Vision Impairment and Blindness Prevalence in the United States: Variability of Vision Health Responses across Multiple National Surveys

Abstract

Purpose: To support survey validation efforts by comparing prevalence rates of self-reported and examination evaluated presenting visual impairment (VI) and blindness measured across national surveys.

Design: Cross-sectional comparison.

Participants: Participants in the 2016 American Community Survey, the 2016 Behavioral Risk Factor Surveillance System, the 2016 National Health Interview Survey, the 2005-2008 National Health and Nutrition Examination Survey (NHANES), and the 2016 National Survey of Children's Health.

Methods: We estimated VI and blindness prevalence rates and confidence intervals for each survey measure and age group using the Clopper-Pearson method. We used inverse variance weighting to estimate the central tendency across measures by age-group, fitted trend lines to age-group estimates, and used the trend-line equations to estimate the number of United States persons with VI and blindness in 2016. We compared self-report estimates with those from NHANES physical evaluations of presenting VI and blindness.

Main outcome measures: Variability of prevalence estimates of VI and blindness.

Results: Self-report estimates of blindness varied between 0.1% and 5.6% for those younger than 65 years and from 0.6% to 16.6% for those 65 or older. Estimates of VI varied between 1.6% and 24.8% for those younger than 65 years and between 2.2% and 26.6% for those 65 years or older. For summarized survey results and NHANES physical evaluation, prevalence rates for VI increased significantly with increasing age group. Blindness prevalence increased significantly with increasing age group for summarized survey responses but not for NHANES physical examination. Based on extrapolations of NHANES physical examination data to all ages, we estimated that in 2016, 23.4 million persons in the United States (7.2%) had VI or blindness, an evaluated presenting visual acuity of 20/40 or worse in the better-seeing eye before correction. Based on weighted self-reported surveys, we estimated that 24.8 million persons (7.7%) had presenting VI or blindness.

Conclusions: Prevalence rates of VI and blindness obtained from national survey measures varied widely across surveys and age groups. Additional research is needed to validate the ability of survey self-report measures of VI and blindness to replicate results obtained through examination by an eye health professional.

Keywords: ACS; BRFSS; NHANES; NHIS; NSCH; blindness; low vision; presenting visual acuity; prevalence; self-reported vision problems; survey; vision; vision impairment.

Figure 1.

Graph showing blindness prevalence as measured by each national survey measure plotted by survey-weighted average age and a weighted prevalence using inverse weighting across self-report questions (SURVEYS). Average age from American Fact Finder Census data was used to plot Behavioral Risk Factor Surveillance System (BRFSS) data. Two trend lines—SURVEYS and presenting acuity from the National Health and Nutrition Examination Survey (NHANES)—were fitted to the weighted prevalence of self-report questions and physical evaluation of presenting visual acuity in the better-seeing eye of 20/200 or worse. ACS = American Community Survey; NHIS = National Health Interview Survey; NSCH = National Survey of Children’s Health.

Figure 2.

Graph showing vision impairment prevalence as measured by each national survey measure plotted by survey-weighted average age and a weighted prevalence using inverse weighting across self-report questions (SURVEYS). Two trend lines—SURVEYS and presenting acuity from the National Health and Nutrition Examination Survey (NHANES)—were fitted to the weighted prevalence of self-report questions and physical evaluation of presenting visual acuity between 20/40 and 20/200 in the better-seeing eye. NHIS — National Health Interview Survey.