Vision loss is a significant burden for patients and for society as a whole, with studies citing increased incidences of depression, falls, adverse health outcomes, mortality and lower quality of life. A large-scale study recently published in Ophthalmology adds to the growing body of evidence that the socioeconomically disadvantaged have a substantial need for vision-related public health interventions.

The number of people experiencing blindness varies in states across the country, as shown in the map above. In data from the IRIS registry, higher prevalence rates were reported among those older than 85, smokers, those living in rural locations and those with Medicaid, Medicare or no insurance vs. commercial insurance. Black and Hispanic individuals also had higher odds of blindness compared with white non-Hispanics. Click image to enlarge.

Using data from the IRIS Registry, researchers retrospectively evaluated associations among patient characteristics, likelihood of blindness and eyecare utilization. The researchers identified patients in the Registry with legal blindness (defined as better-eye distance-corrected vision 20/200 or worse) and visual impairment (defined as vision worse than 20/40).

After mapping vision by state and population characteristics, including demographics and eyecare utilization, the team reported that 6.98% (about 1.3 million) of the more than 19 million 2018 IRIS Registry individuals had visual impairment and 0.98% (about 190,000) had blindness. Likelihood of blindness was highest among those over the age of 85, as well as those who smoked, lived in a rural location and had Medicaid, Medicare or no insurance vs. commercial insurance.

Race also played a factor, with Hispanic and Black patients having higher odds of blindness compared with white non-Hispanic patients. Hispanic and Black patients were also significantly proportionally underrepresented in the IRIS Registry compared with white patients relative to the Census.

The researchers found that overall blindness was less prevalent in the National Health and Nutrition Examination Survey (NHANES) than in the IRIS Registry, but they pointed out that “prevalence in adults aged 60+ was lowest among Black participants in NHANES (0.54%) and second highest among comparable Black adults in IRIS Registry (1.57%).”

“These potential disparities may have substantial impact, since patients with poor vision are at increased risk for falls, depression, inability to drive or live independently and unemployment, as well as increased mortality,” the researchers explained in their paper. “Identifying and addressing the underlying reasons for disproportionately low utilization of eye care and disproportionately high prevalence of blind patients in vulnerable populations will be a critical public health priority.”