From The JAMA Network |

Is the Prevalence of Visual Impairment Rising or Falling in the People With Diabetes Mellitus?  It Depends on Who You Study

Ronald Klein, MD, MPH1; Barbara E. K. Klein, MD, MPH1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
JAMA Ophthalmol. 2013;131(7):948-950. doi:10.1001/jamaophthalmol.2013.4023.
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Prevalence of Nonrefractive Visual Impairment in US Adults and Associated Risk Factors, 1999-2002 and 2005-2008

Fang Ko, MD; Susan Vitale, PhD, MHS; Chiu-Fang Chou, DrPH; Mary Frances Cotch, PhD; Jinan Saaddine, MD; David S. Friedman, MD, MPH, PhD

Context: Over the past decade, chronic illnesses with ophthalmic sequelae such as diabetes and diabetic retinopathy have increased.

Objectives: To estimate prevalence of nonrefractive visual impairment and to describe its relationship with demographic and systemic risk factors including diagnosed diabetes.

Design, Setting, and Participants: The National Health and Nutrition Examination Survey (NHANES) examined a representative sample of the US noninstitutionalized population. In 1999-2002 and 2005-2008, 9471 and 10 480 participants aged 20 years or older received questionnaires, laboratory tests, and physical examinations. Visual acuity of less than 20/40 aided by autorefractor was classified as nonrefractive visual impairment.

Main Outcome Measure: Nonrefractive visual impairment.

Results: Weighted prevalence of nonrefractive visual impairment increased 21% among US adults aged 20 years and older from 1.4% in 1999-2002 to 1.7% in 2005-2008 (P = .03); and increased 40% among non-Hispanic whites aged 20-39 years from 0.5% to 0.7% (P = .008). In multivariable analyses, statistically significant risk factors for nonrefractive visual impairment in 1999-2002 included age (per year odds ratio [OR], 1.07; 95% CI, 1.05-1.09), poverty (OR, 2.18; 95% CI, 1.31-3.64), lack of insurance (OR, 1.85; 95% CI, 1.16-2.95), and diabetes with 10 or more years since diagnosis (OR, 1.93; 95% CI, 1.15-3.25). In 2005-2008, risk factors included age (OR, 1.05; 95% CI, 1.04-1.07), poverty (OR, 2.23; 95% CI, 1.55-3.22), education less than high school (OR, 2.11; 95% CI, 1.54-2.90), and diabetes with 10 or more years since diagnosis (OR, 2.67; 95% CI, 1.64-4.37). Prevalence of diabetes with 10 or more years since diagnosis increased 22% overall from 2.8% to 3.6% (P = .02); and 133% among non-Hispanic whites aged 20-39 years from 0.3% to 0.7% (P < .001).

Conclusion: Prevalence of nonrefractive visual impairment was significantly higher in 2005-2008 than in 1999-2002 and may be attributable, in part, to higher prevalence of diabetes, an associated risk factor that increased in prevalence during this time period.

JAMA. 2012;308(22):2361-2368. doi:10.1001/jama.2012.85685.


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