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Aging Ment Health. Author manuscript; available in PMC 2022 February 01.
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Published in final edited form as:

Aging Ment Health. 2021 February ; 25(2): 360–366. doi:10.1080/13607863.2019.1683813.

Low Rates of Eye Care Utilization among Visually Impaired

Subsidized Senior Housing Residents
Amanda F. Elliott, PhD, APRN1, Megan Heskett, RN2, Christopher Spiker, MD, MPH3, Gerald
McGwin Jr., PhD3,4,5, Cynthia Owsley, PhD, MSPH3
1College of Nursing, University of Florida
2College of Nursing, University of South Florida
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3Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham

4Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
5Department of Surgery, School of Medicine, University of Alabama at Birmingham

Abstract
Objective: To examine the rate of self-reported vision impairment, eye disease, and eye care
utilization among residents of subsidized senior housing (SSH) communities.

Methods: In this cross-sectional, observational study, residents of 14 SSH communities in

Jefferson County, AL, USA self-reported their vision status and eye care utilization as part of
vision screening events held in their community.
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Results: 237 residents self-reported their vision status, presence of eye disease, and eye care
utilization. A third of participants (33.3%) reported difficulty with distance vision while 38%
reported difficulty with near vision. Rates of eye disease among this sample were as follows:
40.3% reported having cataracts, 13.6% reported having glaucoma, 4.2% reported having age-
related macular degeneration, and 5.5% reported having diabetic retinopathy. The majority of
participants (52.8%) had not been to see an eye care provider within the last year. Persons with
vision impairment were less likely to report having seen an eye care provider within the last year
than those without impairment (p=0.03).

Conclusion: This study illuminates the low utilization of eye care among socioeconomically
disadvantaged older adults residing in SSH, especially among those with vision impairment and
eye disease. Vision-related health care is important in maintaining both physical and mental health
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in older adults.

Keywords
Vision Impairment; Eye Care; Older Adults

Older adults experience higher rates of eye diseases and conditions that can cause vision
impairment, such as diabetes and hypertension, as compared to younger adults. (American

Corresponding Author: Amanda F. Elliott, College of Nursing, University of Florida, 1225 Center Drive, PO Box 100197,
Gainesville, FL 32610-0197, (205) 602-5985, Amanda.elliott@ufl.edu.
 Elliott et al. Page 2

Diabetes Association, 2013; Bhargava, Ikram, & Wong, 2012; Prevent Blindness America,
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2008). Impaired vision can be debilitating, leading to impairments in both physical and
mental health. Older adults with vision impairment experience decreased ability to perform
basic activities, loss of driving ability, and ultimately a loss of independence (Wood et al.,
2005). Older adults with vision impairment also report lower self-rated health than those
without vision impairment (Damian, Pastor-Barriuso, & Valderrama-Gama, 2008; Hwang,
Rudnisky, Bowen, & Johnson, 2015; Wang, Mitchell, & Smith, 2000; Whitson, Malhotra,
Chan, Matchar, & Ostbye, 2014). Impaired near vision has been associated with incident
cognitive impairment, a risk factor for transitioning to a nursing home from a more
independent living situation (Lin et al., 2004; Reyes-Ortiz et al., 2005; Wang, Mitchell,
Smith, Cumming, & Leeder, 2001). Additionally, vision impairment had been found to be
associated with anxiety, depression, and dementia among older adults (Hamedani,
VanderBeek, & Willis, 2019). However, the majority of vision impairment in older adults is
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caused by reversible or correctable conditions (Friedman et al., 2005; Tielsch, Javitt,

Coleman, Katz, & Sommer, 1995). Therefore seeking care for vision related issues is a
necessary step to maintaining one’s physical and mental health as well as independence later
in life.

