Population Prevalence of Vision Impairment in US Adults 71 Years and Older

Abstract

ImportanceExisting estimates of the prevalence of vision impairment (VI) in the United States are based on self-reported survey data or measures of visual function that are at least 14 years old. Older adults are at high risk for VI and blindness. There is a need for up-to-date, objectively measured, national epidemiological estimates.ObjectiveTo present updated national epidemiological estimates of VI and blindness in older US adults based on objective visual function testing.Design, Setting, and ParticipantsThis survey study presents a secondary data analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. NHATS includes community-dwelling older adults or their proxies who complete in-person interviews; annual follow-up interviews are conducted regardless of residential status. Round 11 NHATS data were collected from June to November 2021, and data were analyzed in August 2022.InterventionsIn 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity with habitual correction.Main Outcomes and MeasuresNational prevalence of impairment in presenting distance visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), presenting near visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), and contrast sensitivity (>1 SD below the sample mean). Prevalence estimates stratified by age and socioeconomic and demographic data were calculated.ResultsIn the 2021 round 11 NHATS sample, there were 3817 respondents. After excluding respondents who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362), there were 3026 participants. Of these, 29.5% (95% CI, 27.3%-31.8%) were 71 to 74 years old, and 55.2% (95% CI, 52.8%-57.6%) were female respondents. The prevalence of VI in US adults 71 years and older was 27.8% (95% CI, 25.5%-30.1%). Distance and near visual acuity and contrast sensitivity impairments were prevalent in 10.3% (95% CI, 8.9%-11.7%), 22.3% (95% CI, 20.3%-24.3%), and 10.0% (95% CI, 8.5%-11.4%), respectively. Older age, less education, and lower income were associated with all types of VI. A higher prevalence of near visual acuity and contrast sensitivity impairments was associated with non-White race and Hispanic ethnicity.Conclusions and RelevanceMore than 1 in 4 US adults 71 years and older had VI in 2021, higher than prior estimates. Differences in the prevalence of VI by socioeconomic and demographic factors were observed. These data could inform public health planning.

Objectively Measured Visual Impairment and Dementia Prevalence in Older Adults in the US

“…Near VI was defined as more than 0.30 logMAR (Snellen equivalent, worse than 20/40) . CS impairment was defined as more than 1 SD below the sample mean …”

“…7 CS impairment was defined as more than 1 SD below the sample mean. 8 NHATS defines participants as having dementia if they scored 1.5 SDs or more below the mean of self-respondents in 1 or more cognitive domains (memory, orientation, and executive function), had an AD8 Dementia Screening Interview Score indicating probable dementia, or had previously received a medical diagnosis of dementia. 9 Self-reported covariates included age, sex, education, race and ethnicity, smoking, and number of chronic conditions (diabetes, hypertension, stroke, myocardial infarction, heart disease, lung disease, or cancer).…”

Internecine Impairments

“…A common feature of a dementia diagnosis is loss of attention, which would impair an individual’s ability to test for contrast sensitivity. A limitation of the study by Killeen et al is the absence of data to rule out the component of the association that may be due to simple inability to complete the vision tests. There may not be any ophthalmologic pathology in some of the participants and especially those with mild impairment.…”

The Importance of Public Health Surveillance for Vision Impairment in Older Adults

“…Killeen and coauthors found in their multivariable model that near visual acuity impairment was greater in individuals who were 75 years or older, had less than a high school education, or had an income less than $40 000. 2 If income and education are the main drivers behind the greater prevalence of vision impairment in older individuals, then public policies or outreach programs aimed at providing access to inexpensive reading glasses-perhaps closer to the $2 threshold set by the International Agency for the Prevention of Blindness 7 -and increasing health education campaigns focused on the importance of reading glasses or other portable optical magnifiers in improving near vision may be effective and should be studied. Whatever the case may be, it is important that we follow the current study with future surveillance and intervention studies because of the tremendous patient and economic burden of near visual acuity impairment on our society.…”

“…The report by Killeen and coauthors on the population prevalence of visual impairment uses data collected from the National Health and Aging Trends Study, which tested distance visual acuity, near visual acuity, and contrast sensitivity using tablet-based tests in the homes of participants who were 71 years or older. This study is a welcome addition to our need for good surveillance data on the US population because it is the first objectively measured population-based data on visual impairment in the US since the National Health and Nutrition Examination Survey in 2008 …”