Vision Impairment Affects More than 1 in 4 Older Adults in the United States

Joshua R. Ehrlich, MD, MPH

New estimates on the prevalence of vision impairment in the United States suggest more than a quarter of adults 71 years and older had an impairment in 2021, based on data from the National Health and Aging Trends Study (NHATS).

Differences in visual function based on socioeconomic and demographic factors were additionally noted, with those who were older, Hispanic, non-White, less educated, and reporting lower income enduring greater prevalence of impairment.

“The up-to-date data presented in this study are vital for informing surveillance of vision health in the United States and may enable public health programs to target individuals at highest risk of poor vision,” Joshua R. Ehrlich, MD, MPH, Department of Ophthalmology and VIsual Sciences, University of Michigan.

Older adults are disproportionately affected by vision impairment and poor vision is associated with numerous adverse outcomes by later life, including depression, dementia, and mortality. The current estimates of the prevalence of vision impairment in the US were based on best-corrected visual function measures at least 14 years old and self-reported survey data.

As a result, investigators note the critical need for up-to-date, objectively measured, national epidemiologic estimates of vision impairment prevalence among older adults. The current survey study reports a secondary analysis of the 2021 NHATS, in which the national study began including objective measures of presenting visual function in its protocol.

The study tested distance visual acuity, near visual acuity, and contrast sensitivity using tablet-based tests. It additionally used World Health Organization (WHO) definitions of vision impairment based on binocular testing of presenting vision with habitual correction. Investigators collected socioeconomic and demographic variables including age in 5-year intervals, sex, race and ethnicity, educational attainment, and family income.

The Round 11 NHATS data were collected from June to November 2021 and analyzed for the current study in August 2022. Primary measures of note were the national 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 20/400), and contrast sensitivity (>1 SD below the mean).

The 2021 NHATS sample had 3817 respondents. Exclusions of those who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362) left 3026 participants included in the analysis.

In this population, 29.5% were aged 71 to 74 years (95% confidence interval [CI], 27.3% - 31.8%), 55.2% (95% CI, 52.8% - 57.6%) were female respondents, and 79.8% (95% CI, non-Hispanic White respondents (95% CI, 77.2% - 82.4%).

The study findings estimated that more than 1 in 4 adults 71 years and older in the US had a vision impairment (27.8% [95% CI, 25.5% - 30.1%]) in 2021.

The data show the prevalence of near visual impairment was 22.3% (95% CI, 20.3% - 24.3%), while the prevalence was 10.3% (95% CI, 8.9% - 11.7%) and 10.0% (95% CI, 8.5% - 11.4%) for distance impairment and contrast sensitivity, respectively.

Investigators found all types of visual impairment were associated with older age, less education, and lower income. Both near visual impairment and contrast sensitivity impairments were additionally associated with non-White race and Hispanic ethnicity.

When the socioeconomic and demographic characteristics were incorporated into multivariable linear regression models, all measures of visual function were found to be worse with increasing age, lower education, and lower income. However, race and ethnicity were not significantly associated with visual function, suggesting that the observed differences may be driven by socioeconomic factors like education and income.

“These findings build on the emerging work that has been published on social determinants of vision health and substantiate the need for additional research to disentangle individual- and community-level factors that shape vision health outcomes and access to eye care,” Ehrlich wrote.

The study, “Population Prevalence of Vision Impairment in US Adults 71 Years and Older,” was published in JAMA Ophthalmology.