As the American population ages, an exponentially large number of older adults will face the staggering impacts of blindness and significant vision loss, their negative effect on quality of life, and sobering correlations between vision loss and social determinants of health.
In 2015, there were approximately 12.44 million Americans older than age 40 who were blind or visually impaired. By 2050, this number is projected to increase by 118%, challenging the lives of more than 27 million adults ages 40 and older.
According to the National Eye Institute’s strategic plan, Vision for the Future 2021–2025, “Vision loss and blindness are a leading cause of disability in the United States. The public health and economic impacts are enormous, particularly when considering associated problems such as lost productivity, social isolation, and acceleration of dementia. There are often significant barriers to accessibility of vision care for high-risk groups such as elderly people … communities of color, and those in rural or urban underserved communities.”
Although 7.3% of older Americans in the United States report blindness or low vision, there is a higher prevalence of vision loss reported among women, certain ethnic groups, and adults ages 80 and older. Recognizing that the prevalence of vision loss varies significantly dependent upon geographic, demographic, and other factors, VisionServe Alliance and The Ohio State University College of Optometry recently partnered on the Big Data Report Project.
‘We have limited resources to address public health initiatives when considering things like vision.’
The data sets analyzed are from the CDC’s Behavioral Risk Factor Surveillance System and U.S. Census Bureau’s American Community Survey. The resulting national and state Big Data Report briefings identify the complexities of vision loss and are the only studies that analyze statewide data to comprehensively describe Americans ages 65 and older who are blind or have low vision.
Why is this so important? Dean VanNasdale, associate professor at The Ohio State University College of Optometry explained, “We have limited resources to address public health initiatives when considering things like vision. Determining where the most immediate needs are turns out to be very helpful, so you can start to direct scarce resources to groups that could benefit the most.”
Significant Impact of Blindness and Vision Loss
Blindness and low vision profoundly affect older people and those who care for and about them. Vision loss makes everyday activities such as climbing stairs, crossing the street, driving a car, riding a bus, cooking dinner, cleaning the house, paying bills, and identifying prescribed medications difficult or impossible. Falls or a fear of falling may further compromise safety and independence. Blindness and low vision can cause isolation and lead to anxiety and depression, forcing people to stay home when they would rather be with family and friends or connecting with others facing similar struggles.
Although many older adults facing blindness and low vision wish to continue working, job loss is common, as is having to relinquish valued commitments, including serving as primary caregivers for other family members.
As of 2017, only 4.3% of eligible adults received vision rehabilitation services.
Many older adults with blindness and low vision have reduced education levels and income. Thirty-seven percent of older adults with vision loss have annual incomes of less than $20,000, with many living below the poverty level.
Nationally, the annual financial burden of major adult visual disorders is more than $35 billion ($16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses), with an annual government budget impact of $13.7 billion.
Vision Rehabilitation Strategies
Research confirms that people with vision loss are less likely to access routine medical care and eye care. But when they do, once vision correction, vision surgeries and other medical interventions achieve maximum results, the next level of intervention—Vision Rehabilitation—can vastly improve safety, independence and quality of life. A growing network of public and private agencies provides vision rehabilitation services to support communication (including assistive technology for smartphones and computers), independent living skills (personal and medical care and medication management), travel and mobility skills, adaptive equipment, self-advocacy and more. Most vision rehabilitation services involve eye reports or low vision evaluations from a referring physician.
Although most adults with vision loss would benefit significantly from vision rehabilitation services, as of 2017, only 4.3% of eligible adults received them. In addition to facilitating aging in place, vision evaluation and rehabilitation can eliminate or delay the need for institutionalization and its attendant economic burden.
Crafting a timely and efficient response to the varied health and rehabilitation needs of older people with blindness and low vision requires thoughtful, innovative and seamlessly integrated strategies on multiple fronts, including but not limited to eye care providers, the aging network, public health, transportation, housing agencies and more.
As America’s older population increases, so does the urgent need to reframe aging and vision loss so that everyone who needs vision rehabilitation services can understand the value of these life-changing services and access them.
For more information about Vision Rehabilitation resources and services, contact VisionServe Alliance at info@visionservealliance.org.
John Crews, DPA, is senior data scientist for VisionServe Alliance. He retired from the CDC, where he was lead scientist in the Disability and Health Branch in the National Center on Birth Defects and Developmental Disabilities, and later senior scientist with the Vision Health Initiative in the Division of Diabetes Translation.
Photo credit: Shutterstock/ThomsonD
