NEI Webinar: Enhancing Eye Health Among Hispanics/Latinos

Uploaded by NIHOD on 20.09.2012

Hello and welcome to today's webinar,
Enhancing Eye Health Among Hispanics/Latinos:
a Look at Their Knowledge, Attitudes and Practices,
Results From Nationwide Research.
This is Neyal Ammary-Risch, and
I'm the director of NEHEP.
Our goal is to educate professionals and the public
about eye health, eye health awareness, and
to increase awareness about early detection of eye diseases.
We have five program areas, and today's webinar is
a program from our ¡Ojo Con Su Visión! or
Watch Out for Your Vision! program.
It is my pleasure to present today's webinar, Conducting
Research in Hispanics/Latinos in the United States.
Co-presenting today will be Dr. Rohit Varma, a member of
the NEHEP Planning Committee, and principal investigator of
the Los Angeles Latino Eye Study.
Dr. Varma has served as an advisor to NEHEP for several
years, and he's the director of Glaucoma Service Ocular
Epidemiology Center, and the clinical trial unit within the
department of ophthalmology at the University of
Southern California Keck school of medicine.
He holds a medical degree from the University of New Delhi, in
India, and a Master's of Public Health from
Johns Hopkins University.
In addition to Los Angeles Latino Eye Study, he has
conducted numerous population-based studies on
aging minorities and children: The Chinese/American Eye Study,
Advancing Images in Glaucoma Study, and the Multiethnic
Pediatric Eye Disease Study.
He holds honors from the American Academy of
Ophthalmology, Research to Prevent Blindness, and
Association for Research in Vision and Ophthalmology,
among other organizations.
Welcome Dr. Varma.
Also co-presenting is Ms. Marcela Aguilar,
a senior public health manager at ICF International.
She holds a master's degree in behavioral sciences in health
education from John Hopkins Bloomberg School of Public
Health, has more than 15 years of experience designing,
implementing, and leading health communication and
social marketing programs.
Her areas of expertise include strategy development, campaign
management, audience research, and materials development.
Marcela has managed health communication projects and
provided training and technical assistance in
Africa, Asia, Latin America, the Middle East, and North America.
Fluent in English and Spanish, she was instrumental in engaging
participants in the focus groups with Hispanics and Latinos,
which you'll hear about shortly.
Welcome Ms. Aguilar.
During this presentation, you'll hear from Dr. Varma
about the prevalence of eye disease among Hispanics/Latinos,
and from Ms. Aguilar about focus groups and other research that
has been conducted with this population.
Before we begin, I just want to say a brief word about the
¡Ojo Con Su Visión! program.
I did mention it is one of five NEHEP program areas.
We also have a program area on diabetic eye disease, one on
low vision, one on glaucoma, another on vision and aging, and
again our Ojo program.
For the Ojo program, our target audiences are
Hispanics/Latinos and also health professionals and
community health workers who work with them.
Originally, this program was designed to address diabetic
eye disease among Hispanics and Latinos, but as science has
progressed, there was an increased need to address other
eye health issues among this population.
We expanded it to cover glaucoma, common vision
problems, and other eye conditions such as
eye safety and low vision.
All of our messages through this program stress that Hispanics
and Latinos are at highest risk for vision loss and blindness.
The eye diseases have no early warning signs or symptoms, and
that early detection, timely treatment, and appropriate
follow-up may help prevent vision loss or blindness.
I'll be talking a little more later about some of the
resources we have available for this population, and for
health professionals and community health workers
who work with them, but first I'm going to turn things over to
Dr. Varma, who's now going to give an overview about
the eye health of Latinos.
Neyal, I appreciate you inviting me to help you with this.
I'm going to speak a little bit about eye disease in this
particular ethnic group, Hispanics as well as Latinos,
but prior to that, I just want to give you all a little bit of
an overview of how fast this population is growing and what
a large proportion it currently has.
According to the 2010 Census,
there are about over 50 million people in the U.S. that belong
to this particular ethnic group, and that is about
16 percent of the population.
A majority of them come from south of the border, Mexico, and
then there's an additional group that comes from Cuba,
as well as Puerto Rico.
