Linguistic diversity in the United States presents significant challenges to health care communication. According to the US Census Bureau, nearly 42 million Americans speak Spanish, more than 3 million speak Chinese, and many others speak Tagalog, Vietnamese, Arabic, Korean, and other languages.1 In fact, nearly 22% of Americans speak a language other than English at home, and about 8% speak English “less than very well.”2 This diversity is especially prominent in urban centers and regions with high immigrant populations. Thus, addressing language disparities in health care is no longer optional—it is a necessity. It is crucial that health care providers have the resources necessary to meet the communication needs of these varied communities.
The language barrier in health care, particularly in specialized fields such as ophthalmology, is not simply an issue of possible miscommunication—it directly affects trust, patient safety, and informed consent. Conditions such as diabetic retinopathy, macular degeneration, and glaucoma require both clear instructions and ongoing patient education. Without effective communication, even well-intentioned treatments can lead to complications, misdiagnoses, or irreversible vision loss; thus, patients must fully understand the importance of regular eye examinations, medication adherence, and treatment schedules.
This article explores the profound influence that language has on ophthalmic care, underscoring how communication—or the lack of communication—affects patient outcomes. It also examines the tools available to health care providers to bridge these gaps, ensuring that non–English-speaking patients receive the care they need to maintain their vision and overall health.
THE IMPORTANCE OF CLEAR COMMUNICATION IN OPHTHALMOLOGY CARE
Effective communication is a cornerstone of successful ophthalmic care, encompassing more than the simple exchange of information. It ensures that patients fully understand their diagnosis, treatment options, risks, and the long-term management of their conditions. This becomes particularly important when long-term compliance and follow-up care are involved, as miscommunication can lead to worsening conditions and irreversible damage to vision. For instance, glaucoma management involves continuous use of eye drops, regular monitoring, and an understanding of the disease’s progression. A miscommunication in any of these areas could result in vision loss. Similarly, cataract surgery and retinal interventions demand that patients understand preoperative instructions, the risks involved, and the steps for post-surgical recovery. Failure to properly communicate any of these elements could jeopardize treatment success; for example, patients may not use the prescribed eye drops correctly or may miss warning signs of a complication that should prompt them to seek immediate care.
Informed consent is another crucial aspect of ophthalmic care, and patients must understand the procedures and the potential risks, benefits, and alternatives.
THE ROLE OF INTERPRETERS
To address language barriers, ophthalmology practices can rely on various interpreter services, including phone, telehealth, and in-person interpreters. Each method has its own strengths and weaknesses, with the decision ultimately depending on multiple factors, including patient needs, the complexity of the case, and available resources.
Phone interpreters offer immediate access to language services, making them essential for high-volume clinics or after-hour emergencies. However, phone interpretation lacks visual cues, such as facial expressions, which are vital for discussing sensitive topics such as vision loss. In addition, technical issues such as poor audio or dropped calls can disrupt communication, and some patients may feel uncomfortable discussing complex diagnoses over the phone. Therefore, while cost-effective, phone interpretation may not be ideal for every situation.
Telehealth interpreters offer audio and video communication, thus capturing both audio and visual cues such as body language. This method enhances accessibility and reduces delays compared with in-person interpreters. However, it can also be challenging for older patients or those unfamiliar with the technology, and issues such as poor internet connectivity may affect the quality of interpretation.
In-person interpreters are considered the standard, offering real-time, face-to-face communication. This method ensures the most accurate translation, including both verbal and nonverbal cues. However, availability of interpreters can be limited, particularly for less commonly spoken languages, and it is more costly and less feasible in rural or underserved areas. Coordinating in-person interpreters can also be difficult in urgent situations.
CULTURAL SENSITIVITY AND BUILDING TRUST
Language is more than just words—it’s also a reflection of cultural norms and values. In health care, cultural sensitivity is especially important because different cultures may have varying beliefs about health, medical treatments, and the importance of following medical advice. For example, some patients may be hesitant about undergoing surgery, while others may not fully appreciate the significance of adhering to postoperative care instructions.
Interpreters, particularly those who are in-person, play a critical role in bridging these cultural gaps. They not only translate words but also help health care providers navigate cultural nuances, such as differing views on health or varying expectations about treatment. This cultural understanding can significantly enhance the patient’s experience and improve treatment adherence. When health care providers take the time to understand and respect a patient’s cultural background, it can lead to improved patient satisfaction and better health outcomes.3,4
Furthermore, cultural sensitivity in communication can foster trust between the health care provider and the patient. Trust is a critical component of any health care relationship, but it’s particularly important in ophthalmology, where patients often need to return for long-term management of chronic conditions. When patients feel understood and valued, they are more likely to follow through with treatment plans, attend follow-up appointments, and actively participate in managing their condition.
