Vision Problems in the U.S. Prevalence of Adult Vision Impairment and Age-Related Eye Disease in America 2008 Update to the Fourth Edition Founded in 1908, Prevent Blindness America is the nation's leading volunteer eye health and safety organization dedicated to fighting blindness and saving sight. Focused on promoting a continuum of vision care, Prevent Blindness America touches the lives of millions of people each year through public and professional education, advocacy, certified vision screening, training, community and patient service programs and research. These services are made possible through the generous support of the American public. Together with a network of affiliates, divisions and chapters, Prevent Blindness America is committed to eliminating preventable blindness in the U.S. The National Eye Institute (NEI), a component of the National Institutes of Health (NIH), supports and conducts research aimed at improving the prevention, treatment, and rehabilitation of diseases that affect the eye and vision. The NIH, a Federal government agency, is part of the U.S. Department of Health and Human Services. Research is conducted on the NIH campus in Bethesda, Maryland, and at universities, medical schools, hospitals, and other institutions throughout the United States and abroad. Vision Problems in the U.S. © 2008, 2002 Prevent Blindness America All rights reserved. SECTION 1 VisionImpairment andBlindness The term "blindness" can have many connotations and is difficult to define precisely. To many people, blindness refers to the complete loss of vision with no remaining perception of light. However, this ultimate form of complete blindness is rare. Far more people have permanent loss of some, but not all, of their eyesight. The severity of vision loss can vary widely and may result in equally varying degrees of functional impairment. "Legal blindness" represents an artificial distinction and has little value for rehabilitation, but it is significant in that it determines eligibility for certain disability benefits from the federal government. In the United States, it is typically defined as visual acuity with best correction in the better eye worse than or equal to 20/200 or a visual field extent of less than 20 degrees in diameter. These overly simple criteria for visual impairment are far from comprehensive in defining the visual function deficits that can cause difficulties for daily living tasks. Vision impairment is defined as having 20/40 or worse vision in the better eye even with eyeglasses. People with the least degree of vision impairment may still face challenges in everyday life. For instance, people with vision worse than 20/40 cannot obtain an unrestricted driver's license in most states. Almost everyone with blindness or vision impairment can benefit from vision rehabilitation, which can help make the most of whatever vision remains. Unfortunately, blindness and vision impairment represent a significant burden, not only to those affected by sight loss, but to our national economy as well. Prevent Blindness America's 2007 study, The Economic Impact of Vision Problems: The Toll of Major Adult Eye Disorders, Visual Impairment and Blindness on the U.S. Economy estimates the costs associated with adult vision problems in the United States at $51.4 billion. Blindness, as defined above, affects more than one million Americans age 40 and older (see table on pages 8 and 9). The visually impaired, including those who are blind, total more than 3.6 million older Americans (see table on pages 6 and 7). Blindness affects Blacks more frequently than Whites and Hispanics (see chart on page 5). Hispanics, however, have higher rates of vision impairment than other races. The prevalence of blindness and vision impairment increases rapidly in the later years, particularly after age 75. 