Turn the Curve Thinking

Our focus must be on the desired end state of our clients: LVS empowers the blind and visually impaired to live safe, meaningful, and fulfilling lives. Our programs are the means by which we do this, but they are not the end state.

LVS utilizes a framework known as Results Based Accountability (RBA). This concept is based on Mark Friedman’s book Trying Hard Is Not Good Enough, and was first introduced to LVS by our philanthropic partners at the Coastal Community Foundation of SC. Now championed by an increasing number of funders, this framework helps LVS create better Client Population data on the individuals we are serving rather than relying on Whole Population data that may not reflect local circumstances.

You can think of the RBA Framework as a quadrant of metrics:

While each of these metrics is valuable, the bottom right quadrant is the most important. This quadrant measures improvements in our Client Population. These measures are outcomes. The least important quadrant would be the top left. While it is helpful to know how much we did, these metrics are outputs and do not tell us what change our clients actually experienced.

Utilizing a pre- and post-service survey, LVS tracks a variety of quantitative and qualitative measures. Our curent impact is illustrated below.

Community-Level Eyecare

There are a variety of causes of vision impairment which vary by ethnicity in the United States. These distinctions remind us of the challenges in vision health as in many other fields of public health as well. Utilizing a 2016 study from the National Academies of Sciences, Engineering, and Medicine we can compare this national data with our program data in South Carolina to gauge our success in addressing some of the most pressing vision health issues in our community.

Across the board cataracts are the most prevalent cause of low vision in every ethnic population (59.2% for White persons, 50.9% for Black persons, and 46.7% for Hispanic persons). Many of the LVS Eye Surgery clients fall into this category of “low vision” as they are not yet legally blind. Cataracts accounted for 72% of all LVS eye surgeries in the last year, underscoring the prevalence of this trend.

However, when we evaluate the causes of blindness by ethnicity, we see differences begin to emerge. The most prominent cause of blindness in Black persons is cataracts (36.8%), in Hispanic persons is glaucoma (28.6%), and in White persons is age-related Macular Degeneration (54.4%).

We believe the trend in our program data indicates a particular success with regards to preventing blindness among African American clients. Last year 70.6% of all eye surgeries for Black persons at LVS were cataract surgeries. This means we are significantly decreasing the likelihood that Black persons who apply for eye surgery through LVS will ultimately succumb to the most prevalent form of vision loss within their ethnic population.

Similarly, cataracts are the leading cause of low vision for white persons (59.2%) and 90.3% of all eye surgeries for white persons at LVS were cataract surgeries.

For Hispanic persons, there is a more evenly disbursed propensity for the leading cause of blindness being Glaucoma (28.6%), other eye conditions (28.6%), cataracts (14.3%), diabetic retinopathy (14.3%), or age-related Macular Degeneration (14.3%). Interestingly, Hispanic persons at LVS had the most evenly disbursed array of eye surgeries performed during the year, including 30.8% for diabetic retinopathy, 23.1% for cataracts, 23.1% for pterygiums, 7.7% for retinas, 7.7% for glaucoma, and 7.7% for strabismus. We believe this indicates improved equity in eye surgery performance for Hispanic clients during the last year.

We have work still to do to refine these results and move our program performance closer towards the industry benchmarks for equity, but this trend is encouraging to our staff that we are impacting social determinants of health in the communities we are serving.