Older adults live in a variety of settings such as in the community, assisted living facilities,
or nursing homes. Much of the previous research concerning the prevalence of vision
impairment and eye diseases in older adults has focused on either community dwelling older
adults or nursing home residents. These studies have found that residents of nursing homes
have vision impairment rates that are 3 to 15 times higher than their community dwelling
counterparts (Crews & Campbell, 2004; Mitchell, Hayes, & Wang, 1997; Owsley et al.,
2007; Tay et al., 2006; Tielsch et al., 1995). Less attention has been paid to
socioeconomically disadvantaged older adults residing in federally subsidized senior
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housing (SSH) communities. Through Section 202 of the United States Housing Act of 1959
and amendments, the Department of Housing and Urban Development provides funds to
subsidize rent within apartment facilities to provide housing for senior adults who are
economically disadvantaged. To qualify, the resident must be 62 years of age or older, have
an annual income less than 50% of the median income within the county of residence, and
be without significant disability (Barbara et al., 2008; Perl, 2010). Previous research has
shown that eye care utilization rates are lower among socioeconomically disadvantaged
adults (Zhang et al., 2012). Additionally, Varadaraj and colleagues (2019) found through 9-
years of National Health Interview Survey data that Americans with lower poverty-to-
income ratios (PIR) had lower eye care use and more difficulty affording glasses than those
with higher PIR. They also found that minorities were less likely to use eye care than whites.
It is likely that persons living in these SSH communities where a large percentage of
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residents are minorities could have poorer utilization of eye health services than other
community-dwelling older adults.

Previous research has found that socioeconomically disadvantaged minority older adults are
also more likely to experience mental health disorders such as anxiety and depression than
non-minorities. Robinson and colleagues (2009) examined mental health among minority
older adults living in low-income senior housing and found that 17% of older black residents
experienced major depressive disorder and 6% experienced generalized anxiety disorder. It

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is also important to note that vision impairment presents another risk factor for mental health
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disorders. Older adults with vision impairment were found to have significantly higher rates
of major depressive disorders and anxiety disorders as compared to their normally sighted
peers (van der Aa, Comijs, Penninx, van Rens, & van Nispen, 2015). Very little is known
about the specific vision difficulties experienced by those living in federally SSH
communities. Given that the population of older adults in the U.S. is expected to almost
double by 2050, (Ortman, Velkoff, & Hogan, 2014) and a proportion of older adults will
reside SSH communities, it is important to understand their vision health needs in order to
develop programs to provide preventive care for both their physical and mental health. The
aim of the current study is to present a description of self-reported eye disease, vision
impairment, and eye care utilization rates among a sample of SSH residents in Jefferson
County, Alabama. To our knowledge, this is the first study to present self-reported vision
data in this economically disadvantaged subgroup of older adults.
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Methods
Federally SSH communities in Jefferson County, Alabama were identified through the
Department of Housing and Urban Development. The manager at each community was sent
a recruitment letter inviting them to participate in a no cost vision screening event to be held
at their housing community. Detailed study procedures and methods regarding the vision
screening events have previously been described (Elliott, McGwin, Kline, & Owsley, 2015).
Briefly, each housing community received at least 2 follow-up telephone calls to determine
whether they were interested in having an event at their facility. After two unreturned
follow-up phone calls and voice messages it was concluded that the housing community was
uninterested. Of the 19 SSH communities identified, 14 desired participation, one declined
participation, and four were unreachable via letter and telephone (74% participation rate).
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Two weeks prior to the date of the vision screening, packets were mailed to the housing
community’s manager containing letters to be distributed to all of the residents which
described the vision screening event including the date, time, and location where it would be
held onsite. Flyers containing this same information were also provided to be posted around
the community in advance of the screening event. On the day of the screening event,
residents were seen on a first come, first served basis although some residents had chosen to
make appointments in advance as this option was offered through the letters/flyers they
received in advance of the screenings. If all interested residents at a community could not be
accommodated in a single day, arrangements were made to return to provide additional
screening events. No person was denied vision screenings. This resulted in a convenience
sample of residents who chose to attend the screenings. If residents were 60 years of age or
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older they were invited to complete interviewer-administered questionnaires on basic

demographic information (e.g., birth date, marital status), general health, mental status, eye
care utilization, the presence of eye conditions, and whether they experience any difficulty in
everyday visual tasks. The Vision Module questionnaire of the Behavioral Risk Factor
Surveillance System (BRFSS) (Centers for Disease Control and Prevention) was used in
collecting this information. Informed consent was obtained from each resident prior to
administration of the questionnaires by trained research staff. This study was approved by

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the Institutional Review Board of the University of Alabama at Birmingham and follows the
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tenets of the Declaration of Helsinki.