4 Vision Impairment and Blindness Estimated Specific Prevalence Rates for Vision Impairment and Blindness 0.24 0.22 0.20 Prevalence Rate 0.18 White 0.16 Black 0.14 Hispanic 0.12 Other Vision Impairment 0.10 0.08 0.06 0.04 0.02 plu Age 80 75 -7 9 4 -7 70 65 -6 9 4 -6 60 55 -5 9 4 -5 50 40 -4 9 s 0.00 0.10 0.09 0.08 White 0.06 Black Hispanic 0.05 Other 0.04 Blindness 0.03 0.02 0.01 plu Age 80 -7 9 75 4 -7 70 9 -6 65 -6 4 60 9 -5 55 -5 4 50 -4 9 s 0.00 40 Prevalence Rate 0.07 Vision Impairment and Blindness 5 Estimated Number of Cases of Vision Impairment (including Blindness) in the U.S. Population Age 40 and Older by State, Race and Sex State Total U.S. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 6 Vision Impairment and Blindness Total Female Male White Black 3,638,186 52,935 4,692 67,811 33,898 447,807 43,715 50,957 10,102 7,061 275,412 77,450 40,343 14,999 154,097 73,682 43,716 35,912 46,133 49,218 17,655 65,204 89,861 123,101 62,252 31,505 72,234 12,012 22,959 23,018 15,109 118,155 23,122 259,421 94,758 9,495 148,515 44,909 46,769 193,167 16,566 46,972 11,162 65,673 210,636 19,289 7,664 81,444 74,493 24,651 70,901 5,548 2,380,848 34,399 2,943 43,406 22,388 286,641 28,557 34,242 6,515 4,139 175,135 50,149 25,504 9,727 102,057 49,506 29,648 23,924 31,050 31,266 11,802 41,564 60,970 80,826 41,618 20,217 48,018 7,849 15,336 14,168 10,022 78,243 14,872 171,568 62,098 6,401 98,864 29,472 30,712 130,152 11,316 30,160 7,474 43,632 135,861 12,311 5,085 52,555 48,709 16,506 47,650 3,592 1,257,338 18,536 1,749 24,405 11,510 161,166 15,158 16,715 3,587 2,922 100,277 27,301 14,839 5,272 52,040 24,176 14,068 11,988 15,083 17,952 5,853 23,640 28,891 42,275 20,634 11,288 24,216 4,163 7,623 8,850 5,087 39,912 8,250 87,853 32,660 3,094 49,651 15,437 16,057 63,015 5,250 16,812 3,688 22,041 74,775 6,978 2,579 28,889 25,784 8,145 23,251 1,956 2,829,010 40,545 2,665 54,371 29,142 255,851 35,939 45,308 8,323 1,875 217,181 56,253 4,129 14,057 122,765 67,013 42,516 32,802 42,638 34,645 17,361 46,579 80,917 105,210 58,867 21,997 64,498 11,167 21,668 17,033 14,675 91,913 12,814 188,443 73,944 9,133 131,722 35,853 42,504 174,171 15,280 34,626 10,432 56,354 139,023 17,255 7,497 61,953 62,717 23,506 66,728 5,141 303,016 11,150 101 1,239 3,781 20,236 1,184 2,525 1,296 4,604 18,809 17,172 123 25 16,342 4,562 405 1,264 2,683 12,265 44 12,728 2,809 12,916 763 8,778 5,573 18 482 1,288 55 10,130 318 27,377 16,428 2 12,897 2,069 445 12,851 366 11,138 22 7,778 18,671 92 20 13,320 1,341 737 1,739 27 Hispanic 226,139 437 92 7,110 366 63,380 4,425 1,744 167 258 33,257 1,564 439 370 6,811 1,059 352 874 297 1,053 67 1,399 2,037 1,691 506 267 679 109 383 1,943 111 7,732 7,128 21,297 1,183 36 1,309 731 982 2,221 466 452 56 562 43,497 832 54 1,531 1,640 134 827 213 Other 280,021 803 1,834 5,091 609 108,340 2,167 1,380 316 324 6,165 2,461 35,652 547 8,179 1,048 443 972 515 1,255 183 4,498 4,098 3,284 2,116 463 1,484 718 426 2,754 268 8,380 2,862 22,304 3,203 324 2,587 6,256 2,838 3,924 454 756 652 979 9,445 1,110 93 4,640 8,795 274 1,607 167 White Female White Male Black Female Black Male Hisp. Female Hisp. Male 1,904,562 27,655 1,649 35,084 19,774 169,324 23,866 30,950 5,574 1,236 140,165 38,552 2,588 9,167 84,373 45,902 28,976 22,152 29,162 23,506 11,623 