The number of adults in the United States with blindness or low vision will increase substantially over the next 35 years as a result of shifting demographics and an aging population, according to a new analysis from the National Eye Institute, published online May 19 in JAMA Ophthalmology. However, routine vision screening and early intervention could reduce the prevalence substantially.
In 2015, the overall estimated prevalence of legal blindness and visual impairment (VI) in the United States among adults aged 40 years and older was 0.68% (approximately 1.02 million adults) and 2.14% (approximately 3.22 million adults), respectively, according to a pooled analysis of data from six major population-based studies. (VI was defined as the best-corrected visual acuity less than 20/40 in the better-seeing eye.)
"By age, the largest proportion of VI was among those 80 years and older (1.61 million of 3.22 million [50.0%], followed by those aged 70 to 79 years (24.2%), 60 to 69 years (16.1%), 50 to 59 years (5.3%), and 40 to 49 years (4.0%)," the authors report.
Using geographic and demographic information from the most recent census and data from studies funded by the National Eye Institute, the researchers estimate a per decade relative increase of 24.6% for VI and 20.6% for blindness during the next 35 years.
By 2050, they report, 2.01 million adults will be legally blind and 6.95 million will have VI. In addition, another 16.4 million are expected to have VI resulting from uncorrected refractive error such as myopia or hyperopia that can be fixed with glasses, contacts, or surgery.
By age group, the projected proportion of adults with VI in 2050 ranges from 63.3% for adults 80 years and older to 2.3% for those 40 to 49 years old.
"This increase in VI and blindness results from an aging population," the authors explain. "All members of the Baby Boomer generation (born in 1946–1964) will reach the ages of 65 years and older by 2029. Furthermore, the proportion of the US population 75 years and older will increase to 12% by 2050."
An assessment of the projected prevalence rates by race and gender between 2015 and 2050 indicates that non-Hispanic white adults and women will "remain the largest demographics with respect to absolute numbers of VI and blindness," the authors write. "Women are projected to outnumber men by 30% to 32% with respect to VI and by 6% to 11% with respect to blindness."
The estimated prevalence of VI among African-American individuals is projected to increase from 15.2% in 2015 to 16.3% in 2050. Among Hispanic adults, the prevalence is projected to rise from 9.9% to 20.3%, the authors write.
Looking at the current and projected prevalence rates by geography, the highest per capita rate for VI is in Florida, followed by Hawaii, and the highest per capita prevalence for blindness is in Mississippi, followed by Louisiana. These projections are expected to remain unchanged from 2015 to 2050, according to the authors.
Early Screening Could Help
The investigators also estimated current and projected rates of individuals with VI resulting from uncorrected refractive error (URE). "We estimate that up to 71.9% of US individuals with VI (8.24 million estimated with URE/3.22 million with best corrected RE + 8.24 million with URE) and 22.1% of individuals with blindness could experience clinical improvement with vision screening followed by proper refractive correction," they write.
The actual and quality-of-life costs of URE, the leading cause of VI in the United States and worldwide, are high, the authors explain. The diminished capacity to complete vision-related daily tasks can compromise quality of life. "It also contributes to the annual cost of VI and blindness to the US economy, estimated at $5.48 billion in medical and informal care," they note.
Vision screening for refractive error and early eye disease could potentially "prevent a high proportion of unnecessary vision loss and blindness and promote better quality of life with age," the authors state, noting that targeting screening programs to high-risk populations, such as older non-Hispanic white women, might have the greatest effect.
In addition to quality-of-life enhancements, direct and indirect costs associated with blindness and VI would be reduced. "[T]he relatively low cost of vision screening and refractive correction may result in lower costs to the US economy for medical services and lost productivity related to VI and blindness," the authors write.
The study was funded in part by grants from the National Eye Institute, National Institutes of Health. The authors have disclosed no relevant financial relationships.
JAMA Ophthalmol. Published online May 19, 2016. Full text
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Cite this: Blindness, Vision Problems Expected to Double by 2050 in US - Medscape - May 20, 2016.