To evaluate associations of patient characteristics with United States eyecare utilization and likelihood of blindness.
Retrospective observational study.
19,546,016 patients with 2018 visual acuity (VA) records in American Academy of Ophthalmology IRIS® Registry (Intelligent Research In Sight).
Legal blindness (20/200 or worse) and visual impairment (VI) (worse than 20/40) were identified from corrected distance acuity in the better-seeing eye and stratified by patient characteristics. Multivariable logistic regression models evaluated blindness and visually impaired (VI) associations. Blindness was mapped by state and compared to population characteristics. Eyecare utilization was analyzed by comparing population demographics to US Census estimates, and proportional demographic representation among blind/VI patients versus a nationally-representative US population sample (National Health and Nutritional Examination Survey, NHANES).
Prevalence and odds ratios for VI and blindness; proportional representation in IRIS Registry, Census, and NHANES by patient demographics.
VI was present in 6.98% (n=1,364,935) and blindness in 0.98% (n=190,817) of IRIS Registry patients. Adjusted odds of blindness were highest among patients 85+ years old (OR=11.85, 95%CI=10.33-13.59, versus 0-17 year-olds). Blindness was also positively-associated with smoking (OR=1.13, 95%CI=1.08-1.17), rural location (OR=1.09, 95%CI=1.04-1.14) and Medicaid (OR=3.85, 95%CI=3.57-4.15), Medicare (OR=1.66, 95%CI=1.53-1.82), or no insurance (OR=1.77, 95%CI=1.37-2.27) versus commercial insurance. Hispanic (OR=1.59, 95%CI=1.46-1.74) and Black patients (OR=1.73, 95%CI=1.63-1.84) had higher odds of blindness versus white non-Hispanic patients. Proportional representation in IRIS Registry relative to Census was higher for white than Hispanic (2-4 fold) or Black patients (11-85%) (p<0.001). Blindness was overall less prevalent in NHANES than IRIS Registry; however, prevalence in adults aged 60+ was lowest among Black participants in NHANES (0.54%) and second highest among comparable Black adults in IRIS Registry (1.57%).
Legal blindness from low VA was present in 0.98% of IRIS patients and associated with smoking, rural location, public or no insurance, and older age. Compared to US Census estimates, minorities may be underrepresented among ophthalmology patients, and compared to NHANES population estimates, Black individuals may be overrepresented among blind IRIS Registry patients. These findings provide a snapshot of US ophthalmic care and highlight need for initiatives to address disparities in utilization and blindness.
Copyright © 2023. Published by Elsevier Inc.