31,384 55,684 71,256 39,656 15,193 43,752 7,298 14,605 10,679 9,763 62,757 8,375 128,590 50,473 6,164 89,823 23,914 28,121 119,480 10,552 23,482 6,989 38,560 92,856 11,105 4,988 41,816 41,526 15,850 45,238 3,344 924,448 12,890 1,016 19,287 9,368 86,527 12,073 14,358 2,749 639 77,016 17,701 1,541 4,890 38,392 21,111 13,540 10,650 13,476 11,139 5,738 15,195 25,233 33,954 19,211 6,804 20,746 3,869 7,063 6,354 4,912 29,156 4,439 59,853 23,471 2,969 41,899 11,939 14,383 54,691 4,728 11,144 3,443 17,794 46,167 6,150 2,509 20,137 21,191 7,656 21,490 1,797 156,904 5,977 42 570 2,026 10,025 549 1,310 657 2,506 9,398 9,146 46 8 8,416 2,313 193 624 1,393 6,315 18 6,503 1,425 6,511 342 4,584 2,919 7 235 573 21 5,251 144 14,876 8,839 1 6,590 1,029 212 6,872 173 5,901 7 4,106 9,491 34 6 6,835 587 402 862 10 146,112 5,173 59 669 1,755 10,211 635 1,215 639 2,098 9,411 8,026 77 17 7,926 2,249 212 640 1,290 5,950 26 6,225 1,384 6,405 421 4,194 2,654 11 247 715 34 4,879 174 12,501 7,589 1 6,307 1,040 233 5,979 193 5,237 15 3,672 9,180 58 14 6,485 754 335 877 17 145,130 268 55 4,487 215 40,605 2,774 1,138 101 178 21,797 931 278 214 4,130 626 212 534 178 710 44 921 1,332 1,025 300 165 422 68 224 1,191 71 5,059 4,524 14,506 687 23 810 430 587 1,400 311 275 36 342 27,729 516 34 983 977 85 493 130 81,009 169 37 2,623 151 22,775 1,651 606 66 80 11,460 633 161 156 2,681 433 140 340 119 343 23 478 705 666 206 102 257 41 159 752 40 2,673 2,604 6,791 496 13 499 301 395 821 155 177 20 220 15,768 316 20 548 663 49 334 83 Other Female 174,252 499 1,197 3,265 373 66,687 1,368 844 183 219 3,775 1,520 22,592 338 5,138 665 267 614 317 735 117 2,756 2,529 2,034 1,320 275 925 476 272 1,725 167 5,176 1,829 13,596 2,099 213 1,641 4,099 1,792 2,400 280 502 442 624 5,785 656 57 2,921 5,619 169 1,057 108 Other Male 105,769 304 637 1,826 236 41,653 799 536 133 105 2,390 941 13,060 209 3,041 383 176 358 198 520 66 1,742 1,569 1,250 796 188 559 242 154 1,029 101 3,204 1,033 8,708 1,104 111 946 2,157 1,046 1,524 174 254 210 355 3,660 454 36 1,719 3,176 105 550 59 State Total U.S. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Vision Impairment and Blindness 7 Estimated Number of Cases of Blindness in the U.S. Population Age 40 and Older by State, Race and Sex State Total U.S. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 8 Vision Impairment and Blindness Total Female Male 1,035,100 16,232 1,336 18,145 9,929 120,684 11,857 14,564 2,999 2,547 75,132 24,022 11,464 4,169 44,885 21,210 12,359 10,205 13,225 15,414 4,935 20,140 25,531 36,295 17,664 10,009 20,958 3,360 6,490 6,339 4,245 33,721 5,509 73,787 28,636 2,671 43,417 12,786 13,123 55,869 4,691 14,639 3,145 19,383 55,635 5,308 2,142 24,595 21,081 6,942 20,147 1,527 652,292 9,709 829 11,464 6,296 74,639 7,621 9,607 1,834 1,171 45,801 14,186 7,213 2,718 28,444 13,947 8,412 6,729 8,740 8,802 3,322 11,796 17,166 22,859 11,819 5,734 13,558 2,211 4,322 3,772 2,830 21,461 3,417 46,436 17,533 1,817 27,980 8,251 8,633 36,829 3,185 8,544 2,120 12,307 33,747 3,388 1,433 14,815 13,720 4,630 13,488 991 382,808 6,523 507 6,681 3,633 46,045 4,236 4,957 1,165 1,376 29,331 9,836 4,251 1,451 16,441 7,263 3,947 3,476 4,485 6,612 1,613 8,344 8,365 13,436 5,845 4,275 7,400 1,149 2,168 2,567 1,415 12,260 2,092 27,351 11,103 854 15,437 4,535 4,490 19,040 1,506 6,095 1,025 7,076 21,888 1,920 709 9,780 7,361 2,312 6,659 536 White 794,099 11,254 744 15,143 8,108 72,218 10,088 12,841 2,322 530 60,705 15,676 1,163 3,944 34,594 18,802 12,001 9,252 11,889 9,659 4,856 13,122 22,854 29,571 16,620 6,102 18,072 3,129 