title: Age-related eye diseases and visual impairment among U.S. adults.
abstract: BACKGROUND
  Visual impairment is a common health-related disability in the U.S. The association between clinical measurements of age-related eye diseases and visual impairment in data from a national survey has not been reported.
  
  
  OBJECTIVE
  To examine common eye conditions and other correlates associated with visual impairment in the U.S.
  
  
  METHODS
  Data from the 2005-2008 National Health and Nutrition Examination Survey of 5222 Americans aged ≥40 years were analyzed in 2012 for visual impairment (presenting distance visual acuity worse than 20/40 in the better-seeing eye), and visual impairment not due to refractive error (distance visual acuity worse than 20/40 after refraction). Diabetic retinopathy (DR) and age-related macular degeneration (AMD) were assessed from retinal fundus images; glaucoma was assessed from two successive frequency-doubling tests and a cup-to-disc ratio measurement.
  
  
  RESULTS
  Prevalence of visual impairment and of visual impairment not due to refractive error was 7.5% (95% CI=6.9%, 8.1%) and 2.0% (1.7%, 2.3%), respectively. The prevalence of visual impairment not due to refractive error was significantly higher among people with AMD (2.2%) compared to those without AMD (0.8%), or with DR (3.5%) compared to those without DR (1.2%). Independent predictive factors of visual impairment not due to refractive error were AMD (OR=4.52, 95% CI=2.50, 8.17); increasing age (OR=1.09 per year, 95% CI=1.06, 1.13); and less than a high school education (OR=2.99, 95% CI=1.18, 7.55).
  
  
  CONCLUSIONS
  Visual impairment is a public health problem in the U.S. Visual impairment in two thirds of adults could be eliminated with refractive correction. Screening of the older population may identify adults at increased risk of visual impairment due to eye diseases.
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia. Electronic address: CChou@cdc.gov.
authors.forename: Chiu-Fang
authors.initials: CF
authors.lastname: Chou
authors.affiliation: Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda.
authors.forename: Mary
authors.initials: M
authors.lastname: Frances Cotch
authors.affiliation: Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda.
authors.forename: Susan
authors.initials: S
authors.lastname: Vitale
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: Wilmer Eye Institute , Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Barbara E K
authors.initials: BEK
authors.lastname: Klein
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000453:epidemiology; D004522:Educational Status; D005128:Eye Diseases / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology* / Q000503:physiopathology; D014792:Visual Acuity