Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Grassroots health care reform

Although it is winter in the Northeast, there is never a dull day in Philadelphia.

This winter we were enamored with another run for the Super Bowl with the steady hand of our back-up quarterback, and no one can doubt that the football gods were with us after that dramatic “doink-doink” win in Chicago.

Beyond that, however, there was yet another dust-up over our city’s famous sweet beverage tax. A local supermarket that is closing up shop is publicly blaming the beverage tax for the demise of the store (McCrystal).

Our beverage tax is not your ordinary sugar tax that is growing in popularity around the world. This tax includes artificially sweetened beverages as well. Now the original bill did not include the sugar-free soda, but this provision was tacked on in the sausage grinder of Philadelphia politics. But again, as luck would have it, this is turning out to be yet another health advantage to our local law.

In a recent study published online in the September/October issue of Clinical and Experimental Ophthalmology, diet soda has been found to increase the risk for proliferative diabetic retinopathy. According to the authors, people with diabetes that consume four or more cans of diet soda per week will double their risk of developing proliferative retinopathy.

Current opinion of experts in the health and wellness field are converging on the theory that sugar is an addictive substance (Schaefer et al.). Sugar has been shown to release dopamine in the brain and may even activate the opiate receptors. Once this process begins, even the sweetness of artificial substances can sustain the addiction.

The U.S. Constitution defines the role of government to include promoting the general welfare of our people. As such, once we have compelling evidence of a threat to our people, the government must take strides to protect us. It is hard to ignore the obesity epidemic in America and to note the effect of excessive dietary sugar intake even at a very young age. Yet to pass laws that would outlaw sugary drinks would interfere with our basic freedoms as American citizens. Creating barriers, however, especially ones that provide revenue for other projects, would seem an ideal solution. Over the past half century we have seen this successfully implemented with the tobacco tax that has helped dramatically reduce the number of American smokers.

Public health issues are often best implemented at the grassroots level. Clean water, clean air and general health education are much more effective than more doctors and new medicines to treat disease. In America, however, we take these things for granted, and creating barriers to unhealthy activity as seen in the soda tax is a logical next step (Leonhardt).

As primary care providers, optometrists have a significant role as advocates for public health policy. Measures like the soda tax that create barriers without prohibiting unhealthy activity need our support. These issues, however, are never simple and will require close monitoring and fine tuning to be effective. With new information as seen in this study on diet soda, optometry is now on the front line to educate policymakers as well as our patients on the prevention of vision loss.


Fenwick EK, et al. Clin Exp Ophthalmol. 2018;doi:10.1111/ceo.13154.

Leonhardt D. The case for health taxes. New York Times. Posted January 18, 2018.

McCrystal L. Jeff Brown to close West Philly Shop Rite, blames soda tax. Updated January 2, 2019.

Schaefer A, et al. Experts agree: Sugar might be as addictive as cocaine. Reviewed October 10, 2016.