6,097 4,705 4,124 25,922 3,575 53,031 20,611 2,574 37,008 9,989 11,972 49,057 4,334 9,630 2,941 15,700 38,825 4,826 2,101 17,338 17,705 6,539 18,797 1,435 Black Hispanic 129,790 4,686 49 558 1,592 8,811 534 1,087 563 1,892 8,190 7,412 60 12 6,975 1,956 181 551 1,146 5,252 20 5,536 1,220 5,543 360 3,736 2,367 8 213 577 26 4,329 141 11,494 6,931 1 5,484 900 199 5,374 162 4,727 12 3,321 8,117 46 10 5,710 621 305 769 12 31,009 60 17 987 53 8,693 613 238 23 32 4,470 223 62 54 966 150 50 123 44 141 7 190 281 236 72 37 93 17 55 276 18 1,059 971 2,864 171 3 181 106 139 308 64 64 5 79 5,974 117 4 213 234 18 118 30 Other 80,202 232 526 1,457 176 30,962 622 398 91 93 1,767 711 10,179 159 2,350 302 127 279 146 362 52 1,292 1,176 945 612 134 426 206 125 781 77 2,411 822 6,398 923 93 744 1,791 813 1,130 131 218 187 283 2,719 319 27 1,334 2,521 80 463 50 White Female White Male Black Female Black Male 539,404 7,752 466 9,864 5,560 48,163 6,758 8,843 1,571 354 39,507 10,852 734 2,596 23,985 12,994 8,254 6,305 8,211 6,614 3,280 8,918 15,863 20,209 11,298 4,263 12,374 2,066 4,146 2,980 2,767 17,843 2,359 36,502 14,208 1,754 25,455 6,721 7,993 33,947 3,017 6,597 1,989 10,851 26,169 3,132 1,412 11,815 11,827 4,454 12,865 943 254,695 3,502 278 5,279 2,548 24,055 3,330 3,998 751 176 21,198 4,824 429 1,348 10,609 5,808 3,747 2,947 3,678 3,045 1,576 4,204 6,991 9,362 5,322 1,839 5,698 1,063 1,951 1,725 1,357 8,079 1,216 16,529 6,403 820 11,553 3,268 3,979 15,110 1,317 3,033 952 4,849 12,656 1,694 689 5,523 5,878 2,085 5,932 492 47,246 1,784 13 174 605 3,029 168 397 200 735 2,848 2,795 15 1 2,529 694 59 188 418 1,900 5 1,989 432 1,955 108 1,374 875 1 71 173 6 1,580 42 4,457 2,647 1,966 311 64 2,040 52 1,773 2 1,239 2,881 11 1 2,055 182 118 265 2 82,544 2,902 36 384 987 5,782 366 690 363 1,157 5,342 4,617 45 11 4,446 1,262 122 363 728 3,352 15 3,547 788 3,588 252 2,362 1,492 7 142 404 20 2,749 99 7,037 4,284 1 3,518 589 135 3,334 110 2,954 10 2,082 5,236 35 9 3,655 439 187 504 10 Hisp. Female 15,923 29 8 494 24 4,456 305 125 11 19 2,369 102 31 23 459 69 23 60 21 77 4 100 148 112 33 18 45 8 26 132 9 558 493 1,594 76 2 89 48 65 154 35 29 2 37 3,043 57 2 109 109 9 55 14 Hisp. Male Other Female Other Male 15,086 31 9 493 29 4,237 308 113 12 13 2,101 121 31 31 507 81 27 63 23 64 3 90 133 124 39 19 48 9 29 144 9 501 478 1,270 95 1 92 58 74 154 29 35 3 42 2,931 60 2 104 125 9 63 16 49,719 144 342 932 107 18,991 390 242 52 63 1,077 437 6,433 98 1,471 190 76 176 90 211 33 789 723 583 380 79 264 136 79 487 48 1,480 523 3,883 602 61 470 1,171 511 688 81 145 127 180 1,654 188 18 836 1,602 49 303 32 30,483 88 184 525 69 11,971 232 156 39 30 690 274 3,746 61 879 112 51 103 56 151 19 503 453 362 232 55 162 70 46 294 29 931 299 2,515 321 32 274 620 302 442 50 73 60 103 1,065 131 9 498 919 31 160 18 State Total U.S. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Vision Impairment and Blindness 9 Estimated Prevalence Rates of Vision Impairment and Blindness for Persons Age 40 and Older by State The map above reflects estimated state-by-state prevalence rates of vision impairment, including blindness. The overall national rate is 2.80%. When this rate is applied to the total U.S. population age 40 and older of approximately 130 million, the result indicates that more than 3.6 million older Americans are blind or visually impaired. Eighteen states and the District of Columbia have rates above the national average, while 32 states have rates at or below the average. Hawaii and Rhode Island have the highest rates at 6.83% and 3.27% respectively. Alaska has the lowest rate at 1.77%. The largest majority of states (36 states and DC) are within the 2.5% to 3.5% range. Differences between states are likely due to demographic differences in age, race and/or gender distribution. 