Estimates of Incidence and Prevalence of Visual Impairment, Low Vision, and Blindness in the United States

Abstract

Importance: Updated estimates of the prevalence and incidence rates of low vision and blindness are needed to inform policy makers and develop plans to meet the future demands for low vision rehabilitation services.

Objective: To provide updated estimates of the incidence and prevalence of low vision and blindness in the United States.

Design, setting, and participants: Visual acuity measurements as a function of age from the 2007-2008 National Health and Nutrition Examination Survey, with representation of racial and ethnic groups, were used to estimate the prevalence and incidence of visual impairments. Data from 6016 survey participants, ranging in age from younger than 18 years to older than 45 years, were obtained to estimate prevalence rates for different age groups. Incidence and prevalence rates of low vision (best-corrected visual acuity [BCVA] in the better-seeing eye of <20/40 and <20/60) and blindness (BCVA of ≤20/200) in older adults were estimated from exponential models, fit to prevalence rates as a function of age (specified in 5-year age bins). The prevalence and annual incidence of low vision and blindness in the United States were estimated, using the 2010 US census data by age, from the rate models applied to the census projections for 2017, 2030, and 2050. Data were collected from November 1, 2007, to October 31, 2008. Data analysis took place from March 31, 2016, to March 19, 2017.

Main outcomes and measures: Prevalence and incidence rates of low vision and blindness in the United States.

Results: Of the 6016 people in the study, 1714 (28.4%) were younger than 18 years of age, 2358 (39.1%) were 18 to 44 years of age, and 1944 (32.3%) were 45 years of age or older. There were 2888 male (48%) and 3128 female (52%) participants. The prevalence of low vision and blindness for older adults (≥45 years) in the United States in 2017 is estimated to be 3 894 406 persons (95% CI, 3 034 442-4 862 549 persons) with a BCVA less than 20/40, 1 483 703 persons (95% CI, 968 656-2 370 513 persons) with a BCVA less than 20/60, and 1 082 790 persons (95% CI, 637 771-1 741 864 persons) with a BCVA of 20/200 or less. The estimated 2017 annual incidence (projected from 2010 census data) of low vision and blindness among older adults (≥45 years) in the United States is 481 970 persons (95% CI, 375 541-601 787 persons) with a BCVA less than 20/40, 183 618 persons (95% CI, 119 878-293 367 persons) with a BCVA less than 20/60, and 134 002 persons (95% CI, 83 383-215 567 persons) with a BCVA of 20/200 or less. The total annual incidence for each BCVA criterion is 12.4% of the total prevalence.

Conclusions and relevance: Low vision and blindness affect a substantial portion of the older population in the United States. Estimates of the prevalence and annual incidence of visual impairment assist policy planners in allocating and developing resources for this life-changing loss of function.

Figure 1.. Annual Mortality Rate vs Age

Solid circles indicate the Centers for Disease Control and Prevention estimates of annual mortality rate in the US population as a function of age. The curve fit to the data is generated by the function in m(t) = 6 × 10⁻⁵ exp (0.082t), where m refers to annual mortality rate and t refers to age.

Figure 2.. Prevalence Rate vs Age for 3 Best-Corrected Visual Acuity (BCVA) Levels

The solid line is log_e prevalence rate vs age with the slope fixed to 0.087 for all BCVA levels. This figure illustrates how well the model fits the 3 data sets after the data are adjusted to equate the intercepts.

Figure 3.. Prevalence Rate vs Age for 3 Best-Corrected Visual Acuity (BCVA) Criteria

Solid circles indicate the fit of the exponential model to the National Health and Nutrition Examination Survey prevalence rate vs age for the BCVA criteria of less than 20/40 (A), less than 20/60 (B), and 20/200 or less (C), with the rate constant constrained to 0.087. Dotted lines bound the 95% CI for the estimated function (indicated by solid lines). Open circles in panels A and C are estimates from the Congdon et al study and are plotted for comparison.