An alarming number of visual impairment cases arise from elderly patients failing to get proper corrective eyewear. Photo: Anthony Metcalfe/Unsplash.

A new study published in JAMA Ophthalmology offers a sobering look at the extent of vision problems among Medicare beneficiaries, finding that 27.8% of those 71 years old or older experience some form of visual impairment (VI).

The researchers explained that these new, national epidemiological estimates were much needed, as existing ones outlining the prevalence in the US were at least 14 years old. Also updated were the methods of measurement, as prior estimates were based on self-reported data and measures of visual function.

The report included tablet-based test of distance and near visual acuity and contrast sensitivity with habitual correction. Out of 3026 patients included, distance visual acuity impairments were seen in 10.3%, near acuity impairments in 22.3% and contrast sensitivity impairments in 10.0%. The finding that more than one quarter of those 71 years or older had some form of visual impairment was higher than previous estimates, the authors noted in their paper. All VI types were additionally linked to older age and lower education and income.

Being of any non-white ethnicity was also correlated with near VI and contrast sensitivity impairments; this was especially greater in non-Hispanic Black and Hispanic populations. Despite this observation, race and ethnicity were not associated with visual function measures, suggesting that “the observed differences between racial and ethnic groups may be driven by socioeconomic factors like education and income,” the authors of the study relate.¹

The authors draw attention to the finding that most near VI observed in this older population can be treated with reading glasses, an inexpensive and readily available option. Most distance VI can similarly be treated with glasses. And despite these relatively easy fixes, Medicare—the primary insurer of older adults—does not provide eyeglass benefit except after cataract surgery.

The authors of the study urge others to keep in mind that “understanding the epidemiology of VI and blindness in this population is critical because adults 85 years and older are the fastest growing age group in the United States and may also be at high risk for such downstream sequelae of VI as injurious falls, depression, cognitive decline and early mortality.”¹

In an invited commentary on the study by the same journal, one author further highlights the importance of the original study’s updated estimations. The author relates that without surveillance data, it is not possible to tell if improving access has worked or if there are other adverse trends at play.

They do make sure to note of the limitations of the tablet-based tests used to determine data, such as the lighting conditions and lack of standardization for near vision testing distance. But, even with these considered, the author finds the data startling because “there is such a high prevalence of near visual acuity impairment.”²

In a similar vein, they bring up the point that this should not happen when reading glasses are inexpensive. From this, they bring up potential reasons for this trend, such as the cost being a hurdle for this population, failing on educating the population of visual needs for the elderly, resulting in lack of usage and smartphones and other screens’ ability to increase font size somewhat masking the extent of the impairment. 

The author of the commentary agrees with the authors of the study—suggesting as an action plan that “if income and education are the main drivers behind the greater prevalence of visual impairment in older individuals, then public policies or outreach programs aimed at providing access to inexpensive reading glasses […] and increased 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.”²

1. Killeen OJ, De Lott LB, Zhou Y, et al. Population prevalence of vision impairment in US adults 71 years and older. JAMA Ophthalmol. January 12, 2023. [Epub ahead of print]. 2. Coleman AL. The importance of public health surveillance for vision impairment in older adults. JAMA Ophthalmol. January 12, 2023. [Epub ahead of print].