Statistical Analysis
Descriptive statistics (e.g., means, proportions) were used to calculate the rate of overall and
age-specific demographic information and self-reported vision difficulties, eye diseases, and
eye care utilization. Chi-square analyses were conducted to evaluate if any observed
differences noted within the self-reported demographic and vision health responses differed
by age or whether vision difficulties were at near or far distances. Two-sided p-values ≤ 0.05
were considered statistically significant and all analyses were performed using Statistical
Analysis Software (SAS Institute Inc., Cary, North Carolina).

Results
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A total of 237 residents who participated in the vision screening events were eligible to
participate in the questionnaire portion of this study. Results of the objective vision
screening are described in Elliott et al. (2015). Participation rates of residents in the
screening events varied among communities ranging from 9% to nearly 40%. Table 1
presents the demographic and medical characteristics of participants stratified by self-
reported vision impairment. Vision impairment was defined as a BRFSS response of a little
difficulty, moderate difficulty, extreme difficulty, or unable to do due to eyesight on either
the near or far visual task BRFSS question. (Note: for these analyses responses of don’t
know were treated as missing). The sample ranged in age from 60 to 99 years old with the
majority being in their 60s or 70s. Due to the low number of participants in their 90s (n=19),
for analytical purposes they were combined with the 80 year old group to allow for more
balanced group sizes. The majority of participants were African American (74.7%), female
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(74.3%), single (including separated, divorced, and widowed) (97.9%) and lived alone
(98.3%). Fifty-eight percent had a high school or higher level of education. Three-quarters
of participants self-reported having hypertension and 38.8% reported having diabetes. There
were very few demographic differences between those with and without vision impairment.
Chi-square tests revealed that self-reported general health status was significantly poorer
among those with vision impairment (p=0.023).

The overall and age-specific prevalence of self-reported vision impairment, eye care
utilization and eye disease as addressed in the BRFSS in this sample are presented in Table
2. A third of participants (33.3%) self-reported difficulty with distance vision. Slightly more
participants (38%) self-reported difficulty with near vision. The majority of participants
(52.8%) had not been to see an eye care provider within the last year. A similar number
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(54.1%) had not had a dilated eye exam in the past year, indicating that most participants
who had visited an eye care provider within the last year had received a dilated eye exam.
The most common reasons provided by participants for why they had not been to see an eye
care provider within the last year were that they had no reason to go (43.3%), had not
thought about going (18.9%), cost (13.4%), and did not have transportation (11%). Most
participants (61.6%) were aware that they had health insurance coverage for eye care with
Medicare (83.5%) being the most common type of health insurance reported by participants.

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Rates of eye disease among this sample were as follows: 40.3% reported having cataracts,
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13.6% reported having glaucoma, 4.2% reported having age-related macular degeneration,
and 5.5% reported having diabetic retinopathy. There were no significant age-specific
differences between groups for any BRFSS measure, except for the expected differences in
health coverage noted in the 60–69 year old group which includes those ineligible for
Medicare. This likely also explains why this age group had higher cost issues associated
with visiting an eye care provider. Although not statistically significant, the rate of glaucoma
and age-related macular degeneration increased with age, while those in the oldest age group
reported the lowest rates of both cataract and diabetic retinopathy.

