In this episode of the Purpose in Practice podcast, ACU’s Rick Brown speaks with Dr. Ashley Burns, the Chair of ACU’s Vision Services Committee and the Director of Optometry at Coastal Family Health Center in Biloxi, MS. Listen as they talk about the ways that vision care can make a difference in overall health, the challenges that patients living in medically under-resourced areas may face in accessing care, and more!

Full Transcript

Rick Brown: My name is Rick Brown, and I am the Associate Director of Communications and Membership with the Association of Clinicians for the Underserved. I’m here today with Dr. Ashley Burns, Director of Optometry at Coastal Family Health Center. It’s a pleasure to have you with us.

Ashley Burns: Thank you so much for having me. I’m honored to be a part of everything that you’re doing at ACU.

Rick Brown: I wonder if we could start off by just asking if you could tell us a little bit about yourself, about the type of patients that you and Coastal serves, and the community where you provide care.

Ashley Burns: I graduated in 2013 from Optometry school, and this was my first job out of school and I’m still here, so 10 years next year. I live on the Mississippi Gulf Coast, and the organization that I’m a part of, we actually have 11 clinics throughout all the little cities. Majority of them are urban, but we do have a couple that are more in the rural areas of Mississippi. And then we have three of our 11 locations have optometry services. I practice in Biloxi, and then I also go to our rural clinic in Leakesville, Mississippi. The populations are very different from the urban, and then our rural patients, a lot of them actually do have insurance, but they don’t have the access to care, so I’m the only optometrist there in that city. So we’d see a lot of patients just for that reason alone. And then on the coast we see a lot more patients that are uninsured, maybe our Medicaid Medicare population. We have a pretty good mix of different demographics, so majority of the coast population is Caucasian, but we also have a large Hispanic population being on the coast, or being in the South rather. And then we also have a pretty large Vietnamese community because, just the history of the area, there was a lot of immigrants that came for the fishing industry. We see all different types of patients and a lot of them just have a great need for eyecare.

Rick Brown: Honestly, that must make for such an interesting practice seeing such a diversity of patients.

Ashley Burns: Yeah, it’s really great. I feel good that I can serve all different kinds of people and help all different kinds of people and just attend to whatever needs they have and just try to be aware of their unique needs that they have or understanding of eyecare.

Rick Brown: You talked a little bit about this in your answer to our previous question, but for those who aren’t as familiar, why is eye health and vision care important to an individual’s overall health?

Ashley Burns: I feel like eyecare is so important because it’s one of the things that we rely on so heavily, but we take for granted. If you lose your vision, you really do lose your independence. So we really want to try to keep a good quality of life for people. A lot of eye conditions can be caught early and treated early, and so we want to catch those before they become a burden to the patient to where their quality of life is decreased. But your eyes is such an amazing organ. This is the only place we can see into your body without having to cut you open. And the structures are very similar to other structures in the body. So whatever’s happening in your eye is actually happening all over your body. And we can tell that with just a dilated exam. So a lot of times eye doctors are the first to catch diabetes, high blood pressure, even cancer sometimes. We say the eyes are windows to the soul, but there’s really a lot of truth to that in terms of just telling how healthy a person is.

Rick Brown: A fantastic way of putting it. So talk a little bit more about your diverse patient populations. What would you say are their general unique healthcare needs and eye health needs specifically?

Ashley Burns: I forgot to mention we have a large African-American population as well. So just having a lot of people of color on the coast, we are disproportionately affected by eye disease like glaucoma, macular degeneration, and just the effects of diabetes and high blood pressure on the eye. We’re more prone to getting those things. We really want to encourage our patients, really everybody, but especially that population because a lot of eye diseases are comorbid with other conditions that are already existing in patients in health centers. So we try to get them to come in and they may not have any symptoms at all, but we can tell through their eye exam that they have such and such going on. Like I said, glaucoma or any other eye conditions, they don’t necessarily have symptoms. So that’s why it’s so important if they do already have some health problems to have an eye exam as well.

Rick Brown: Thinking a little bit about broader issues both in the Gulf area and just in general, why would you say the individuals living in medically underserved areas often lack access to adequate vision care? And what are some of the barriers they face?

Ashley Burns: Some of the biggest barriers based in eyecare is just having access to either an optometrist or ophthalmologist. There’s actually close to a quarter of counties all over the United States that don’t have access to any kind of eyecare provider. That’s the biggest barrier. You could say even transportation kind of goes hand in hand with that, but even if you have access to transportation, sometimes the nearest eye doctor can be two or three hours away and they may not even take your Medicare or Medicaid. So that’s probably the biggest factor. We know that income, neighborhood, and education can all contribute to access to care as well.