As you can see from this map, the vast majority of people that
belong to the ethnic groups sort of are in the southern and
the western part of the United States with the three largest
states that have people belonging to this ethnic group
being Florida, Texas, and of course, California.
It's also important to realize that this particular group is
also changing over time, and they're getting older and aging.
What the Census Bureau projects is that people in
this particular ethnic group, Hispanics, will be about
132.8 million in 2050, which is an enormous and
a remarkable growth in this particular ethnic group.
In addition to that, the life expectancy is also increasing.
Now, it is estimated that by 2030, one in three
adults will have diabetes.
That's for the entire group, for all the U.S., but in this
particular ethnic group, the prevalence is even higher and
I'll get into that in just a minute.
What this sort of highlights is that diabetic eye disease is
going to be a major problem in the U.S.,
not just for individuals in this ethnic group,
but throughout the U.S., if you will.
I'm going to now get into some of the studies, which have
been done, which show the burden of disease in
this particular ethnic group.
Proyecto Ver, which was a study in Tucson and
Nogales in Arizona, looked at about 4,500
Mexican/Americans who were age 40 and older.
This was a study which was sponsored by the NEI, and
it was to assess vision health amongst Hispanics.
What they found in that study was that about 20 percent of
all individuals have diabetes.
Twenty-three percent of individuals who were newly
identified as having diabetes had retinopathy and about
nine percent of the individuals were actually in
danger of losing vision because of retinopathy.
So, what this points to is that in this particular ethnic group,
Hispanics, there is a huge burden of this disease,
particularly diabetic eye disease, and
I think one needs to pay special attention to it.
In addition to that study done in Arizona, we conducted
a study in L.A., which looked at about 6,300 Hispanics,
again primarily Mexicans.
This study was also funded by the NEI, and I'm very grateful
to them for having supported this over the years.
What we did in this study was we went to each of the
6,300 individuals and we did a complete eye exam and
a blood test to determine what their level of blood sugar was.
What we found overall in terms of eye disease was
that 60 percent of all eye disease in Hispanics
was undetected and undiagnosed.
The range varied with the rates being over 75 percent of those
with glaucoma to being about 40 percent of those with just with,
I guess, refractive error.
So, one of the things, one of the additional things we found
was that about 25 percent of individuals have diabetes, which
again is one in four, which is an extraordinarily high
prevalence of this disease.
Of those that have diabetes, half of those in fact had
retinopathy, again a really high proportion of
individuals with eye disease.
Almost five percent had glaucoma, of which 75 percent
was previously undetected, and one in five people, or almost
20 percent, had cataract.
So what we found in that original study was what was
the burden of existing eye disease and what we wanted to
then know in a second phase was how many new people get
eye disease every year or every four years.
So, we went back after four years and re-examined them in
2010 to see what was the burden of new eye disease or
incidence of eye disease in this population.
And what we found was that over the four-year period between the
initial exam and the second phase, which was done four years
after the first exam, nearly three percent of individuals
had developed visual impairment, and if you
look at the oldest age group, about almost 20 percent of
people 80 years and older had become visually impaired, and
almost four percent had become blind in both eyes.
Of the individuals that had diabetes at the original exam
four years ago, but did not have any eye disease,
34 percent of those went onto develop
new eye disease four years later.
Again, that's an extraordinarily high
burden of eye disease in this population.
Now, in addition to identifying the burden of
this disease, it's also important to know what people
know about this disease, about eye disease.
In 2005, the NEI along with Lions Club
International conducted a national public survey of
the knowledge, attitudes, and practices related to eye health
and disease amongst U.S. adults age 18 years and older.
A sample of all ethnicities were included in this, and
the things which were studied were general health,
eye health, how often do people get eye examinations,
knowledge about eye disease, specific eye disease, and then
the sources that people go to for getting information
about their eye health.
What this study found was that compared to other racial
ethnic groups, Hispanics reported the lowest access to
eye health information.
They were the least likely to have their eyes examined.
Seventy-two percent reported that the loss of eye sight would
have the greatest impact on their daily life, and of all
the racial ethnic groups, people in this ethnicity
were least likely to know about eye health.
