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Susan Vitale, Janine A. Clayton; Prevalence Of Near Vision Impairment In The United States: NHANES 1999-2006. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4229.
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To estimate prevalence of impairment in near vision (NV) for people ≥50 years in the U.S. and associations with demographic characteristics.
The National Health and Nutrition Examination Survey (NHANES) examines nationally representative samples of the U.S. population. In 1999-2006, NHANES included a vision exam assessing distance visual acuity (VA) and refraction via autorefractor for those ≥12 y. In those ≥50 y, NV was measured using a near card (number symbols; 20/400 (line 1), 20/200, 20/63, 20/40, and 20/25 (line 5)) held at comfortable reading distance, with both eyes open, wearing usual NV correction. NV was recorded as the smallest line on which 4 of 5 symbols were correctly read. NV impairment (NVI) was defined as reading 0, 1, or 2 lines correctly. Participants rated difficulty with reading newsprint or doing work/hobbies requiring them to see well up close as "no", "a little", "moderate", "extreme", or "unable to do because of eyesight". Functional NV impairment (FNVI) was defined as "extreme difficulty" or "unable to do because of eyesight". Distance vision impairment (DVI) was defined as distance VA <20/40 in the better-seeing eye when aided by automated refraction results. SUDAAN was used to account for the probability sampling used in NHANES.
In the 1999-2006 NHANES, 8895 persons ≥50 y were examined; 7922 (92.0%) had complete data for NVI, FNVI, and DVI. The prevalence of NVI was 4.8% (95% CI, 4.2-5.3%); of FNVI: 4.6% (95% CI, 4.1-5.1%), and of DVI: 2.1% (95% CI, 1.7-2.4%). Prevalence of NVI was highest for those who were ≥80 y (13.2%), Mexican-American (Mex-Amer) (8.6%), < high school education (HSE) (11.1%), or lacked private health insurance (8.2%). NVI was present in 3.4% of those without and 32.2% of those with DVI. After adjustment, NVI was associated with older age (p<.001), Black, Mex-Amer, and other race/ethnicity (vs White) (OR=1.60, 1.38, 1.65; p=.0002, .02, .04), male sex (OR=1.30, p=.054), < HSE (vs > HSE) (OR=3.1; p<.001), and lacking private health insurance (OR=1.85; p<.001). FNVI was present in 3.1% of those without and 27.4% of those with NVI. After adjustment, FNVI was associated with older age (p<.0001), Black, Mex-Amer, and other race/ethnicity (vs White) (OR=1.87, 1.58, 1.41; p=.0001, .01, .06), < HSE (vs >HSE) (OR=2.51; p<.001), and lacking private health insurance (OR=1.79; p<.001).
1 in 20 Americans aged 50+ has near vision impairment. The associations of NVI with older age, non-White race/ethnicity, less education, and lack of private health insurance suggest that factors shown to be important in access to eye care also influence NVI.
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