Rick Brown: And it sounded like from what you were mentioning earlier, there’s a disproportionate impact, particularly in communities of color?

Ashley Burn: Yes. That’s what the research shows is that African-American and Hispanic populations between 2015 and 2050 are going to be the greatest impacted by vision loss.

Rick Brown: And I guess thinking about some of the potential solutions for this, what would you say is needed to improve access to vision care for people and then medically under-resourced communities?

Ashley Burns: That’s exactly what we’re doing on the Vision Services Committee at ACU. So, our goal with the committee is to increase access to eyecare within already existing health centers, because health centers are already in the best position to treat patients that are affected by these social determinants of health, and they’re already in places where people can get better access. So, just having eyecare in health centers would really make a huge difference to these populations. There’s only about 20% of health centers that have eyecare on site, so that’s something that we really want to work on, and I believe that would have the greatest impact on, just access to care—it’s really lacking in optometry.

Rick Brown: And I guess speaking specifically about rural areas, how would you say that we can best advance health equity for patients living in those areas?

Ashley Burns: I do strongly believe in onsite optometry. I think that’s going to be your best quality care. But a lot of health centers may need to look into telehealth optometry. Sometimes you can take retinal photographs and have somebody offsite to take a look at the pictures and see if there’s any hint of anything that needs to be looked into further. That is actually a big help at rural places. Even though it is not ideal, it can still help us catch some eye diseases sooner than later.

Rick Brown: I wonder too, destroying from your own experience, would you have any specific advice or tips or lessons learned that you’ve had for health centers who are looking to start vision services for the first time?

Ashley Burns: Yeah, it’s definitely a challenge. A lot of the health centers that we’ve worked with, of course, the cost is a burden. Having the right space is a burden, but it just is such a good service to provide to communities, and it’s just a much needed service. So I would just want these health centers to really consider how much they could be helping their patients even more so than they already are. That’s what we want to do at ACU with the Vision Services Committee, is just provide some more resources, some more funding to get the ball going. It is hard, but we want to support as much as possible. So that’s our passion here. It’s been like two years now that we’ve been in existence, so we’ve done a lot in that time. Really excited for some of the projects that we have upcoming.

Rick Brown: And I was just curious, just from a personal perspective to what drew you to optometry at health centers and at Coastal specifically?

Ashley Burns: Well, I’ve actually always just been kind of, I guess, a charitable person. I always wanted to give back, always been a helper. So that’s just where my heart is in all aspects of my life. The fact that I can make a living doing optometry and also help people is just a perfect marriage. I had a mentor that was in community health, and she kind of helped introduce me. In the whole state of Mississippi, there’s only three health centers that have optometry, so we’re a perfect example of a place that really needs to work on access for patients. And at the time when I first started about 10 years ago there was only two. So we’re making some progress. I just want to be here for my patients and let them know that we care and that it’s important to get your eyes checked because it really affects your quality of life ultimately.

Rick Brown: Absolutely. And I imagine you must have so many stories from your own practice that it probably stuck with you.

Ashley Burns: That’s one thing I like about optometry. Majority of the time, we just are helping people see, so it is very positive feedback that we get from patients majority of the time. Sometimes it can be sad because while optometry is primary care, we don’t actually do any kind of surgeries or invasive procedures. And a lot of times patients can’t afford to have these surgeries. So that can be discouraging, but we just do what we can for them to get them to the point where they can have the surgery, just give them resources and encouragement. But overall, it’s just really nice to see somebody put on a pair of glasses and see the world again for the second time.

Rick Brown: Oh, indeed. And honestly, this has been such a wide ranging interview. I wonder just whether it’s on optometry or just in health equity in general, is there anything you’d like to add?

Ashley Burns: I would like to add that if you’re a health center that’s considering optometry, it doesn’t have to be a big undertaking, just consider it. Consider maybe taking the first step. Consider maybe having vision screenings. We can take baby steps in the right direction, but I would just like to encourage vision services to be on your mind.

Rick Brown: Absolutely. I loved some of the ways that you put things, too. The idea of being able to put on glasses and see the world again. That’s a wonderful way of characterizing it. And thank you, too, for making time in your schedule with how busy you are to speak to us.

Ashley Burns: I’m so glad that you guys thought of us. Thank you. I really appreciate it.

Outro: Thanks for listening to this episode of ACU’s Purpose in Practice podcast. We hope you enjoyed our conversation. You can access all our episodes, including show notes and links as well as learn more about ACU on our website at www.clinicians.org.