Amid the tumultuous changes in today’s health care system
patients are often challenged to understand and participate effec
tively in their own care. Worries about insurance coverage, co
payments and deductibles, and other financial concerns often de
tract from a patient’s ability to navigate the care system and wor
with his or her physician to obtain the best care available. It is no
surprising to learn that older patients often have the most diffi
culty successfully utilizing the full range of available health car
For patients with eye diseases, this is of special concern. Th
likelihood of suffering from a major chronic eye disease rises wit
age and increases dramatically after the age of sixty-five. Indeed
nearly half of Medicare beneficiaries will have glaucoma, macu
lar degeneration, diabetic retinopathy, or a combination of thes
conditions over the next few years. When we include cataract an
associated conditions, it is clear that nearly every older America
will at some point have to deal with eye conditions that could re
duce his or her vision.
At the same time, increasing demands forcare, and the resultin
pressures on health care providers to see more patients, may mea
that time for education and counseling will become increasingl
precious. When the first wave of Baby Boomers reaches Medicar
age in 2011, these forces may combine to create a ‘‘perfect storm
within our health care system. Because Baby Boomers are mor
likely to demand detailed information and to be more skeptica
than past generations, physicians and other providers will be har
pressed to meet the needs of this growing number of patients, le
alone more intense demands from each patient.
The signs of these forthcoming changes—and fortunately th
solutions to these challenges—have been with us for quite a while
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