impact and Cost of Vision Loss in Australia.  Melbourne, Australia Centre for Eye Research Australia2004;
Access Economics, The Health of Nations: The Value of a Statistical Life.  Canberra, Australia Access Economics2008;
Morse  ARYatzkan  EBerberich  BArons  RR Acute care hospital utilization by patients with visual impairment. Arch Ophthalmol 1999;117 (7) 943- 949
PubMed Link to Article
Schmier  JKCovert  DWLau  ECMatthews  GP Medicare expenditures associated with diabetes and diabetic retinopathy. Retina 2009;29 (2) 199- 206
PubMed Link to Article
Taylor  HRPezzullo  MLNesbitt  SJKeeffe  JE Costs of interventions for visual impairment. Am J Ophthalmol 2007;143 (4) 561- 565
PubMed Link to Article
Leal  JLuengo-Fernández  RGray  APetersen  SRayner  M Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 2006;27 (13) 1610- 1619
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 1. Prevalence of Visual Impairment in Japan by Age, Sex, and Severity
Table Graphic Jump LocationTable 2. Summary of Health Care Costs for Visual Impairment in Japan
Table Graphic Jump LocationTable 3. Summary of Other Financial Costs for Visual Impairment in Japan
Table Graphic Jump LocationTable 4. Cost Summary of Visual Impairment by Item and Bearer in Japan
Table Graphic Jump LocationTable 5. Cost of Visual Impairment per Person With Visual Impairment by Country

