Rohit Varma

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SCEI’s Vision Van – Working to Increase Equity in Eye Care.

In the summer of 2019, the Southern California Eye Institute (SCEI) and its founding director, Dr. Rohit Varma, launched a new venture designed to make vital vision care services more available throughout the community.

With the Vision Van, Dr. Varma and his team are bringing high-quality ophthalmologic diagnostics and treatments to some of the Los Angeles area’s most vulnerable populations. The ultimate goal is to reduce inequities in access to vision care and to lower the rate of eye disease in these communities.

- Studying vision needs of under-researched populations

The Vision Van project aligns with the population health research conducted by Dr. Varma and his team. He has led or contributed to multiple population-based vision studies focusing on Hispanic Americans, African Americans, and Chinese Americans in Southern California. These studies are among the largest and most comprehensive of their kind to date. In addition, they have produced information that has changed the way physicians and decision-makers understand vision care and public policy.

- A team effort to broaden access

The Vision Van draws on the skills of the SCEI ophthalmology care team, bringing their expertise to the task of offering free access to screenings and follow-up care. The target population is people who are unable to obtain vision care because of problems with transportation, financial difficulties, or lack of insurance.

Another goal of the Vision Van is to promote a campaign of public understanding of the importance of proper eye care and to disseminate information on the dangers of vision loss from preventable and treatable causes.

To advertise the Vision Van and its services, the SCEI team is working to get the van front-and-center at numerous local community programs and health fairs. In addition, the public awareness campaign involves direct mail as well as online and traditional media promotions. Interested community organizations can also request a visit from the Vision Van at one or more of their events.

- Reaching as many people as possible

On a typical community visit, the Vision Van will bring at least one ophthalmologist and sometimes as many as three. These physicians are accompanied by several ophthalmology technicians and support staff. Together, this team is able to see about 100 people per community event visit.

- The challenge of building trust

In a recent interview to discuss the Vision Van and its new role in the Southern California community, Dr. Varma noted that one of the most challenging issues in launching the project has been building community members’ trust. Indeed, trust is a huge issue in healthcare, especially in historically marginalized and non-white communities.

Research published in the American Journal of Public Health has shown that Black and Hispanic people report higher levels of mistrust in physicians than white people, though mistrust also varies by individual and geographic area. Similarly, research in Social Science Research indicates that Black and Latino people are less likely than white people to trust a doctor’s interpersonal competence.

- A painful history of prejudice in medicine

This lack of trust is understandable, especially given the many historic incidents of medical injustice, such as the now-infamous, decades-long Tuskegee Institute study.

In this study, begun in the 1930s, researchers used hundreds of African American men as subjects without giving them the chance to provide informed consent. The researchers did not tell the men about the true purpose of the study—they lied, telling the men that they would receive treatment for “bad blood.” Then, the researchers infected many of the men with syphilis without their knowledge, then denied these men the treatments needed to fight the disease. After a journalistic expose in the early 1970s, the research ended. Congressional hearings and a class action lawsuit resulted in a $10 million settlement for the victims.

- A continuing problem

Historic injustices are just one reason why many non-white communities may have less trust in physicians and the US healthcare system. Harmful racial prejudices and stereotypes continue to persist in the medical field, just as they do in broader society. Other barriers to trust include language differences and fear of deportation if the individual’s immigration status is in question or just perceived to be in question.

The mistrust felt by many in historically marginalized communities is grounded in reality.
For example, researchers have documented numerous instances of medical staff treating patients from “minority” backgrounds differently than white patients. This bias even extends to concepts about the universal human experience of pain. Research by the University of Virginia indicated that half of the medical students surveyed incorrectly believed that Black patients feel less pain than white patients because of differences in the skin, blood, and nerve endings.

- The urgent need today

As SCEI points out, women and non-white populations in the U.S. currently bear the greatest burden when it comes to lack of access to high quality vision care. The team estimates that, by the year 2050, large numbers of the country’s aging population will develop one or more forms of visual impairment, due to glaucoma, cataracts, macular degeneration, diabetic retinopathy, and other diseases.

These factors taken together make the Vision Van’s mission a critical one for the health of Los Angeles’ people, its economy, and its quality of life. Plans are already in the works to expand the service by outfitting additional Vision Vans in the area.

Hollywood Presbyterian’s Dr. Varma Launches ‘Vision Van’ The CHA Hollywood Presbyterian Medical Center's Southern California Eyecare and Vision Research Institute, under the direction of world renowned eye care specialist Dr. Rohit Varma, has launched a Vision Van