Table 3 presents rates of eye care utilization, health insurance, and eye disease by self-
reported vision impairment status. Chi-squared analyses revealed a few statistically
significant differences between groups. Persons with vision impairment were less likely to
report having seen an eye care provider within the last year than those without impairment
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(p=0.03); this same trend was true for dilated eye examinations but did not reach statistical
significance. Those with impairment were less likely to report having Medicare (p= 0.04)
and more likely to report having some other form of health insurance (p= 0.05). Those with
impairment were more likely to have been told that diabetes affected their eyes (p= 0.05)
(e.g. had diabetic retinopathy).

Discussion
There has not been much previous research regarding the visual status and eye care
utilization rates among the socioeconomically disadvantaged older adult population. This
study contributes to our understanding of visual status, eye care utilization, and presence of
eye disease among socioeconomically disadvantaged older adults residing in SSH.
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Understanding the state of vision and utilization of vision services in this population will
help direct public health efforts in this area. Previous research has shown that both age, male
sex, nonwhite race, lack of insurance, and lower socioeconomic status have been associated
with vision impairment (Zebardast, Friedman, & Vitale, 2017; Zheng et al., 2011) and that
vision impairment is a risk factor for poor self-rated health, impaired cognitive performance,
anxiety, depression, and social isolation (Arokiasamy et al. 2015; Hamedani et al., 2019; Lin
et al., 2004; Reyes-Ortiz et al., 2005; Wang, Mitchell, Smith, Cumming, & Leeder, 2001;
Wood et al., 2005). We previously found that 40% of this population failed an objective
distance vision test and 58% failed an objective near vision test (Elliott et al., 2015). Asking
for residents’ self-report of their vision status allows us to recognize any disparity between
their self-perceived visual function and that of objective measures. This may also allow us to
understand why they may or may not be accessing eye care. Participants in this study self-
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reported lower levels of vision impairment than what we found using objective measures of
distance and near visual acuity (33.3% vs 40% for distance; 38% vs 58% for near). These
results highlight a disparity between how this group viewed their vision and what was
measured objectively. This may explain why a large proportion of the residents (43.3%) who
had not been to see an eye care provider cited not having no reason to go as the main reason
for why they had not been to see an eye care provider. Maintaining independence is
necessary to remain in SSH as no formal health care assistance is provided in these
residential communities, therefore, it is possible that rates of self-reported vision impairment

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were lower than objectively measured rates if residents were concerned about their vision
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affecting these independence requirements. However, rates of very low vision/blindness

were very low and the vision impairment found in this study was unlikely to have affected
residents’ ability to live independently.

The majority of our participants were African American, a population at higher risk for
developing hypertension and diabetes; conditions for which there are vision-related sequelae
(American Heart Association, 2015; Centers for Disease Control and Prevention, 2015). In
our sample, 39% self-reported having diabetes and 76% self-reported having hypertension. It
is important for people with these chronic diseases to receive regular eye examinations. The
American Academy of Ophthalmology (AAO) (2015) recommends that all older adults with
diabetes and/or hypertension have an eye exam at least annually or more frequently if
recommended. Furthermore, AAO (2015) recommends that all people ages 65 and over have
an eye exam every 1 to 2 years even in the absence of risk factors or symptoms.
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In our sample, the rate of self-reported impairments for distance and near vision were 33.3%
and 38% respectively. This is higher than previous research using the same BRFSS
questionnaire in a national sample of adults over 50 years of age, where the self-reported
rates of distance and near vision impairment were 16.6% and 32.8% respectively (McGwin,
Khoury, Cross, & Owsley, 2010). It is not surprising that higher rates of perceived vision
impairment were noted in our study since this sample was comprised of older persons (60+)
with less socioeconomic means than those surveyed by the BRFSS nationally (McGwin et
al., 2010). Our findings are consistent with research indicating that both increased age and
lower socioeconomic status may be associated with higher rates of vision impairment
(Zheng et al., 2011). The rates of cataract and glaucoma found in the present sample (40.3%
and 13.6%) were higher than those found by McGwin and colleagues (2010) using the
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BRFSS on a national level (19.6% and 6.4%). Given that our sample was largely African
American, it is not surprising that our rates of glaucoma were twice as high as those in the
national sample as glaucoma is more prevalent in African Americans than Whites and
Hispanics (Friedman et al., 2004). Unsurprisingly, our participants reported lower rates of
age-related macular degeneration than the national sample (4.2% vs. 5.8%) as macular
degeneration is more commonly found in people of European ancestry than of African
descent (Jonas, Cheung, Panda-Jones, 2017). Diabetic retinopathy was self-reported by 5.5%
of participants in our study, this is slightly higher than previous general population estimates
of diabetic retinopathy of 3.4% among U.S. adults age 40 and over (Kempen et al., 2004)