In comparison, African/Americans,
non-Hispanic Whites, and Asians were much more likely
to know about eye disease than were Hispanics.
And it's not because they did not value or appreciate
their eye sight, because they really did.
They just did not seem to have access to all this information.
In addition, when it came to specific eye diseases when
one looks at people in this particular ethnic group,
Hispanics, they were less likely to know about glaucoma,
AMD, and as well as diabetic eye disease.
The problem here is that because many of these eye diseases are
initially asymptomatic, there are no signs or symptoms,
people don't know about it.
Unless they have a regular eye exam they're very unlikely
to have this detected.
The reasons why individuals in this ethnic group said that
they went and had eye exams was because it was, almost half of
them said that they had an eye exam, because it was part of
their regular checkup, and then about 20 percent said
it was because they had trouble seeing, and a smaller
percentage was because they needed new eyeglasses or
had infection or injury or eye disease.
While all of these are good reasons to see an eye care
professional, it's important that eye care
and eye examinations become a routine part of
health for every individual.
So, who has the most influence on Hispanics
going and getting an eye exam?
Findings again from the same 2005 survey suggest that
primary care providers have a large say in that,
followed by family member or coworkers and employees,
but other individuals, also including religious leaders,
can contribute to people going and getting eye exams.
Again, what this points to is that there's a need for not just
the healthcare community, but also the overall community and
the individuals work together in raising awareness about
eye disease, and then converting that into actions and going and
getting eye care, if you will.
Just about a couple of months ago, the
National Eye Institute and Prevent Blindness America
released data showing how eye disease continues to be a major
public health problem, and if one looks at this particular
ethnic group of Hispanics,
particularly those age 40 years and older, in 2012,
it's estimated that about 1.8 million have cataracts;
1.2 million have retinopathy; 224,000 have glaucoma; and about
a quarter million, 250,000, have low vision.
If you look at the slide at what the estimates are just about
20 years from now in 2030, you can see that there's almost more
than a doubling of the burden of disease in this particular
ethnic group with 4.7 million having cataracts and over
3 million having retinopathy.
Again, this points to not just the huge existing burden,
but the fact that in the coming 20 odd years, these numbers are
going to grow exponentially and I think we really need to
pay attention to the burden of eye disease in this population.
I think now I'll turn it over to Ms. Aguilar,
who will go into how the results of these studies have been
reinforced by recent qualitative research effort,
which has been carried out by NEHEP.
Thank you so much, Dr. Varma.
Beginning in late 2010 and then during 2011,
this is five years after the test study was completed,
the National Eye Health Education program conducted
nationwide focus groups with a wide variety of audiences.
Among them, Hispanics/Latinos.
The purpose of these focus groups was to gather
information on the importance of eye health, knowledge of eye
health, and preferred sources of eye health information,
along with health information preferences.
The National Eye Health Education Program conducted
a total of 108 focus groups across the country.
We were in 11 cities on the west coast, on the east coast, in
the north, and in the south and we reached various segments of
the population who are at risk for eye diseases and conditions.
We spoke with African Americans, with Whites, with English- and
Spanish-speaking Hispanics/Latinos,
and each of our focus groups had approximately
eight to 12 participants.
The sessions lasted approximately 90 minutes each,
and the participants themselves were people who had diabetes,
people who were at higher risk for glaucoma,
those with self-reported vision loss, and older adults.
We covered some general topic areas during our focus groups;
everything from general health to knowledge, attitudes,
and beliefs about vision.
We also talked about the health information preferences, and
asked for suggestions on improving people's access
to information about vision and eye diseases.
Our participants ranged from 18 years old to 70 years old, and
some of them had seen their eye care professionals as
recently as the day prior to the focus groups, and
some couldn't even recall the last time that they saw
an eye care professional.
Let me spend the next few minutes telling you about
some of the information that specifically Hispanics/Latinos,
shared with us in these focus groups.
Just to give you a better idea about the
Hispanic/Latino participants in our focus groups, we had a total
of 47 groups that were conducted with both Spanish- and English-
speaking Latinos who lived in one of the following cities:
Atlanta, Chicago, Denver, Houston, Miami, Portland,
and Washington DC.
