For the past decade or so, employers and employees alike have been stunned by the alarming rise in the cost of health care, which is sometimes blamed on over-treatment -- too many unwarranted tests and expensive therapies.

But the opposite it true, too. Some workers never or rarely see a doctor, which means by the time they seek treatment for a problem, it's likely more advanced than if caught early, resulting in greater medical costs and perhaps more time away from work for the employee.

Such was the case for Bill Pender, a New Jersey resident who worked in commercial banking until recently. Pender says that it had been years since he had had a routine physical exam, prior to developing vision problems two years ago.

Pender began noticing that he was having difficulty seeing when transitioning from sunny areas to shady ones while driving. "I'd be looking at the car in front of me and when I went into the shade, the car would disappear," he says, noting that he was also having difficulty seeing his computer screen at work.

Pender, 53, did what many people do when they encounter vision problems: He went to see his eye doctor, thinking that he just needed an updated prescription for his eyeglasses. Unfortunately, a routine eye exam revealed that Pender had diabetic retinopathy, damage to the retina caused by long-term diabetes that is the leading cause of blindness among working age-Americans, according to the National Institutes of Health.

The diagnosis was devastating for Pender, who was forced to retire early and now relies on disability payments to help make ends meet.

Eye Exams Go Beyond Vision Care

Unfortunately, it's all too common for optometrists to detect the presence of disease during a routine eye exam, says Pender's eye doctor, Dr. Paul Berman, whose practice is in Hackensack, N.J.

Berman diagnosed Pender's diabetes after he found evidence of damaged, or "leaking," blood vessels during a part of the exam in which optometrists shine a small beam of light through the pupils (the black dot in the center of the eye) to view the back of the eye.

Unfortunately, Pender's diagnosis came too late to protect his vision. The portion of his sight that he has lost is gone for good, Berman says. "Once it's gone, it's hard to get back," he says, noting that Pender has seen some modest improvement in his eyesight. "But we did prevent it from getting worse."

Patients who are reluctant to go to a primary-care physician -- even for routine physicals and blood tests -- often don't have the same inhibition about seeing an eye doctor, says Susan Egbert, director of eye health management at VSP Vision Care, a nonprofit provider of employer-sponsored vision plans.

People are more apt to get eye exams than physicals because routine eye exams are less invasive, but also because sudden changes in vision, no matter how slight, are hard to ignore, she says.

Yet another reason is that eye doctors are readily available and don't usually require a referral from a primary-care physician. Moreover, patients with vision insurance, such as those offered through an employer, are more likely to seek treatment since out-of-pocket costs are reduced.

VSP, which recently released findings from a two-year study on the benefits of vision plans, found that eye doctors detected signs of certain chronic conditions before any other health-care provider, including up to 65 percent of the time for high cholesterol and 20 percent of the time for diabetes.

Overall, the study found that vision plans saved employers $4.5 billion in costs over two years through early disease detection. "With health-care costs spiraling out of control," says Rob Lynch, CEO at VSP, the cost-savings "clearly demonstrate the importance of stand-alone eye-care benefits."

More Care Available at Large Companies

Large employers are more apt to offer vision benefits as part of a larger wellness initiative that many have undertaken in recent years to help keep health-care costs under control.

"Preventative care is really a huge piece of one of the things that we try to instill in people," says David Twitchell, director of human resources at Rutland Regional Medical Center in Vermont. "If [employees] pay attention to the things that need to be taken care of you can reduce some of your health expenses at a later point."

Still, while more large employers in recent years have added a vision plan to their overall benefits package, smaller companies have been less inclined.

Large firms that employ 200 or more workers are much more likely than small firms, with 3 to 199 workers, to offer or contribute to a separate vision-care benefit -- 55 percent compared to 17 percent, respectively, according to an annual survey by the Kaiser Family Foundation.

A separate study conducted by the Society for Human Resource Management showed a better outcome -- with 77 percent of all employers surveyed responding that they offered a vision benefit, while 61 percent of small employers (defined by SHRM as those with fewer than 100 employees) did so.

The recent recession has resulted in VSP losing some of its membership as employees have been laid off and discontinued their benefits, Egbert says. But employers by and large haven't cut vision benefits as a way to trim costs. Instead, some employers have asked employees to begin paying a portion or a greater amount for their vision benefits.

Regardless of who pays, it's important for workers to get their eyes checked.

Berman notes that a full quarter of all diabetics go undiagnosed and more people die of the disease than breast cancer or HIV/AIDS. "it's really a major public health issue," he says. "So by making a routine eye examination part of a wellness program, you really can pick this disease up earlier."

Eye Care for the Uninsured

Many Americans don't have health or vision insurance through their job -- especially if they work for a small company. But there are resources that can help reduce or eliminate the cost of getting an eye exam and, if needed, glasses or contacts.

Here are a few:

EyeCare America provides comprehensive eye exams and care for up to one year, often at no out-of-pocket expense to those 65 and older. The organization also offers glaucoma screenings and an early childhood eye care program.

Vision USA, coordinated by the American Optometric Association, provides free eye care to eligible uninsured, low-income workers and their families.

Lions Clubs International, a social service organization, frequently sponsors programs in local communities to help people get eyeglasses and obtain eye care.

New Eyes for the Needy provides vouchers for the purchase of new prescription eyeglasses.

Sight for Students is a VSP Vision Care charity that provides free vision exams and glasses to low-income, uninsured children. The program operates nationally through a network of community partners who identify children in need and VSP network doctors who provide the eye care services.

VSP Mobile Eye Program operates three mobile eye care clinics. Services include comprehensive eye exams that include evaluation of overall eye health. Glasses provided to patients who need them.

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