Over half of our sample had not been to see an eye care provider within the last year. This is
higher than the rates that McGwin and colleagues (2010) report where one-third of a
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national sample reported not visiting an eye care provider within the last year. Both
nationally and in the present study, the majority of people cited not having a reason to go to
the eye care provider as the primary reason for not seeking an eye examination (49%
nationally, 43.31% present study) (McGwin et al., 2010). The second most frequent reason
cited by participants in the present study for not visiting an eye care provider was that they
had not thought of it (18.9%). This was substantially higher than what McGwin and
colleagues (2010) found in the national data set (6.7%). This is an important finding
considering the high rate of hypertension and diabetes in this sample as people with these

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chronic conditions should be educated on the importance of having at least an annual dilated
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eye examination (AAO, 2015). This may indicate that public health efforts to increase
awareness of the importance of routine eye care visits may be lacking in this group of older
adults. In the present study a much higher percentage of persons reported that transportation
was a major reason for not going to the eye care provider (11.02%) than what was found in
national data (1.9 %) (McGwin et al., 2010). This highlights a concern for this specific
population who may recognize the need for eye care but are unable to access it due to
limited transportation options. While cost was one of the largest factors for not visiting an
eye care provider for our participants aged 60–69, this decreased significantly as age
increased likely due to this age group containing those ineligible for Medicare. However it is
unknown if having Medicare was why participants in older age groups were less likely to
report cost as a factor as Medicare does not cover routine eye exams. Medicare part B will
cover a yearly eye exam for people with diabetes, a yearly glaucoma test for those at risk,
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cataract surgery, and some macular degeneration treatments (Centers for Medicare and
Medicaid Services, n.d.). A recent examination of receipt of eye care worldwide found that
only greater wealth was associated with having had a recent eye exam while factors such as
worse memory, social isolation, and no health insurance were associated with lower rates of
recent eye exams and higher rates of vision impairment (Ehrlich, Stagg, Andrews, Kumagai,
& Musch, 2019).

Participants who reported vision impairment were more likely to have fair or poor subjective
health (59.8%) compared to the 37.1% who did not report vision impairment. In the Blue
Mountains Eye Study, Wang and colleagues (2000) also found that people with vision
impairment were more likely to report fair or poor subjective health (35.5% with mild
impairment and 48.8% with moderate or severe impairment) than those without vision
impairment (24.5%). These findings show that vision impairment has a significant effect on
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how older adults perceive their health status.

Interestingly, in our sample, people who self-reported vision impairment (38.9%) were less
likely to have received an eye exam within the last year as compared with those who did not
self-report vision impairment (55.3%). This may be reflective of the benefits of having
received eye care in that people who did see the eye care provider were then not reporting
vision impairment. Alternatively, since the group who reported vision impairment were more
likely to self-report having diabetic retinopathy than those who did not report impairment, it
would be important to make certain that anyone self-reporting vision impairment was
educated on the need for regular eye examinations, especially those who have chronic
conditions with potential for vision-related sequelae.. Every participant in our study was
asked if they had an eye care provider and were provided with a list of local eye care
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providers if they needed a provider.