We chose these cities to get a mix of Hispanics/Latinos from
Mexico, from Central and South America, and from the Caribbean,
and we had a total of 456 Hispanics/Latinos
who participated in the focus groups.
The participants included people who had diabetes,
older adults, and those who had self-reported vision loss.
One of the areas that we covered was the importance of
eye health and vision for the focus group participants.
Really across all the groups, the participants expressed the
belief that vision is very important and that
it's important to take good care of your eyes and to avoid
eye diseases and vision loss.
Participants said that vision was something people shouldn't
take for granted, and they said that vision was important to
them because if you lose your sight, you lose everything.
In Spanish, they would say to us
"Si pierdes la visión, lo pierdes todo."
Vision was really characterized as being essential to
people's quality of life.
For participants in all the groups the thought of
losing their vision was really traumatic and frightful.
One of the common sentiments that we heard across the groups
was participants telling us that
"vision is everything to me," "la visión es todo para mi".
They also said that vision was important because
they couldn't do anything without it.
It allowed them to have contact with others and
with the world around them.
The participants in one of the group of older adults, those
ages 60 and over, said that without vision, they would have
no control, and they wouldn't be able to do anything.
Overall, they associated vision with independence,
with mobility, and with the ability to work and enjoy life.
Almost all of the adults in our group said that they would be
somewhat or very likely to have their eyes examined if their
primary care physicians suggested they do so.
So, this is echoing some of the results that
Dr. Varma just presented to us.
The quotes that you see on your screen right now really
reinforce the very high value
that Hispanics/Latinos gave to their vision.
We heard people saying vision is the most important thing,
vision is necessary for living,
vision is important for everything, and finally,
if people couldn't see, they couldn't work.
In terms of participants' knowledge about eye health,
most were familiar with eye health-related diseases,
although some descriptions of eye diseases
were not entirely accurate.
For example, the term "diabetic retinopathy" was
unfamiliar to most participants unless they or someone in their
family had diabetes; in that case, they had heard of it.
The term "cataract," however, was most familiar to
participants in all of the groups and especially in
the groups of older adults.
Several of our participants had been diagnosed with
cataract or had family members with this diagnosis.
A smaller number of our older participants appeared to be
somewhat familiar with the term
"age-related macular degeneration," and
when we asked them how they heard about this disease,
participants stated that it was their eye care professionals
that had discussed it with them.
Most participants in our Spanish-speaking groups said
they had heard the terms in Spanish-catarata, glaucoma, and
baja visión or low vision-however,
many were unaware about these eye diseases, about
their treatments, and about the steps that can be taken
to prevent vision loss.
In general, those who have heard of eye-related terms knew them
because either they, a family member, or someone they know
had the disease.
We also asked our participants about the symptoms for
eye diseases, and some participants said that
one of the symptoms of diabetic retinopathy is blurriness.
Glaucoma symptoms were reported to be as maybe
the loss of sight, hazy vision, and an increase in
the pressure in the back of the eye.
Those are quotes from our participants, but in general,
participants didn't really have correct information about
how eye diseases affect the eyes.
For example, some would associate pressure inside
the eyes with diabetic retinopathy.
Dr. Varma, would you like to comment on these results and
whether or not they're consistent with what
you have seen in the LALES study?
They are actually exactly similar to what we find in
LALES, where the vast majority of people have
undetected eye disease and don't know about eye disease.
Again, it emphasizes again the need for having eye
examinations be a part of the regular physical exam that
an individual has every year.
Exactly, thanks Dr. Varma.
So, our efforts are geared at getting people into the routine
of having their eyes examined and we asked them who do they
trust to receive eye health information from?
This is going to help us understand where
Hispanics/Latinos find health information and
where eye health information should be available to them.
Participants indicated, again reflecting the results that
we just heard from Dr. Varma, their most trusted source of
eye health information is our physicians, their doctors.
The majority of focus group participants mentioned that they
would like to receive health information from their doctors.
Family members, friends, especially those who work in
the medical field are also trusted sources of information.
In fact, family members play a very important role in
the health care of Hispanics/Latinos.
