# 28 {#section .Chapter-# .unnumbered}

# Vision and Hearing

#### Vision

28-1 Dilated eye examinations

28-2 Vision screening for children

28-3 Impairment due to refractive errors

28-4 Impairment in children and adolescents

28-5 Impairment due to diabetic retinopathy

28-6 Impairment due to glaucoma

28-7 Impairment due to cataract

28-8 Occupational eye injury

28-9 Protective eyewear

28-10 Vision rehabilitation services and devices

28-10a Rehabilitation services

28-10b Visual and adaptive devices

#### Hearing

28-11 Newborn hearing screening, evaluation, and intervention

28-12 Otitis media

28-13 Rehabilitation for hearing impairment

28-14 Hearing examination

28-15 Evaluation and treatment referrals

28-16 Hearing protection

28-17 Noise-induced hearing loss in children

28-18 Noise-induced hearing loss in adults

### Vision

  ---------------------- ------------------------------------------------
  28-1. (Developmental)  
  Increase the           
  proportion of persons  
  who have a dilated eye 
  examination at         
  appropriate intervals. 

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS.

                         A proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         See Part C for a description of NHIS and BRFSS
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-2. (Developmental)  
  Increase the           
  proportion of          
  preschool children     
  aged 5 years and under 
  who receive vision     
  screening.             

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-3. (Developmental)  
  Reduce uncorrected     
  visual impairment due  
  to refractive errors.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health and Nutrition Examination Survey
                         (NHANES), CDC, NCHS.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 28-4. Reduce        |                                                |
| blindness and       |                                                |
| visual impairment   |                                                |
| in children and     |                                                |
| adolescents aged 17 |                                                |
| years and under.    |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 population.                     |
+---------------------+------------------------------------------------+
| **Baseline**        | 25 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children and adolescents aged 17     |
|                     | years and under who have trouble seeing, even  |
|                     | when wearing glasses or contact lenses.        |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children and adolescents aged 17     |
|                     | years and under.                               |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Does---have any trouble seeing?            |
|                     |                                                |
|                     |     (If age 2+ years:) even when wearing       |
|                     |     glasses or focus area contact lenses?      |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  28-5. (Developmental)  
  Reduce visual          
  impairment due to      
  diabetic retinopathy.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS.

                         A proposed State data source is the Behavioral
                         Risk Factor Surveillance System (BRFSS), CDC,
                         NCCDPHP.

                         Diabetic retinopathy is a complication of
                         diabetes that damages the retina and is a major
                         cause of blindness among people with diabetes.

                         See Part C for a description of NHIS and BRFSS
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 28-6.               |                                                |
| (Developmental)     |                                                |
| Reduce visual       |                                                |
| impairment due to   |                                                |
| glaucoma.           |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | The proposed national data source is the       |
|                     | National Health Interview Survey (NHIS), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
|                     | The proposed State data source is the          |
|                     | Behavioral Risk Factor Surveillance System     |
|                     | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
|                     | From the 1999 NHIS, the proposed question used |
|                     | to obtain the national data is:                |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     other health professional that you had     |
|                     |     glaucoma?                                  |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 28-7.               |                                                |
| (Developmental)     |                                                |
| Reduce visual       |                                                |
| impairment due to   |                                                |
| cataract.           |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | The proposed national data source is the       |
|                     | National Health Interview Survey (NHIS), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
|                     | The proposed State data source is the          |
|                     | Behavioral Risk Factor Surveillance System     |
|                     | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
|                     | From the 1999 NHIS, the proposed question to   |
|                     | obtain the national data is:                   |
|                     |                                                |
|                     | -   These next questions are about your        |
|                     |     eyesight. Do you now have cataracts?       |
+---------------------+------------------------------------------------+
|                     | Cataract is classified as a cloudiness of the  |
|                     | lens that may prevent a clear image from       |
|                     | forming on the retina.                         |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  28-8. (Developmental)  
  Reduce occupational    
  eye injury.            

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed national data sources are the Annual
                         Survey of Occupational Injuries and Illnesses
                         (ASOII), DOL, BLS and the National Electronic
                         Injury Surveillance System (NEISS), CPSC, and
                         NIOSH.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-9. (Developmental)  
  Increase the use of    
  appropriate personal   
  protective eyewear in  
  recreational           
  activities and         
  hazardous situations   
  around the home.       

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS.

                         Recreational activities include baseball,
                         basketball, tennis, racquetball, and hockey.

                         Hazardous situations around the home include
                         cooking and yard work.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 28-10.              |                                                |
| (Developmental)     |                                                |
| Increase the use of |                                                |
| vision              |                                                |
| rehabilitation      |                                                |
| services and visual |                                                |
| and adaptive        |                                                |
| devices by people   |                                                |
| with visual         |                                                |
| impairments.        |                                                |
+---------------------+------------------------------------------------+
| 28-10a. Increase    |                                                |
| the use of          |                                                |
| rehabilitation      |                                                |
| services by persons |                                                |
| with visual         |                                                |
| impairments.        |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | A proposed national data source is the         |
|                     | National Health Interview Survey (NHIS), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 28-10b. Increase    |                                                |
| the use of visual   |                                                |
| and adaptive        |                                                |
| devices by persons  |                                                |
| with visual         |                                                |
| impairments.        |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | A proposed national data source is the         |
|                     | National Health Interview Survey (NHIS), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

### Hearing

  ---------------------- ------------------------------------------------
  28-11. (Developmental) 
  Increase the           
  proportion of newborns 
  who are screened for   
  hearing loss by age 1  
  month, have audiologic 
  evaluation by age 3    
  months, and are        
  enrolled in            
  appropriate            
  intervention services  
  by age 6 months.       