This study uses self-reported data which may be subject to participant recall bias. However,
previous research has indicated that older adults are capable of providing reliable self-
reports of their chronic conditions, especially diabetes, but may underreport disease presence
(Goldman, Lin, Weinstein, & Lin, 2003; Leikauf & Federman, 2009; Wu, Li, & Ke, 2000).
Additionally, using the BRFSS, a well-designed and validated survey, contributes to the
strength of these results. The sample selected for this study may not reflect the larger general

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population of older adults residing in SSH as participants who came to the vision screenings
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may have been more concerned about their vision than other residents. However, our study
was designed to evaluate the vision impairment and eye care utilization rates in an
understudied and potentially underserved population and we found a notable amount of
vision impairment and low use of vision health services. It is hoped that this study will aide
in directing eye health initiatives within Jefferson County as well as inform public health
efforts in regards to vision health surveillance. While participation rates varied among
individual facilities, nearly all (14 of 19, 74%) facilities approached for participation were
interested in and participated in the vision screenings. Future studies investigating the eye
care utilization of socioeconomically disadvantaged older adults should begin to develop
strategies to increase both public health awareness of and access to eye care. It is a limitation
of this study that we did not include mental health outcomes. Previous work done by our
group (Owsley et al., 2007) found that vision improving interventions (cataract surgery)
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improved psychological distress in nursing home residents, showing that mental health may
improve in response to improvement in vision. It is important to consider both the physical
and mental health sequelae of vision impairment (e. g., ADL limitations, social isolation,
cognitive impairment, anxiety, and depression, among others) when designing intervention
studies aimed at improving vision and investigators should monitor the effect of the
intervention on these outcomes.

Funding
This work was supported by The Lucille Beeson Trust; Prevent Blindness; the EyeSight Foundation of Alabama;
the Able Trust; the Alfreda J. Schuler Trust; National Institutes of Health [grant P30-AG22838 to C.O.]; and
Research to Prevent Blindness Inc.

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Table 1.

Demographic and medical characteristics by self-reported visual impairment

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N % Without Impairment % With Impairment % p-value

Sex
Male 61 25.74 24.14 28.21 0.4801
Female 176 74.26 75.86 71.79
Age (years)
60–69 78 32.91 42.86 57.14 0.2525
70–79 89 37.55 50.57 49.43
≥ 80 70 29.54 56.52 43.48
Race
Black 177 74.68 75.86 74.36 0.7794
White (Non Hispanic) 57 24.05 22.41 24.79
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Other 3 1.27 1.72 0.85

Marital Status
Married 5 2.12 3.45 0.86 0.7385
Single 62 26.27 25.86 26.72
Separated not Divorced 9 3.81 3.45 4.31
Divorced 55 23.31 23.28 22.41
Widowed 105 44.49 43.97 45.69
Social Support (Do you live)
Alone 233 98.31 97.41 99.15 0.309
Not Alone 4 1.69 2.59 0.85
Last Level of Education Completed
Grade School 33 14.04 11.21 17.24 0.2404
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Some High School 65 27.66 22.41 32.76

High School Graduate 78 33.19 37.07 30.17
Some College 46 19.57 22.41 15.52
College Graduate 10 4.26 5.17 3.45
Graduate or Professional degree 3 1.28 1.72 0.86
Reported Health Status
Excellent to Good 120 50.63 62.07 39.32 0.0023
Fair to Poor 115 48.52 37.07 59.83
Don’t Know 2 0.84 0.86 0.85
Chronic Health Conditions
Diabetes 92 38.82 38.79 38.46 0.9586
Hypertension 180 75.95 73.28 78.63 0.3387
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Table 2.

Overall and age-specific prevalence (%) for eye disease and eye care utilization
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Age Range All 60–69 70–79 ≥80 p-value

Any difficulty with distance vision?

