Globally, an estimated 252.6 (95% CI, 111.4-424.5) million people live with best-corrected visual acuity of 20/60 or worse in the better-seeing eye. 1 People in the US fear losing vision more than memory, hearing, or speech, and consider visual acuity loss among the top 4 worst things that could happen to them. 2 No existing estimates appear to have used empirical data to estimate geographic differences, created estimates for persons younger than age 40 years, or accounted for increased prevalence in group quarters.Previous studies have estimated national visual acuity loss or blindness prevalence for important age ranges. The Vision Problems in the United States (VPUS) study estimated uncorrectable visual impairment and blindness for persons ages 40 years and older to occur in 4.2 million individuals (2.9%) in 2010. 3 Using similar methods and data for 2015, Varma et al 4 estimated national and state visual acuity loss or blindness prevalence for persons ages 40 years and older and arrived at a similar estimate of 4.24 million cases (2.8%). Both of these studies 3,4 are limited, since they excluded persons younger than 40 years and persons living in group quarters, such as nursing homes and prisons. Both studies 3,4 relied on metaanalytic summaries of similar selected population-based study data, and no other data sources, to estimate prevalence by age group, sex, and race/ethnicity and then calculated state-level estimates by applying these summary estimates to each state's population distribution. This method may lead to inaccuracies because the population-based study data (while of high quality) were collected 8 to 36 years in the past from locally IMPORTANCE Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US.OBJECTIVE To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state.

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Vision loss and eye disorders cost the US health care system $65.1 billion in 2013, the fifth leading cause of medical expenditures. 1 Americans fear losing vision as much as or more than memory, hearing, or speech, and consider blindness among the top 4 worst things that could happen to them. 2 It is estimated that as much as 98% of visual impairment and blindness, much of it consisting of uncorrected refractive error and untreated cataracts, in the United States can be prevented through timely diagnosis and early treatment. 3 Currently, no national visual health surveillance system provides information on prevalence, health disparities, or changes over time. Visual health (inclusively defined as vision status, loss, disease, disorders, and injuries) prevalence estimates are usually drawn from meta-analyses of population-based study data, which are not contemporary and lack national representativeness. Estimates are also taken from self-reported responses to visual health questions contained in national surveys, which are generally broad, vary in measure definition, and may suffer from unreliability. In both cases, existing estimates are limited to a small number of common eye conditions, and the resulting visual health estimates may vary widely and inconsistently between various data sources. For example, reported estimates of the number of blind Americans vary from 1.3 to 7.0 million persons. 4,5 In 2016, the National Academies of Science, Engineering, and Medicine issued a call to "develop a coordinated surveillance system for eye and vision health in the United States." 3 Previously, several national institutions have recommended additional surveillance activities or concluded that additional evidence is needed to inform visual health decisions at the population level. A 2012 Centers for Disease Control and Prevention (CDC) panel of visual health experts recommended the establishment of a US visual health surveillance system. In 2016, the US Preventive Services Task Force concluded that visual health information was insufficient to support screening to detect impaired visual acuity in older adults. 6

Background Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. Methods In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18–64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. Results Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0–2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3–1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1–1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4–0.7) than those in nonexpansion states. Conclusions Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics.