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Prevalence of Visual Acuity Loss or Blindness in the USA Bayesian Meta-analysis

Educational Objective
To produce estimates of visual acuity (VA) loss and blindness by age, sex, race/ethnicity, and US state.
1 Credit CME
Key Points

Question  How many people in the US are living with uncorrectable visual acuity loss or blindness?

Findings  This bayesian meta-analysis generated an estimate that, in 2017, there were 7.08 million people living with visual acuity loss, of whom 1.08 million were living with blindness.

Meaning  Per this study, uncorrectable visual acuity loss and blindness are even larger drivers of health burden in the US than was previously known.

Abstract

Importance  Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US.

Objective  To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state.

Data Sources  Data from the American Community Survey (2017), National Health and Nutrition Examination Survey (1999-2008), and National Survey of Children’s Health (2017), as well as population-based studies (2000-2013), were included.

Study Selection  All relevant data from the US Centers for Disease Control and Prevention’s Vision and Eye Health Surveillance System were included.

Data Extraction and Synthesis  The prevalence of visual acuity loss or blindness was estimated, stratified when possible by factors including US state, age group, sex, race/ethnicity, and community-dwelling or group-quarters status. Data analysis occurred from March 2018 to March 2020.

Main Outcomes or Measures  The prevalence of visual acuity loss (defined as a best-corrected visual acuity greater than or equal to 0.3 logMAR) and blindness (defined as a logMAR of 1.0 or greater) in the better-seeing eye.

Results  For 2017, this meta-analysis generated an estimated US prevalence of 7.08 (95% uncertainty interval, 6.32-7.89) million people living with visual acuity loss, of whom 1.08 (95% uncertainty interval, 0.82-1.30) million people were living with blindness. Of this, 1.62 (95% uncertainty interval, 1.32-1.92) million persons with visual acuity loss are younger than 40 years, and 141 000 (95% uncertainty interval, 95 000-187 000) persons with blindness are younger than 40 years.

Conclusions and Relevance  This analysis of all available data with modern methods produced estimates substantially higher than those previously published.

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Article Information

Accepted for Publication: January 26, 2021.

Published Online: May 13, 2021. doi:10.1001/jamaophthalmol.2021.0527

Corresponding Author: Abraham D. Flaxman, PhD, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Seattle, WA 98121 (abie@uw.edu).

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Flaxman AD et al. JAMA Ophthalmology.

Author Contributions: Dr Flaxman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Flaxman, Wittenborn, Gulia, Saaddine, Rein.

Acquisition, analysis, or interpretation of data: Flaxman, Wittenborn, Robalik, Gulia, Gerzoff, Lundeen, Rein.

Drafting of the manuscript: Flaxman, Wittenborn, Robalik, Gulia, Gerzoff, Rein.

Critical revision of the manuscript for important intellectual content: Flaxman, Wittenborn, Gulia, Lundeen, Saaddine, Rein.

Statistical analysis: Flaxman, Wittenborn, Robalik, Gulia, Gerzoff.

Obtained funding: Wittenborn, Rein.

Administrative, technical, or material support: Wittenborn, Gulia, Lundeen, Rein.

Supervision: Wittenborn, Lundeen, Saaddine, Rein.

Conflict of Interest Disclosures: Dr Flaxman reported grants from NORC as a subcontract from a US Centers for Disease Control and Prevention during the conduct of the study; payments from Janssen, IHME, SwissRe, and Merck for Mothers for assistance in analysis and interpretation of licensed data previously produced by IHME; and payment from the startup Agathos Ltd for advising outside the submitted work. Dr Rein reported grants from the US Centers for Disease Control and Prevention Vision Health Initiative during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by funding from the US Centers for Disease Control and Prevention Vision Health Initiative (cooperative agreement U01DP006074, “Establish a Vision and Eye Health Surveillance System for the Nation”).

Role of the Funder/Sponsor: As coauthors, employees of the funding organization (Drs Lundeen and Saaddine) participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additionally, the manuscript was reviewed and approved by the US Centers for Disease Control and Prevention’s scientific clearance process.

Group Information: The Vision and Eye Health Surveillance System Study Group members are listed in Supplement 2.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

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