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the State-based Early
                         Hearing Detection and Intervention (EHDI)
                         Program Network, CDC.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  -----------------------------------------------------------------------
  28-12. Reduce otitis   
  media in children and  
  adolescents.           
  ---------------------- ------------------------------------------------
  **National Data        National Ambulatory Medical Care Survey (NAMCS),
  Sources**              CDC, NCHS; National Hospital Ambulatory Medical
                         Care Survey (NHAMCS), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 population.

  **Baseline**           344.7 (1997).

  **Numerator**          Number of visits to ambulatory care facilities
                         with a diagnosis of otitis media (any mention of
                         ICD-9-CM codes 381.0-381.4, 382) among children
                         and adolescents aged 17 years and under.

  **Denominator**        Number of children and adolescents aged 17 years
                         and under.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The number of otitis media visits to ambulatory
                         care facilities obtained from NAMCS are added to
                         the number of visits obtained from NHAMCS.

                         Otitis media, commonly called ear infection, is
                         an inflammation of the middle ear caused by
                         viral or bacterial infection.

                         Ambulatory care facilities include physicians'
                         offices, hospital emergency departments and
                         outpatient departments.

                         See Part C for a description of NAMCS and NHAMCS
                         and Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-13. (Developmental) 
  Increase access by     
  persons who have       
  hearing impairments to 
  hearing rehabilitation 
  services and adaptive  
  devices, including     
  hearing aids, cochlear 
  implants, or tactile   
  or other assistive or  
  augmentative devices.  

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         National Health Interview Survey (NHIS), CDC,
                         NCHS.

                         The proposed questions to obtain the national
                         data will be included in the 2001 NHIS.

                         Rehabilitation services are those services that
                         address the needs in daily living skills that
                         are directly related to hearing loss.

                         Adaptive devices include large-print materials
                         (books, newspaper), check-writing guides,
                         high-contrast watch dials, and auditory aids,
                         such as talking computers.

                         A hearing aid is an electronic device that
                         brings amplified sound to the ear, usually
                         consisting of a microphone, amplifier, and
                         receiver.

                         Cochlear implant is a medical device that
                         bypasses damaged structures in the inner ear and
                         directly stimulates the auditory nerve, allowing
                         some deaf individuals to hear and to maintain or
                         develop speech and language.

                         Tactile devices are mechanical instruments that
                         make use of touch to help individuals to
                         communicate who have certain disabilities, such
                         as deafness and blindness.

                         Assistive devices are technical tools and
                         devices used to aid individuals who have
                         communication disorders in performing actions,
                         tasks, and activities. Examples include alphabet
                         boards, text telephones (TT/TTY/TTD), and
                         text-to-speech conversion software. (See Focus
                         Area 6. Disability and Secondary Conditions.)

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-14. (Developmental) 
  Increase the           
  proportion of persons  
  who have had a hearing 
  examination on         
  schedule.              

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed national data sources are the National
                         Health Interview Survey (NHIS), CDC, NCHS, and
                         the National Health and Nutrition Examination
                         Survey (NHANES), CDC, NCHS.

                         The proposed questions to obtain the national
                         data will be included in the 2001 NHIS.

                         See Part C for a description of NHIS, NHANES,
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-15. (Developmental) 
  Increase the number of 
  persons who are        
  referred by their      
  primary care physician 
  for hearing evaluation 
  and treatment.         

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed national data sources are the National
                         Ambulatory Medical Care Survey (NAMCS), CDC,
                         NCHS, and the National Health Interview Survey
                         (NHIS), CDC, NCHS.

                         See Part C for a description of NAMCS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-16. (Developmental) 
  Increase the use of    
  appropriate ear        
  protection devices,    
  equipment, and         
  practices.             

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health Interview Survey (NHIS), CDC, NCHS.

                         The proposed questions to obtain the national
                         data will be included in the 2001 NHIS.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-17. (Developmental) 
  Reduce noise-induced   
  hearing loss in        
  children and           
  adolescents aged 17    
  years and under.       

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health and Nutrition Examination Survey
                         (NHANES), CDC, NCHS.

                         Noise-induced hearing loss is caused by either a
                         one-time exposure to very loud sound(s) or by
                         repeated exposure to sounds at various loudness
                         levels over an extended period of time. Hearing
                         loss may be temporary or permanent.

                         See Part C for a description of NHANES and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  28-18. (Developmental) 
  Reduce adult hearing   
  loss in the            
  noise-exposed public.  

  **Comments**           An operational definition could not be specified
                         at the time of the publication.

                         Proposed national data sources are the National
                         Health Interview Survey (NHIS), CDC, NCHS and
                         the National Health and Nutrition Examination
                         Survey (NHANES), CDC, NCHS.

                         Proposed questions used to obtain the national
                         data will be included in the 2001 NHIS.

                         Hearing loss for adults aged 20 to 69 years is
                         determined from a hearing test conducted in each
                         ear at 500, 1000, 2000, 3000, 4000, 6000, and
                         8000 Hz.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  