10 Vision Impairment and Blindness State Total U.S. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Rate 0.0280 0.0256 0.0177 0.0282 0.0270 0.0304 0.0229 0.0303 0.0264 0.0300 0.0323 0.0218 0.0683 0.0255 0.0280 0.0268 0.0313 0.0295 0.0244 0.0253 0.0263 0.0260 0.0302 0.0270 0.0273 0.0252 0.0274 0.0262 0.0294 0.0233 0.0242 0.0293 0.0273 0.0297 0.0254 0.0316 0.0280 0.0283 0.0285 0.0319 0.0327 0.0249 0.0316 0.0245 0.0237 0.0243 0.0245 0.0244 0.0269 0.0270 0.0279 0.0231 State Alaska Georgia Colorado Wyoming Nevada Texas New Hampshire Utah Kentucky Virginia Tennessee Vermont South Carolina Mississippi Louisiana North Carolina Idaho Alabama Maryland Montana Maine Delaware Indiana Washington Arkansas Michigan West Virginia Minnesota New Mexico Missouri Wisconsin Illinois Ohio Arizona Oklahoma Oregon New Jersey Nebraska Kansas New York District of Columbia Massachusetts Connecticut California Iowa North Dakota South Dakota Pennsylvania Florida Rhode Island Hawaii Rate 0.0177 0.0218 0.0229 0.0231 0.0233 0.0237 0.0242 0.0243 0.0244 0.0244 0.0245 0.0245 0.0249 0.0252 0.0253 0.0254 0.0255 0.0256 0.0260 0.0262 0.0263 0.0264 0.0268 0.0269 0.0270 0.0270 0.0270 0.0273 0.0273 0.0274 0.0279 0.0280 0.0280 0.0282 0.0283 0.0285 0.0293 0.0294 0.0295 0.0297 0.0300 0.0302 0.0303 0.0304 0.0313 0.0316 0.0316 0.0319 0.0323 0.0327 0.0683 Vision Impairment and Blindness 11 Acknowledgements Funding for Vision Problems in the U.S. and the 2008 Update to the Fourth Edition, was provided through a subcontract from the National Eye Institute, National Institutes of Health, and the U.S. Department of Health and Human Services. Research described in this report was conducted by dozens of scientists from all over the world. We gratefully acknowledge the invaluable contribution of data from their work. Prevalence estimates for Vision Problems in the U.S. were created under a grant from Prevent Blindness America to Johns Hopkins University. We offer our appreciation to the investigators: Principal Investigator David S. Friedman, MD, MPH Assistant Professor of Ophthalmology Wilmer Eye Institute Johns Hopkins University Co-investigators Nathan Congdon, MD, MPH Assistant Professor of Ophthalmology Wilmer Eye Institute Johns Hopkins University John Kempen, MD, PhD Assistant Professor of Ophthalmology Wilmer Eye Institute Johns Hopkins University James M. Tielsch, PhD Professor Bloomberg School of Public Health Johns Hopkins University Dr. Tielsch also serves on the board of directors of Prevent Blindness America and was project leader for this publication. The investigators were assisted by staff at ORC Macro International, including: Benita J. O’Colmain, MPH, PhD Wanda Parham, MPA Arlen Rosenthal, MA Adrienne Y. Semidey, MA Saundra Townsend Ceres Wright, BS Text written by John A. Shoemaker 2008 Updates to the Fourth Edition provided by: Kevin D. Frick, PhD Associate Professor Bloomberg School of Public Health Johns Hopkins University Christine S. Spencer, ScD Associate Professor School of Public Affairs University of Baltimore Cover design donated by Saatchi & Saatchi Healthcare Illustrations Soumya Netrabile National Eye Institute 2020 Vision Place Bethesda, MD 20892-3655 (301) 496-5248 www.nei.nih.gov Prevent Blindness America 211 West Wacker Drive Suite 1700 Chicago, Illinois 60606 800-331-2020 www.preventblindness.org