Vision Impairment Found in More Than a Quarter of Older US Adults

More than 1 in 4 US adults 71 years and older were found to have vision impairment (VI) in 2021, which was a higher number than previous estimates according to JAMA Ophthalmology. The prevalence of VI also differed according to socioeconomic and demographic factors.

Older adults are more likely to be affected by VI, with 60% of people with VI or blindness being 65 years or older in the United States. Growth of the older population will cause a doubling of the number of people affected by VI from 2015 to 2050. This study aimed to give a national estimate of VI and blindness in the United States using testing of visual function. VI was defined according to World Health Organization (WHO) criteria.

The researchers used the National Health and Aging Trends Study (NHATS), which is a representative study of Medicare beneficiaries, for their study. All participants of NHATS completed in-person interviews, had annual follow-up interviews, and self-reported their race and ethnicity. NHATS oversamples older and Black individuals.

NHATS began using an objective way to measure visual function in a participant’s home in 2019 and started testing visual acuity and contrast sensitivity in 2021. The visual acuity tests stopped when a participant read fewer than 3 letters on the screen.

Age was separated into 5-year intervals, starting with 71 to 74 years. Sex, race and ethnicity, education, and family income were all recorded. Distance VI was evaluated using WHO definitions.

A total of 3026 participants were included in the final analysis, of which 29.5% were aged 71 to 74 years, 55.2% were women, and 79.8% reported non-Hispanic White ethnicity. The researchers estimated that more than 1 in 4 adults who were 71 years or older had VI in the United States (27.%; 95% CI, 25.5%-30.1%).

Distance VI had a prevalence of 10.3% in adults 71 years and older (95% CI, 8.9%-11.7%), with a mean visual acuity of 0.13 logMAR. Distance VI correlated with older age, with people aged 71-74 years having a prevalence of 4.2% (95% CI, 2.3%-6.1%) vs people 85 years and older who had a prevalence of 21.8% (95% CI, 17.6%-26.1%).

Education was also found to be associated with the prevalence of distance VI, with those with lower total education having a higher prevalence: 18.2% (95% CI, 13.7%-22.6%) among those with less than high school diploma vs 8.5% (95% CI, 6.4%-10.6%) among those with a college degree.

Family income was also correlated with visual acuity, with those who made less than $21,000 having a prevalence of 16.0% (95% CI, 13.2%-18.8%) and participants who make $75,000 and over having a prevalence of 7.5% (95% CI, 5.1%-9.8%). Race and ethnicity and sex did not correlate to visual acuity.

The prevalence of mild, moderate, and severe VI or blindness was 5.5% (95% CI, 4.5%-6.5%), 3.9% (95% CI, 3.1%-4.7%), and 0.9% (95% CI, 0.5%-1.3%), respectively. Near VI in US adults was prevalent in 22.3% of adults. Older age also was associated with visual acuity impairment, with 16.3% of people aged 71 to 74 years having an association (95% CI, 12.3%-20.2%) compared with 37.9% of participants 85 years and older (95% CI, 33.7%-42.2%).

Education and income were also associated with prevalence of VI, with those of low education and low income having higher rates of prevalence. Non-Hispanic White participants (20.4%) had the lowest prevalence compared with Black non-Hispanic participants (31.7%).

The overall prevalence of contrast sensitivity impairment was found to be 10.0% (95% CI, 8.5%-11.4%). Older participants, those with lower education, participants with lower income, and participants who were Hispanic had a higher prevalence of contrast sensitivity impairment. Sex was not found to be associated with this indicator.

The study had a few limitations. Cross-sectional data were used, which means incidence of VI and vision trends over time could not be estimated. Participants who were older, female, members of racial and ethnic groups outside of non-Hispanic White, and were less educated were more likely to have missing data. Also, participants younger than 71 years were not included in NHATS in 2021.

The researchers concluded that more than 1 in 4 adults who were older than 71 years had VI, with prevalence increasing in participants who were older, Hispanic, non-White, were less educated, and had lower incomes.

Reference

Killeen OJ, De Lott LB, Zhou Y, et al. Population prevalence of vision impairment in US adults 71 years and older: the national health and aging trends study. JAMA Ophthalmol. Published online January 12, 2023. doi:10.1001/jamaophthalmol.2022.5840