A good number of our participants, especially
those who were older adults, mentioned that
a family member will sometimes go with them
to their doctor's appointment.
Participants also said that they would read information
that was given to them by healthcare professionals or
information that they received at
community centers and health fairs.
A number also said that they like to read newsletters
that were sent out by their health insurance.
For example, older adults mentioned that they read
the AARP newsletter.
Traditional media and the Internet also played an
important role in disseminating
health information for Hispanics/Latinos.
One of the TV shows that participants mentioned
repeatedly in the groups with the Spanish-speaking
Hispanics/Latinos were the Dr. Alyssa television spots,
sometimes referred to as cápsulas informativas.
For English speakers, it was Dr. Oz.
Google, the search engine, was mentioned in the majority of
the groups, as were the Mayo Clinic website, WebMD, and
the American Diabetes Association website.
In terms of newspapers, local newspapers, and those
that participants could access via the Internet,
particularly those from their countries of origin,
were mentioned as sources of information.
Now, it was very interesting for us to find out that radio and
magazines were rarely mentioned by these participants as
a source of health information.
Finally, the participants in the English-speaking
Hispanic/Latino groups said that they prefer to receive
information in English and conversely,
the Spanish-speaking Hispanic/Latino participants
preferred receiving their health information in Spanish.
During the focus groups, we also asked participants
how comfortable they were communicating with
their primary care physician.
English-speaking participants said they had very open
communication with their healthcare professionals.
In fact, they received calls from their doctors
and they exchanged e-mails.
In general, the groups with English-speaking participants
felt that their physicians were culturally sensitive and did not
discriminate against them.
Some participants reported that they felt very comfortable with
their primary care physicians;
however, there was a feeling that physicians sometimes
treated them "like a number," especially younger doctors.
Participants said that older doctors, older physicians,
were perceived as being more caring than younger ones.
In the Spanish-speaking groups, some participants reported
feeling comfortable talking with their healthcare professionals,
but others stated that sometimes these professionals
seemed a little too busy to talk to them and cultural
differences seemed to be a bigger problem with
Spanish-speaking Hispanics/Latinos,
as was language, which becomes a barrier, an impediment
to understanding health information.
Some participants mentioned that they felt discriminated against.
One participant said, "With Hispanics, we do not get a
Spanish-speaking doctor, and we do not understand
what they are saying."
Another participant said to us, "The minute you give them
your name, they make you wait longer than necessary.
They pass you from one place to the next until
the translator comes out.
I could see their rejection."
Most participants in our groups tended to look for
Spanish-speaking eye care professionals, and some
reported having to be accompanied by a relative,
particularly a daughter, son, sometimes a friend,
who was fluent in English so that they could translate or
serve as an interpreter for them when seeing healthcare
professionals who do not speak Spanish.
So based on our focus group findings, really language was
the significant barrier among Spanish-speaking
Hispanics/Latinos and their primary care physician.
Like I said, many rely on family or friends who are
"fluent" in English to serve as an interpreter.
But time is also an issue.
In general, Hispanics/Latino participants reported that
doctors just did not spend enough time with them.
Then, finally, cultural differences really play
a role in impeding effective communication between
primary care physicians and their Hispanic/Latino patients.
Some of these cultural characteristics, for example,
are the importance of family, "la familia" and the key role
that the family plays in their decisions,
especially in health care.
The concept of "respeto", or respect, that Hispanics/Latinos
manifest to elders and authority figures, such as doctors,
might prevent some Hispanics/Latinos from
asking for more information or for requesting clarification if
a medical concept is not clear.
The personal interaction, which is known as "personalismo", is
another cultural concept that is prevalent across the
Hispanic/Latino culture, and this means that
Hispanics/Latinos expect that their daily interactions,
including those with their healthcare providers,
should be warm and friendly.
To engage a Hispanic/Latino patient, healthcare providers
should really demonstrate an honest interest in the patient
and listen to what the person has to say.
This is going to open up yet another path to an important
concept, which is "confianza", or trust.
Healthcare providers can win the trust of their
Hispanic/Latino patients by really demonstrating a true
interest in their health and their personal situation.
