Amblyopia Economic Costs
The second cost is the foregone cost of what could have been in the lives of these individuals but was not due to their impaired vision. The impaired persons who may have become renowned artists, pilots, astronauts, brain surgeons in the absence of preventable blindness are merely the examples of these costs. If vision impairment holds a child back later in life, by however a small margin, the overall costs multiply by the large number of children potentially involved.
In addition to these impediments, amblyopia patients suffer from the disease as a result of worry, fretting over what might have been, what should have been done, what will not happen as a result, etc. Clinicians report that patients with one good eye tend to worry about the loss of the normal eye and likely forgo some otherwise normal life activities as a result in order to protect that eye. And it turns out that this risk is not entirely imagined. The Rotterdam Study1, a population-based cohort of 5,220 subjects aged 55 years or over, including 192 persons with amblyopia (3.7 percent) concluded that amblyopia nearly doubles the lifetime risk of losing the use of the other eye. The toll from the loss of the second eye is enormous for this afflicted group.
Thus, in both physical and emotional dimensions, their utility from life is diminished. Drawing on the work of C. Beauchamp et al2, G. Beauchamp3, Cutler and Richardson4, Konig and Barry5, and Membreno, et al6., the estimated value of these personal costs and diminished utility is about $10 billion annually.
U.S. Census Bureau Estimates of Vision Loss Costs
Are there other measures of the economic toll of visual disabilities? The U.S. Census Bureau is perhaps the most comprehensive collector of data and information in America. It is by far the oldest. Census reports on some aspects of the costs of disabilities as part of its responsibilities under the American with Disabilities Act. The Bureau’s most recent report, issued May 29, 2007, documents significant decrements to income as a result of disabilities. It indicated that median earnings for people with “nonsevere” disabilities is $22,000 annually, versus $25,000 for those with no disability, indicating a 12 percent reduction for these persons. For those with “severe” disabilities, annual earnings average $12,800, or about half those of individuals without disabilities. These figures are for persons who are disabled but still able to work.
This same Census document states that 1.8 million Americans age 15 and older report “being unable to see.” Being unable to see is classified as a severe disability, and it may well interfere with the ability of some persons to work at all. For the persons in this group who work, the total income loss as a result of being unable to see is $23 billion annually. By definition, it is also a loss to the production of the economy as a whole. Since a person’s income fuels spending, the multiplier effects of this large income decrement could sum to something approaching $100 billion annually. And these estimates are likely on the low side because they assume that all those people who are unable to see are working. It seems likely that many are not, and for these the income decrement is $25,000 each annually. This fact seems likely to raise the $23 billion income loss figure by at least an additional $5 billion annually.
As noted above, most people with amblyopia retain normal use of one eye. These people would not be classified as severely disabled, but they lack the full abilities of persons without amblyopia. It seems reasonable to apply the nonsevere categorization to this group. Their average decrement to income would be in the range of $3,000 annually. How large is this group? We estimate it to include approximately 4.5 million persons, (3% incidence times 300 million population [equals 9 million], times 50% successful treatment with current methods [effectiveness for current “investment”] = 4.5 million persons). Multiplying this number by the $3,000 income reduction gives $13.5 billion of impact from vision disabilities from amblyopia. When we add in utility costs from worry and related reduction in quality of life the direct sum of costs is approximately $23 billion. This figure could approach $100 billion when multiplier effects of reduced income on subsequent rounds of re-spending are added.
What about the future? The above are actual decrements to income due to the severe vision disabilities that already exist in the U.S. They give us a way to quantify the impact of vision loss on persons and on society.
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