One in Four Adults over 70 are Visually Impaired

In a recent survey, 27.8% of U.S. adults 71 years and older were visually impaired. And those who were older, had less education and income, were non-White race, or of Hispanic ethnicity had the highest prevalence of visual impairment, according to a new analysis published in JAMA Ophthalmology.

Olivia J. Killeen, M.D.

Investigators, led by Olivia J. Killeen, M.D., department of Ophthalmology and Visual Sciences, University of Michigan, analyzed data from the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. They assessed national prevalence of impairment in distance visual acuity, near visual acuity, and contrast sensitivity, and they stratified prevalence estimates by age and socioeconomic and demographic data.

Investigators wrote that the last time visual function was measured was in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2008, but this survey excluded those in nursing homes and contained a small sample of older adults. In 2021, the National Health and Aging Trends Study began including measures of visual function using tablet-based tests in participants’ homes.

Visual acuity was measured using letters displayed on a tablet, and respondents were shown five letters per screen and the letters would become smaller on the next screens. For contrast sensitivity, respondents were shown two letters per screen, and the letters had a lower contrast on next screens.

To estimate the number of U.S. adults 71 years and older with visual impairment, investigators weighted prevalence data standardized to the July 1, 2020, U.S. census data, excluding Alaska, Hawaii, and Puerto Rico because NHATS participants are not recruiting from these three areas. After excluding respondents who did not complete the sample person interview and those with missing vision data, there were 3,026 participants included in this analysis.

Investigators found that the prevalence of distance impairment in this sample was 10.3%, which corresponds to 2.93 million people in the United States. Prevalence of near vision impairment in adults 71 years of age or older was 22.3%, corresponding to 6.57 million people. The prevalence of contrast sensitivity impairment was 10.0%, corresponding to 2.83 million people. All types of vision impairment were associated with older age, less education, and lower income. Near visual impairment and contrast sensitivity impairments were also associated with race and ethnicity other than non-Hispanic White.

Lower education and income were associated with all types of impairment. “When socioeconomic and demographic characteristics were incorporated into multivariable linear regression models, all measures of visual function were worse with increasing age, lower education, and lower income; additionally, male sex was associated with worse contrast sensitivity,” investigators wrote. “However, race and ethnicity were not significantly associated with any measure of visual function. This suggests that the observed differences between racial and ethnic groups may be driven by socioeconomic factors like education and income.”

A limitation is that the study is that researchers couldn’t measure the incidence of visual impairment and blindness, and visual trends over time could not be assessed. Only presenting visual acuity was measured and not best corrected. Additionally, are researching found that some data were missing, particularly from respondents who were older, female, members of racial and ethnic groups other than non-Hispanic White, and less educated and those who had lower incomes.