FAMILY MEMBERS: A DOUBLE-EDGED SWORD
A non–English-speaking patient may bring along a family member who speaks some English to help with communication. While family members can provide emotional support, health care providers should be cautious about relying on them for interpretation. Family members may not be familiar with medical terminology, which can lead to misunderstandings or incomplete translations. In some cases, they may be emotionally invested in the situation, which can compromise their objectivity and clarity when conveying critical information.
Family involvement can be particularly problematic when discussing complex medical topics. In these situations, the use of a trained interpreter is crucial to ensure accurate communication. Family members may not feel comfortable discussing sensitive issues, such as vision loss or surgical risks, and this can negatively affect the patient’s understanding of their condition.
While they may be an excellent source of emotional support, a patient’s family should never replace professional interpreters in a medical setting. Health care providers must ensure that critical communication is done through qualified interpreters who are trained in both linguistic and cultural nuances.
ADDITIONAL CHALLENGES OF INTERPRETER SERVICES
Despite their importance, interpreter services come with challenges that need to be addressed to ensure the highest quality of care for non–English-speaking patients.
Time Requirements
Interpreter services, especially those involving in-person or telehealth interpreters, require additional time. Due to the need for translation, patient appointments often take longer. This can create scheduling delays, resulting in longer wait times for patients and increased pressure on health care providers to manage their time efficiently. In fast-paced environments, such as an ophthalmology clinic, this can lead to operational inefficiencies and frustration for both patients and providers.
Quality of Interpretation
Another significant challenge is the variability in interpreter quality. Interpreters may be employed directly by health care organizations, contracted through language service providers, or work independently—structures that can affect the consistency and quality of services. While some interpreters are highly skilled and familiar with medical terminology, others may lack the necessary expertise. To improve the quality of interpretation services, health care systems must invest in better training for interpreters, ensure that they are familiar with specialized medical vocabulary, and implement systems for continuous evaluation and feedback.
MOVING FORWARD: POLICY CHANGES AND SOLUTIONS
To improve communication and interpreter services in ophthalmology, health care systems must implement policies that ensure equitable access to care. Under the Civil Rights Act of 1964, patients with limited English proficiency have a right to interpreter services. However, availability and reimbursement for these services are inconsistent, leaving many health care providers to manage this challenge on their own.
Standardizing interpreter access, expanding language options, and increasing trained interpreters are key steps to ensure non-English-speaking patients receive quality care. While bilingual staff can help, physicians are responsible for ensuring patients fully understand medical advice, especially regarding complex ophthalmic care. Practices often use telephone or video interpreters, which are typically subscription- or minute-based. Consulting with insurance providers, such as the Ophthalmic Mutual Insurance Company, can help clarify liability concerns.
Technology also plays a role in improving communication. Real-time translation devices and AI tools can support human interpreters, particularly in straightforward situations, enabling timely care. Additionally, offering longer appointments for non–English-speaking patients can allow sufficient time for effective communication and any questions the patient may have.
PROPER EYE CARE IS EVERYONE’S RIGHT
In ophthalmology, where patient outcomes depend heavily on precise communication, language barriers pose a significant risk to patient safety and satisfaction. By using appropriate interpreter services—whether through phone, telehealth, or in-person methods—eye care providers can ensure that non–English-speaking patients understand their diagnosis, treatment options, and care instructions. In turn, this attention to cultural sensitivity can build trust and help ensure the highest quality of care to all patients.
Editor’s Note: this article is based on "Speaking a Patient's Language: The Power of Language in Ophthalmology Care," presented at the annual AAO meeting, October 20, 2024, in Chicago.
1. Dietrich S, Hernandez E. Nearly 68 million people spoke a language other than English at home in 2019. United States Census Bureau. December 6, 2022. Accessed April 3, 2025. www.census.gov/library/stories/2022/12/languages-we-speak-in-united-states.html
2. Language spoken at home. United States Census Bureau. Accessed April 3, 2025. www.census.gov/acs/www/about/why-we-ask-each-question/language/
3. Cipta DA, Andoko D, Theja A, et al. Culturally sensitive patient-centered healthcare: a focus on health behavior modification in low and middle-income nations-insights from Indonesia. Front Med (Lausanne). 2024;11:1353037.
4. Tucker CM, Marsiske M, Rice KG, Nielson JJ, Herman K. Patient-centered culturally sensitive health care: model testing and refinement. Health Psychol. 2011;30(3):342-350.
