President's Calling - The Consequences of War

Published March 20, 2019

Dear Academy Membership,
There is a great deal of fallout in war. Collateral damage is the name usually given to the deaths of the innocent, the illnesses that progress from the trauma of bombing and the toxins of gas. Even smaller prolonged battles leave their mark. Think of the children of alcoholics, the shock of divorce, the wasted hours of family members who stop speaking to each other.
Within the vision care world, there are battles and wars. Recently I spoke to an ophthalmology colleague who is interested in public health. She informed me that at the highest levels of the US government, there is a disdain for the professions of vision care because of our wars, because we cannot get our story straight, because one faction tells one “truth” and another tells another. Something like the “alternative facts” that we hear about on the news.
Although no bombs have dropped and no nerve gas is in the air, our professional groups must understand that there are actual consequences and real collateral damage related to our battles.
For example, I have learned that vision loss does not reach the top 20 chronic diseases at the Centers of Medicare and Medicaid ( Here is the list of those diseases that are first and foremost in the minds of lawmakers
  • Alzheimer’s Disease and Related Dementia
  • Arthritis (Osteoarthritis and Rheumatoid)
  • Asthma
  • Atrial Fibrillation
  • Autism Spectrum Disorders
  • Cancer (Breast, Colorectal, Lung, and Prostate)
  • Chronic Kidney Disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Heart Failure
  • Hepatitis (Chronic Viral B & C)
  • Hyperlipidemia (High cholesterol)
  • Hypertension (High blood pressure)
  • Ischemic Heart Disease
  • Osteoporosis
  • Schizophrenia and Other Psychotic Disorders
  • Stroke
Notice the glaring absence of vision-related diseases. How is it possible that our patients believe that vision is a sacred sense yet it is not ranked in the top 20 chronic diseases? A 2016 JAMA Ophthalmology article stated that “most individuals surveyed (87.5%) believed that good vision is vital to overall health while 47.4% rated losing vision as the worst possible health outcome.” It appears that vision-related disease does not have the ranking it deserves because of us, because of our inability to speak with one voice. Here, for all to see, is a glaring example of the collateral damage of our particular professional wars — an absence of government attention on vision loss, one of the most critical growing public health problems.
I know there are some who think that this level of collateral damage is acceptable, that each group’s cause is so precious, so vital, that it is worth the continued fight. I hope that many more believe that we should take time to pause and look carefully at this high-level problem.
I remember my grandfather telling me about Christmas day during World War I when a noon ceasefire was called. The German and British soldiers came out of the trenches and walked to each other to exchange cigarettes. The mustard gas hung in the air, the cries of the wounded rose to the sky. My grandfather said that he was stunned by the terrified faces of the young German boys. In one of the most insane moments of human history, they finished their cigarettes, returned to their trenches and started killing each other again.
I want to suggest that we are capable of better. Perhaps we can recognize that working together, within our own ranks and with ophthalmology, can improve our patients' vision health through legislation and high-level funding decisions. Look at the success of the telemedicine bill that was passed recently in Oregon with the co-operation of optometry and ophthalmology. We have children’s vision care to worry about. Is there anyone who disagrees with the need for availability of children’s eye care?
Perhaps we could give collaborative effort a try. What about a ceasefire for one year while we define our common goals. Let’s call it the modern version of a Christmas smoke. If we all believe what we say, that all of our efforts are done FOR THE GOOD OF OUR PATIENTS, perhaps we could have a summit that defines those goals and deals with our upcoming transition into telemedicine and AI. Perhaps we can listen to each other instead of interrupting and fighting.
After all, if it doesn’t work, we can always head back to the trenches.
Barbara Caffery, OD, PhD, FAAO