The treatment of amblyopia is just one more example of how the American Health Care system fails lower income families as the debate over the constitutionality of “Obama Care” heats up in the Supreme Court.
Amblyopia is an eye condition affecting 1-5% of the population. It is better known as “lazy-eye.” It occurs when the brain receives a different image from each eye. One eye is described as weak and the other as strong. The brain favors the strong eye to the point of cancelling out the vision from the weak eye. This causes a lack of depth perception, difficulty seeing, even practical blindness in one eye. It also increases the risk of losing vision in both eyes due to accident. If the amblyopia is not treated before the age 8, (some scientists say 10), it is permanent.
There is effective treatment. By covering the strong eye with a patch or weakening it using atropine drops, the brain is forced to use the weak eye. This treatment over a six to eight week period can fix the problem in many cases. However, amblyopia treatment fails, despite this relatively simple solution.
Patching is effective. So are atropine drops. The problem is that families don’t follow the doctor’s orders and use them. Researchers have asked why. Like so many things in the United States, these answers varied greatly by class. A number of the researchers did a study called, “Barrier to Compliance in Amblyopia Thereapy: Parental Perspectives in Low-and-High-income Families.“ Lower income families cited allergies, child resistance, and cost. Higher income families mostly complained about scheduling appointments and physician contact time. Less than one third of lower income families were consistent. Less than one tenth of lower income families understood how the treatment worked.
A more recent study makes explicit the correlation between amblyopia and wealth. The title makes it very clear: “Poverty predicts amblyopia treatment failure.” They found that children on Medicaid were three times more likely to have bad vision after treatment and twice less likely to have successful results. Are these findings enough to say that poverty causes amblyopia treatment failure?
An easy answer to this question is “yes.” People living in poverty often do not receive adequate health care, let alone eye care, and can’t afford the treatment. Conditions go untreated. There are long term consequences.
However, the situation is more complicated than that. The lower income families studied did receive the patch or drops. They just didn’t follow through. One of the main reasons they didn’t follow through was a reason not mentioned by higher income families: “child removing patch.”
I had amblyopia as a child and I removed my patch. My mother put it right back on. She would have fallen into the higher income family category that researchers describe. What’s different about higher income parents like my mother and lower income parents?
Since children’s resistance was such an issue, the reason for noncompliance is not necessarily money; it’s the symptom of the way money is distributed, class.
My family was middle class and educated. My mother understood the treatment. It didn’t seem like some strange punishment to her. We had insurance. Therefore, the condition and treatment were explained to us by our family doctor and we had regular check ups.
My mother had the time and energy to devote to ensuring my compliance because she was a stay-at-home mom. It is hard to discipline children after a long day at work about anything, let alone an embarrassing patch. Not to mention, the patch is to stave off a long-term problem; these families and parents (often young single parents) often have more immediate concerns such as rent.
Children from lower class families are already disadvantage and these disadvantages accumulate with amblyopia.
For instance, if the child becomes disabled, there is a direct economic effect as the Children’s Eye Foundation argues in an article. The median income for someone with a moderate disability in the U.S.A is 22,000 dollars, 3,000 dollars less than for those without disabilities. Following this logic, poor children with amblyopia grow into adults with amblyopia, who then have poor children with amblyopia and the cycle continues.
It is easy to talk about how assistance to the poor costs money, a short term setback just like the patch, but there are long term benefits. If compassion is not moving enough, estimates say that 23 billion is lost annually from the income adults with amblyopia could have made and could have paid taxes on.
Therefore, government investment in programs that promote awareness, understanding and methods for increasing compliance would not be a cost in taxes but a long-term solution to help low income families, like the patch solve amblyopia.
Still, amblyopia treatment failure is just the symptom of a bigger problem. The divisions between classes have grown starker. This has affected health care. Amblyopia treatment is unique because it affects children.
In the United States, we want to believe that no matter what family a child is born into, they have a chance to succeed. However, amblyopia treatment shows how that isn’t true. The disadvantage of being poor accumulates more disadvantages, such as visual disability. Their visual disability takes away opportunities that require good vision; they can’t be doctors or astronauts. Amblyopia treatment failure is one more way that the American dream is shown to failing due to inequality.
Now, while in the Supreme Court they heatedly debate over healthcare, some will say that health care reform encroaches on freedom. The validity of that statement aside, ask yourselves how “free” a child half-blinded by amblyopia is.
Further Information:
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