Whether it be for skiing in the winter or hiking in the summer, the Grindelwald-First mountain above the charming village of Grindelwald, Switzerland, is truly one of my happy places. The beauty of the countryside is matched only by the warmth of the people. Switzerland also boasts a top ranking in health care for its residents. Part of that stems from a coordinated effort to prevent illness in their populace. A similar pattern is seen in other countries with top health care systems.
In stark contrast, preventive health care in the United States was ignored until 2010, when the Affordable Care Act (ACA) forced insurance companies to cover preventive services. Specifically, “preventive services that have strong scientific evidence … must be covered” by insurance companies, without any patient cost-sharing. Moreover, the ACA set up a $15 billion Prevention and Public Health Fund for research in early detection and prevention of disease. Part of the fund is devoted to the US Preventive Services Task Force, an independent panel of experts who grade the scientific evidence of a given protective service to ensure the coverage changes as evidence improves.
Groundbreaking retinal therapies released over the past 20 years have dramatically reduced the risk of severe vision loss from age-related macular degeneration (AMD), diabetic retinopathy, and other retinal vascular diseases. Studies have shown that we can reduce this rate even more with early detection. In this issue, we look at the cost-effectiveness of early detection of wet AMD conversion with different imaging modalities, and it comes as no surprise the expected QALYs support their use.
We also now have 2 FDA-approved treatments for geographic atrophy (GA). As one would expect, the benefit in preventing severe vision loss with these complement inhibitors hinges on starting treatment before the foveal photoreceptors are permanently damaged. In this issue, we explore patient counseling when managing dry AMD. We also explore imaging features of nascent GA to help identify patients who may need treatment in the future.
The holy grail of AMD would be even earlier management, and we do have several therapies being tested that work earlier. However, when looking at AMD prevention, easy items such as AREDS vitamins, dietary changes, smoking cessation programs, and weight management are not covered by insurance. Their benefits in preventing AMD are clear. Hopefully the task force will look at some of this evidence in the future.