On this screen, you'll see some of the barriers that were
mentioned by our participants for accessing eye care.
For our English speakers, it was really about money,
lack of insurance.
Some mentioned that they didn't really trust their eye doctors,
and finally that eye health was just not a priority for
their primary care physicians,
so it didn't come up during their regular exams.
For Spanish speakers, as we've mentioned now, the language was
really the key barrier to accessing eye care.
The participants felt that doctors were just not
comfortable with people who didn't speak English,
and Spanish speakers had a difficult time understanding
technical terminology that was used by their eye doctors.
There was a sense of embarrassment that they
didn't understand the technical terminology and
they didn't ask for clarification.
Finally, the high cost of exams and of eyeglasses really
prevented our Spanish speakers from seeking out
eye care on a regular basis.
I'm going to turn it back over to Dr. Varma now, but
Dr. Varma, can you tell us what the implications of
these focus group findings are?
So, as you can see, in fact, both the results from these as
well as the KAP study, as well as other research studies which
have been done by NEHEP and the NEI, it sort of reinforces
the need to provide eye health education to people in this
particular ethnic group, and more importantly to try to
improve the communication between physicians and patients.
I think because there is such a high value that's placed by
Hispanics on getting health information from physicians,
it's particularly important that we provide
culturally appropriate material to primary care physicians and
others, so that they can encourage and increase
referrals for eye exams.
NEHEP has developed a wealth of such educational resources and
Neyal will actually introduce you to them in a minute.
Again, I just want to stress that it's critically important
for us to communicate not just with primary care professionals,
but also with nurses and other community health workers
who deliver this crucial message to people that have
various eye care conditions.
So, last of all, in fact, I just want to say we really
need to try to, first, improve the knowledge base, but then to
increase communication with physicians to get more people
to come and get routine eye examinations.
I'm going to now turn it over to Neyal, who can share with
you all about what these wonderful NEHEP resources are.
Thank you, Dr. Varma.
Thank you again, Marcela,
for presenting that great information.
So what do we do with all of this research information?
We have a wealth of quantitative and qualitative data and
we use all of this at NEHEP to really help inform
our programs and our messages.
So, what you see here on the left of the screen shot of our
¡Ojo Con Su Visión!
Program page, which is directed toward health professionals and
community health workers.
This site is where you'll find links to our resources and
educational materials to some of the data that was shared today,
like the focus group results and the KAP survey,
but there's other information like how to work with media,
what kind of community activities you can conduct;
a wealth of other information to help you and also archives of
past webinars are on that page and today's webinar will be
there, up there in a few weeks.
On the right-hand side is a Spanish screen shot of our
Healthy Eyes web page, which is both in English and Spanish.
This is more of the consumer-oriented website.
This is where all of our public service announcements or
health education in outreach initiative point people to do,
and on this site there's a wealth of information just about
what a comprehensive dilated eye exam is, because we find a
lot of people still don't know that there's a difference
between a comprehensive dilated eye exam and
an eye exam you get for glasses and contacts.
What the most common vision problems are, common
age-related eye diseases and conditions, tips for
keeping your eyes healthy, organizations that provide
financial assistance for eye care, how to find an
eye care professional, and more.
I would encourage you to visit these websites or
link to them from your own.
So as Rohit mentioned, we have quite a variety of educational
materials in publications aimed at Hispanics and Latinos, which
is including, but not limited to, brochures and booklets,
flipcharts and teaching tools, e-cards, and a wealth of other
things, such as print and radio public service announcements
that you can customize and use for yourself.
All of our resources and materials are always pilot
tested with the target audiences before we produce them, so we
want to make sure that they're culturally and linguistically
appropriate for the audiences that we want to serve, so you
can access them from the NEHEP Website, you can download them.
And I would remind everybody that Hispanic Heritage Month is
coming up September 15th through October 15th, so that would be
a great time to use some of these materials in your
community, so you can visit the NEHEP Website to order these in
bulk, or you can e-mail me and I'll be happy to
share links to this information with you.