None 65.40 61.54 69.66 64.29 0.7851
A little 20.25 19.23 19.10 22.86
Moderate 7.59 10.26 4.49 8.57
Extreme 2.95 3.85 3.37 1.43
Unable due to eyesight 2.53 3.85 1.12 2.86
Don’t know 1.27 1.28 2.25 0.00
Any difficulty with near vision?
None 62.03 52.56 65.17 68.57 0.4129
A little 16.88 19.23 15.73 15.71
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Moderate 9.28 15.38 7.87 4.29

Extreme 7.59 7.69 7.87 7.14
Unable due to eyesight 3.80 5.13 3.37 2.86
Don’t know 0.42 0.00 0.00 1.43
Last time visited eye care provider?
≤ 1 year ago 47.19 43.42 52.87 44.12 0.7117
> 1 year ago 50.65 53.95 44.83 54.41
Never 2.16 2.63 2.30 1.47
Reason did not use eye doctor past 12 months?
Cost/insurance 13.39 31.82 4.76 2.44 0.0039
No Eye Doctor 4.72 6.82 4.76 2.44
Could not get there 11.02 4.55 14.29 14.63
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Could not get appointment 3.94 4.55 4.76 2.44

No reason to go 43.31 31.82 42.86 56.10
Did not think about it 18.90 11.36 26.19 19.51
Don’t know 4.72 9.09 2.38 2.44
When last dilated exam?
≤ 1 year ago 45.95 44.59 48.81 43.75 0.7065
> 1 year ago 50.00 50.00 46.43 54.69
Never 4.05 5.41 4.76 1.56
Health insurance for eye care?
Yes 61.60 57.69 69.66 55.71 0.3447
No 32.91 37.18 24.72 38.57
Don’t know 5.49 5.13 5.62 5.71
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Kind of health coverage?

Medicare 83.54 69.23 89.89 91.43 0.0002
Medicaid 20.25 29.49 15.73 15.71 0.0465
Supplemental 27 24.36 28.09 28.57 0.8117
Other 15.61 21.79 13.48 11.43 0.1738

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Age Range All 60–69 70–79 ≥80 p-value

Don’t know 2.53 1.28 2.25 4.29 0.4977
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Cataract
Yes 40.25 41.56 43.82 34.29 0.4580
No 59.75 58.44 56.18 65.71
Glaucoma
Yes 13.56 9.09 15.73 15.71 0.3778
No 86.44 90.91 84.27 84.29
Age-related macular degeneration
Yes 4.24 2.60 3.37 7.14 0.3445
No 95.76 97.40 96.63 92.86
Diabetic retinopathy
Yes 5.51 7.79 5.62 2.86 0.4234
No 94.49 92.21 94.38 97.14
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Table 3.

Rates of eye care utilization, health insurance, and eye disease by self-reported vision impairment.
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BRFSS Question All Without Impairment With Impairment p-value

Any difficulty with distance vision?

≤ 1 year ago 47.19 55.26 38.94 0.0284
> 1 year ago 50.65 43.86 57.52
Never 2.16 0.88 3.54
Any difficulty with near vision?
Cost/insurance 13.39 13.21 13.89 0.5889
No Eye Doctor 4.72 1.89 6.94
Could not get there 11.02 7.55 13.89
Could not get appointment 3.94 1.89 4.17
No reason to go 43.31 50.94 37.50
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Did not think about it 18.90 18.87 19.44

Don’t know 4.72 5.66 4.17
Last time visited eye care provider?
≤ 1 year ago 45.95 53.15 38.32 0.0894
> 1 year ago 50.00 43.24 57.01
Never 4.05 3.60 4.67
Health insurance for eye care?
Yes 61.60 62.07 61.54 0.9643
No 32.91 32.76 32.48
Don’t know 5.49 5.17 5.98
Kind of health coverage?
Medicare 83.54 88.79 78.63 0.0358
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Medicaid 20.25 17.24 23.93 0.2068

Supplemental 27 25.00 29.06 0.4854
Other 15.61 11.21 20.51 0.0520
Don’t know 2.53 0.86 3.42 0.1781
Cataract
Yes 40.25 40.00 41.03 0.8736
No 59.75 60.00 58.97
Glaucoma
Yes 13.56 12.17 13.68 0.7333
No 86.44 87.83 86.32
Age-related macular degeneration
Yes 4.24 2.61 5.13 0.3204
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No 95.76 97.39 94.87

Diabetic retinopathy
Yes 5.51 2.61 8.55 0.0493
No 94.49 97.39 91.45

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