Abstract
Purpose:
To examine changes over time in the number and characteristics of US adults who reported moderate-to-severe visual impairment (MSVI) and access to eye care using the 2010 Behavioral Risk Factor Surveillance System (BRFSS) data, with a preliminary longitudinal examination for two states between 2007 and 2010.
Methods:
Eye disease and access to eye care, as reported by 24,509 US adults who completed the 2010 BRFSS Visual Impairment and Access to Eye Care Module, was examined for the rate of visual impairment, annual eye exam, eye insurance, and prevalence of eye diseases (cataract, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR)). Differences in annual eye examination in those with MSVI were analyzed by age, race, education, and income. Rate of annual eye exam was compared to prior studies and within two states with multi-year data from 2007-2010.
Results:
Overall prevalence of visual impairment was 17.5% with subjects reporting greater difficulty with distance than near vision (6.0% vs. 14.9%). Rate of annual eye examination was 61.8%, with 58.6% reporting having insurance including ophthalmic care. Compared to the overall rate, a higher percentage of patients with DR reported having a dilated examination in the past year (74.4%). Prevalence of cataracts, glaucoma, AMD, and DR were 12.5%, 4.3%, 3.9%, and 19.9% respectively. Differences in annual eye exams for those with MSVI were observed by age (≥65 years; OR=2.74, CI=2.18-3.44), income (≥$35,000: OR=1.43, CI=1.06-1.64), and education (<high school: OR= 0.60, CI= 0.41-0.87). Minority populations were more likely to report receiving an annual eye exam than Whites, consistent with prior years using this module. Preliminary longitudinal comparison of two states from 2007-2010 showed variable trends in utilization, which were only significant in Iowa (Alabama: 59.5% vs. 56.2% vs. 53.9% p=0.212; Iowa: 56.6% vs. 65.3% p=0.09 and 65.3% vs. 57.8% p=0.014).
Conclusions:
Despite increased prevalence of reported eye disease since 2008, levels of annual eye exam in the 2010 BRFSS Eye Care Module remain unchanged, particularly in the multi-year analysis, with continued disparities by age, race, education, and income. In spite of this stagnant trend, the overall rate of annual eye examination meets the Healthy People 2020 Vision goals well ahead of schedule. One possible explanation for the slight decrease in the rate of eye examination may be the economic downturn of 2009-2010, in which many patients lost their jobs and insurance benefits, decreasing access to care. Unsurprisingly, those over 65 years of age were more likely to be seen as visit costs are covered by Medicare. Furthermore, the increased rate of eye disease is consistent with an aging population, in whom glaucoma, cataracts, and AMD are more prevalent, in contrast to DR, which is a disease of younger patients. Increased screening in those with DR is promising as newer treatments can prevent further progression of vascular lesions. Limitations of this study include the small number of states which participated in 2010 and which have longitudinal data, the lack of cellular telephone surveying, recall bias, and the decreased number of Hispanic respondents in 2010.