So, one of our most popular items is our Diabetes and
Healthy Eyes toolkit, which is really for community health
workers and promotores de salud, and we developed and launched
this in the fall of 2010 to help community health workers
who are working with people with diabetes to help educate them
about the eye complications associated with diabetes,
why comprehensive dilated eye exams are important and
the early detection of diabetic eye disease.
So we've also been training, conducting training workshops
across the country in both English and Spanish to train
community health workers to use the toolkit, and we give them
the opportunity to not just explore the content and
components, but also practice giving it, and we have a small
group activity to help really create a lively atmosphere for
them so that they can understand how to use the toolkit and how
to use it as part of their own diabetes education activities.
Each participant in the trainings get a copy of the
toolkit to use, and we've also conducted
train-the-trainers for this, as well.
To date, we've trained about 200 community health workers and
program managers to use the toolkit and we're in the process
of developing an online tutorial to help people learn how to
use the toolkit, so stay tuned for that.
For more information, or to download it, you can visit that
website that you see there.
We also have a nice video of a promotora who uses the
diabetes and healthy eyes toolkit in her clinic, often in
her program, so it's really nice to hear firsthand from
the community health workers who are using it.
So, two other popular items are a photo novella,
watch out for your vision.
This booklet is about diabetic eye disease in a kind of
a story format of a woman who has diabetes and how
her friend goes with her to the eye doctor to get a
comprehensive dilated eye exam.
It's been a very, very popular resource.
We actually originally only had it available in Spanish, and
adapted into English a couple of years ago, and
it's been one of our most popular items for the
Hispanic/Latino community people with diabetes.
On the right is a same shot of our Vision Saludable booklet and
this is kind of a general eye health booklet for
Hispanics and Latinos.
It covers basic information about eye exams in general,
eye health and eye safety,
common eye diseases and conditions, and more.
So, these are two booklets that you can order from us in
bulk and distribute in your community.
As I mentioned earlier, we have public service announcements
that you can download and customize and use on your
own websites, your newsletters, where ever you want to put them,
your local newspapers or anywhere.
They come in color, and black and white, and different sizes.
We have them on all different topics from general eye health,
from diabetic eye disease, glaucoma, and more, so
I encourage you to go to the NEHEP Website and
download them and use them.
Also, if you're ever looking for information for your newsletter,
for your website, for any publications that you have,
I would encourage you to use any one of our drop-in articles.
These are articles that are basically you just cut and paste
the text ready to be popped into whatever outlet you're using.
We have a variety of topics from glaucoma and
diabetic eye disease.
We have one on two organizations that provide
financial assistance for eye care, because we know
that's a barrier for many.
We have a drop-in article about tips for taking care of your
eyes, we have them on occupational eye safety, so
again a wealth of information in these drop-in articles.
They're all full of easy-to-understand science-based
information, so you get on your website and send them to your
local newspapers, put them in your church bulletins,
where ever you think would be
appropriate for the audience that you're trying to reach.
So, we also are on Facebook and Twitter and post eye health
messages daily, and we do post messages in English and Spanish,
so I would encourage you to make sure that you're following us on
Facebook and Twitter, and that you re-tweet or share
our information and messages, too, especially those ones in
Spanish if you're working with Spanish-speaking audiences.
So, join us on social media there.
And lastly, if you want to stay updated on a lot of activities
that we're doing, I'd encourage you to sign up for
Outlook, which is our quarterly e-newsletter.
We provide updates on eye health education,
activities and research, some of which you heard about today.
We also get a lot of updates from activities from our
partnership organizations, so it's nice to hear what others in
the eye health community are doing, and you can subscribe to
our newsletter via our website also.
So, lastly again here's our website here.
I know you heard a lot of information today, so we have
a few minutes left, so if you have any questions,
we're happy to entertain them, so just type in your questions
in the chat box on the left-hand side.
Okay, first question, are these materials free?
They're free in small quantities, and then bulk
orders, we don't charge for the actual materials;
we just charge a small shipping and handling fee for them,
but usually for community-based organizations
or any organizations that have financial hardship that can't
pay for it, the National Eye Institute can provide
the materials to them free.
If you do need to order them in bulk, you can just e-mail me and
my contact information is on this slide here, and
we'll be happy to get those to you.