References

Taylor  HRPezzullo  MLKeeffe  JE The economic impact and cost of visual impairment in Australia. Br J Ophthalmol 2006;90 (3) 272- 275
PubMed Link to Article
Frick  KDGower  EWKempen  JHWolff  JL Economic impact of visual impairment and blindness in the United States. Arch Ophthalmol 2007;125 (4) 544- 550
PubMed Link to Article
Rein  DBZhang  PWirth  KE  et al.  The economic burden of major adult visual disorders in the United States. Arch Ophthalmol 2006;124 (12) 1754- 1760
PubMed Link to Article
Lafuma  ABrezin  ALopatriello  S  et al.  Evaluation of non-medical costs associated with visual impairment in four European countries: France, Italy, Germany and the UK. Pharmacoeconomics 2006;24 (2) 193- 205
PubMed Link to Article
Taylor  HRLivingston  PMStanislavsky  YL McCarty  CA Visual impairment in Australia: distance visual acuity, near vision, and visual field findings of the Melbourne Visual Impairment Project. Am J Ophthalmol 1997;123 (3) 328- 337
PubMed
Congdon  NO’Colmain  BKlaver  CC  et al. Eye Diseases Prevalence Research Group, Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004;122 (4) 477- 485
PubMed Link to Article
National Committee of Welfare for the Blind in Japan, Persons With Visual Impairment in Japan.  Tokyo, Japan National Committee of Welfare for the Blind in Japan2005;
Iwase  AAraie  MTomidokoro  AYamamoto  TShimizu  HKitazawa  YTajimi Study Group, Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study. Ophthalmology 2006;113 (8) 1354- 1362
PubMed Link to Article
Iwano  MNomura  HAndo  FNiino  NMiyake  YShimokata  H Visual acuity in a community-dwelling Japanese population and factors associated with visual impairment. Jpn J Ophthalmol 2004;48 (1) 37- 43
PubMed Link to Article
Oshima  YIshibashi  TMurata  TTahara  YKiyohara  YKubota  T Prevalence of age related maculopathy in a representative Japanese population: the Hisayama study. Br J Ophthalmol 2001;85 (10) 1153- 1157
PubMed Link to Article
Yuzawa  MTamakoshi  AKawamura  TOhno  YUyama  MHonda  T Report on the nationwide epidemiological survey of exudative age-related macular degeneration. Int Ophthalmol 1997;21 (1) 1- 3
PubMed Link to Article
Sasaki  KOno  MAoki  K  et al.  Cataract epidemiology survey in three climatically different areas in Japan: prevalence of cataracts and types of lens opacification [in Japanese]. Nippon Ganka Gakkai Zasshi 1995;99 (2) 204- 211
PubMed
Miyazaki  MKubo  MKiyohara  Y  et al.  Comparisons of diagnostic methods for diabetes mellitus based on prevalence of retinopathy in a Japanese population: the Hisayama study. Diabetologia 2004;47 (8) 1411- 1415
PubMed Link to Article
Kuzuya  TAkanuma  YAkazawa  YUehata  T Prevalence of chronic complications in Japanese diabetic patients. Diabetes Res Clin Pract 1994;24 ((suppl)) S159- S164
PubMed Link to Article
Iwase  ASuzuki  YAraie  M  et al. Tajimi Study Group, Japan Glaucoma Society, The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study. Ophthalmology 2004;111 (9) 1641- 1648
PubMed
Yamamoto  TIwase  AAraie  M  et al. Tajimi Study Group, Japan Glaucoma Society, The Tajimi Study report 2: prevalence of primary angle closure and secondary glaucoma in a Japanese population. Ophthalmology 2005;112 (10) 1661- 1669
PubMed Link to Article
Shimizu  NNomura  HAndo  FNiino  NMiyake  YShimokata  H Refractive errors and factors associated with myopia in an adult Japanese population. Jpn J Ophthalmol 2003;47 (1) 6- 12
PubMed Link to Article
Matsumura  HHirai  H Prevalence of myopia and refractive changes in students from 3 to 17 years of age Surv Ophthalmol 1999;44 ((suppl 1)) S109- S115
PubMed Link to Article
Nakae  KMasuda  KSenoo  TSawa  MKanai  AIshibashi  T Ageing Society and Eye Disease: a recent epidemiological study on underlying diseases responsible for visual impairment [in Japanese]. Geriatr Med 2006;44 (9) 1221- 1224
Ministry of Health Labour and Welfare, Statistical Abstracts on Health and Welfare in Japan 2006.  Tokyo, Japan Statistics and Information Dept, Minister's Secretariat, Health and Welfare Statistics Association2007;
Statistics Bureau, Japan Monthly Statistics: Labour and Wages, Director General for Policy Planning (Statistical Standards) and Statistical Research and Training Institute.  Tokyo, Japan Ministry for Internal Affairs and Communications2007;
Statistics Bureau, Labour Force Survey: Director General for Policy Planning (Statistical Standards) and Statistical Research and Training Institute.  Tokyo, Japan Ministry for Internal Affairs and Communications2007;
Stuart  C Welfare costs per dollar of additional tax revenue in the United States. Am Econ Rev 1984;74 (3) 352- 362
Murray  CLopez  A The Global Burden of Disease: A Comprehensive Assessment of Mortality And Disability From Diseases, Injuries and Risk Factors in 1990 and Projected to 2020, Global Burden of Disease and Injury Series.  Boston, MA Harvard School of Public Health1996;
Centre for Eye Research Australia, Clear Insight: The Economic Impact and Cost of Vision Loss in Australia.  Melbourne, Australia Centre for Eye Research Australia2004;
Access Economics, The Health of Nations: The Value of a Statistical Life.  Canberra, Australia Access Economics2008;
Morse  ARYatzkan  EBerberich  BArons  RR Acute care hospital utilization by patients with visual impairment. Arch Ophthalmol 1999;117 (7) 943- 949
PubMed Link to Article
Schmier  JKCovert  DWLau  ECMatthews  GP Medicare expenditures associated with diabetes and diabetic retinopathy. Retina 2009;29 (2) 199- 206
PubMed Link to Article
Taylor  HRPezzullo  MLNesbitt  SJKeeffe  JE Costs of interventions for visual impairment. Am J Ophthalmol 2007;143 (4) 561- 565
PubMed Link to Article
Leal  JLuengo-Fernández  RGray  APetersen  SRayner  M Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 2006;27 (13) 1610- 1619
PubMed Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 7

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

The Rational Clinical Examination
Visual Acuity

The Rational Clinical Examination
Visual Impairment