Dr. Varma, question for you.
What other types of research studies need to
be conducted with Hispanics and Latinos?
There's a whole group of them I think which need to be done, and
we are currently doing a whole series of assessments
on whether or not there are any genetic risk factors which make
people in this ethnic group to be much more susceptible at
getting sort of the more advanced forms of diabetic eye
disease, and again, the NEI is funding those projects.
In addition, I think we need to begin to look a little bit more
at how we can reduce barriers to care, and improve all of this
communication, particularly getting primary care physicians
to get most of these patients to get routine eye exams.
I think getting, having some sort of quick screening
assessment at the primary care physician's office, and
then for those that may have vision loss or aren't seeing as
well and so on, potentially those people can go and get
more detailed examinations.
That's, I think, something which can be implemented easily.
Then, I think, we haven't spoken about this very much, but also
we ought to add to that access to those individuals
that take care of people with chronic diseases, particularly
if you will, diabetes care specialists so that they can
also get people to get eye exams routinely as
course of their regular care.
Thank you.
Another one for you Dr. Varma that you had mentioned the
Hispanics were less aware of pathology versus other
minorities, and we this in alignment with socioeconomic
status or population density, or anything like that?
No, it doesn't have anything to do with socioeconomic status.
We've adjusted for that in these studies.
I just think that we need to have culturally appropriate
Spanish material, as Neyal was actually showing you,
available at those places where people go and get routine exams,
so their primary care providers at the comprehensive
health centers and so on, so that people can learn more about
eye disease, and potentially go and get an eye examination.
Okay, so another one for you.
Someone is curious about any information we have about
the incidents of vision problems in Hispanic/Latino children, so
I know NEI research that we have done has always focused on
adults, so really I'm not sure if you're aware of any studies.
We have published extensively on it.
Actually, NEI has funded this multiethnic pediatric eye
disease study, and we've already put out information on it, and
there's information available on the NEI's Website.
Hispanic children are more likely to have astigmatism, and
so they need sort of better correction of their vision
early on, because if that astigmatism is not corrected
earlier on, they're more likely
to go onto get amblyopia, which may become permanent vision loss
in adulthood in fact.
So, they're genetically predisposed to having sort of
this astigmatism, and that primarily comes from that fact
that 40 to 50 percent of their ancestral genetics is from
native Indian groups where astigmatism is very, very high.
So, one needs to sort of look fairly early on in kids
who are as young as six months to a year to see in fact if
they have astigmatism which can be corrected, and
this particular astigmatism can be assessed objectively,
so you don't need the child to be responding to it.
In fact, I think there are these automotive
refractors which can just give you a pretty good sense of
what the power is needed for correction of the child's eyes.
Thank you.
Okay, a few more questions, some are coming in.
One's asking do we have dates to do a training for
health promoters in southern California.
We're actually this week going to be at National
Rural Health Association meeting in San Diego doing
a training for promotoras.
If an organization is interested in one of our trainings,
contact me, and we'll see if
we have the staff to be able to go out and do that.
We do work with organizations to try to provide training for
them, especially in conjunction with existing conferences or
meetings that are going on.
So, again if your organization is interested in that,
please let me know.
Okay, one more question about Spanish-language materials.
Are all the materials in the drop-in articles
I showcased earlier in Spanish, too?
So yes, I'm sorry if I didn't say that before that
the drop-in articles are also available in Spanish,
so you can use that at your will in English or Spanish, or
whatever you need from us.
Okay, I think that's it for questions right now.
Marcela or Dr. Varma, do you have any closing comments
in the interest of time?
Okay, if we didn't get through everybody's questions,
we will follow up with your e-mail.
We are running a few minutes short on time, but we have
everybody's questions here.
I really want to thank Dr. Varma and Ms. Aguilar for
their input and their help with today's webinar.
Thank you for all your patience in participating today, and
again please join us in celebrating
Hispanic Heritage Month, and help us educate
Hispanics/Latinos throughout the year.
Feel free to contact me anytime with any ideas or suggestions
at how we can collaborate together or anything that
your organization needs.
And again visit our website here to order those materials.
So, thanks and have a wonderful afternoon.