Original Study| Volume 22, ISSUE 6, P1156-1161, June 2021

Prevalence of Vision Loss and Associations With Age-Related Eye Diseases Among Nursing Home Residents Aged ≥65 Years

Published:October 08, 2020DOI:



      To examine data from Delaware nursing homes to determine prevalence of age-related eye diseases (AREDs), vision impairment, and blindness and to compare the findings with the results of 11 US investigations of vision and eye health in nursing homes.


      This is a cross-sectional, retrospective study of nursing home patients.

      Setting and Participants

      Twenty nursing homes in Delaware participated in the study, yielding comprehensive eye examination records for 2019 study participants.


      Summary statistics and regression analyses.


      The overall prevalence of vision impairment or blindness was 63.8% and was above 60% for each age, sex, and race category. Prevalence of vision impairment or blindness was 68.4% among patients with cataracts, 69.4% among patients with macular degeneration, 70.5% among patients with glaucoma, and 68.4% among patients with diabetic retinopathy. Prevalence of blindness was 14.1%. Among patients with AREDs, prevalence of blindness ranged from 15.0% for patients with cataracts to 22.6% for patients with diabetic retinopathy. When compared with other investigations, we found wide variation in vision and eye factors reported and wide variation in the prevalence of those factors. Only 4 studies diagnosed both AREDs and visual function. Seven studies reported AREDs, and 7 reported vision impairment and/or blindness. Vision impairment or blindness ranged from 29% to 67%; cataract ranged from 32% to 83%; macular degeneration ranged from 4.6% to 70.7%. Glaucoma ranged from 5.3% to 41.4%; diabetic retinopathy ranged from 1.7% to 3.1%.

      Conclusions and Implications

      Comprehensive eye examinations showed that vision impairment and blindness affected 63.8% of nursing home residents. Compared with other studies, there was a wide range of vision factors reported and wide variation in the prevalence of vision impairment or blindness and AREDs. This investigation suggests the importance of eye care in nursing homes and the importance of reporting standard vision and eye health factors to inform policy and practice.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Varma R.
        • Vajaranant T.S.
        • Burkemper B.
        • et al.
        Visual impairment and blindness in adults in the United States: Demographic and geographic variations from 2015 to 2050.
        JAMA Ophthalmol. 2016; 134: 802-809
        • Zambelli-Weiner A.
        • Crews J.E.
        • Friedman D.S.
        Disparities in adult vision health in the United States.
        Am J Ophthalmol. 2012; 154: S23-S30.e1
        • Crews J.E.
        • Chou C.F.
        • Sekar S.
        • Saaddine J.B.
        The prevalence of chronic conditions and poor health among people with and without vision impairment, aged ≥65 years, 2010-2014.
        Am J Ophthalmol. 2017; 182: 18-30
        • Crews J.E.
        • Chou C.F.
        • Stevens J.A.
        • Saaddine J.B.
        Falls among persons aged ≥65 years with and without severe vision impairment—United States, 2014.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 433-437
        • Lord S.R.
        Visual risk factors for falls in older people.
        Age Ageing. 2006; 35: ii42-ii45
        • Crews J.E.
        • Chou C.F.
        • Zhang X.
        • et al.
        Health-related quality of life among people aged ≥65 years with self-reported visual impairment: Findings from the 2006-2010 behavioral risk factor surveillance system.
        Ophthalmic Epidemiol. 2014; 21: 287-296
        • Rubenstein L.Z.
        • Josephson K.R.
        • Robbins A.S.
        Falls in the nursing home.
        Ann Intern Med. 1994; 121: 442-451
        • Marx M.S.
        • Werner P.
        • Cohen-Mansfield J.
        • Feldman R.
        The relationship between low vision and performance of activities of daily living in nursing home residents.
        J Am Geriatr Soc. 1992; 40: 1018-1020
        • Eichenbaum J.W.
        • Burton W.B.
        • Eichenbaum G.M.
        • Mulvihill M.
        The prevalence of eye disease in nursing home and non-nursing home geriatric populations.
        Arch Gerontol Geriatr. 1999; 28: 191-204
        • Klein R.
        • Klein B.E.
        • Lee K.E.
        • et al.
        Changes in visual acuity in a population over a 10-year period: The Beaver Dam eye study.
        Ophthalmology. 2001; 108: 1757-1766
        • Mitchell P.
        • Hayes P.
        • Wang J.J.
        Visual impairment in nursing home residents: The Blue Mountains eye study.
        Med J Aust. 1997; 166: 73-76
        • Tielsch J.M.
        • Javitt J.C.
        • Coleman A.
        • et al.
        The prevalence of blindness and visual impairment among nursing home residents in Baltimore.
        N Engl J Med. 1995; 332: 1205-1209
        • Kornzweig A.L.
        • Feldstein M.
        • Schneider J.
        Ocular survey of over one thousand aged persons with special reference to normal and disturbed visual function.
        Am J Ophthalmol. 1957; 44: 29-37
        • Whitmore W.G.
        Eye disease in a geriatric nursing home population.
        Ophthalmology. 1989; 96: 393-398
        • Wingert T.A.
        • Tumosa N.
        • McAlister W.H.
        Epidemiological evidence that access to routine optometric care benefits nursing home residents.
        Optom Vis Sci. 1992; 69: 886-888
        • Keller B.K.
        • Hejkal T.
        • Potter J.F.
        Barriers to vision care for nursing home residents.
        J Am Med Dir Assoc. 2001; 2: 15-21
        • West S.K.
        • Friedman D.
        • Muñoz B.
        • et al.
        A randomized trial of visual impairment interventions for nursing home residents: Study design, baseline characteristics and visual loss.
        Ophthalmic Epidemiol. 2003; 10: 193-209
        • Voytas J.J.
        • Kowalski D.
        • Wagner S.
        • et al.
        Eye care in the skilled nursing facility: A pilot study of prevalence and treatment patterns of glaucoma.
        J Am Med Dir Assoc. 2004; 5: 156-160
        • Friedman D.S.
        • West S.K.
        • Munoz B.
        • et al.
        Racial variations in causes of vision loss in nursing homes: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) study.
        Arch Ophthalmol. 2004; 122: 1019-1024
        • Owsley C.
        • McGwin G.
        • Scilley K.
        • et al.
        The visual status of older persons residing in nursing homes.
        Arch Ophthalmol. 2007; 125: 925-930
        • Andersson R.
        • Al-Namaeh M.
        • Monaco W.
        • Meng H.
        Vision loss among Delaware nursing home residents.
        Gerontol Geriatr Med. 2020; 6: 1-7
        • Larsen P.P.
        • Thiele S.
        • Krohne T.U.
        • et al.
        Visual impairment and blindness in institutionalized elderly in Germany.
        Graefes Arch Clin Exp Ophthalmol. 2019; 257: 363-370
        • Roberts A.W.
        • Ogunwole S.U.
        • Blakeslee L.
        • Rabe M.A.
        The Population 65 Years and Older in the United States: 2016.
        US Department of Commerce, Economics and statistics administration, Washington, DC2018
      1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health. In: Welp A, Woodbury RB, McCoy MA, Teutsch SM, eds. Making Eye Health A Population Health Imperative: Vision for Tomorrow. 2016. The National Academies Collection: Reports funded by National Institutes of Health. Washington, DC: National Academies Press, 2016.

        • World Health Organization
        Global Initiative for the Elimination of Avoidable Blindness: Action Plan 2006-2011.
        World Health Organization, Geneva2007
        • Valentijn S.A.
        • van Boxtel M.P.
        • van Hooren S.A.
        • et al.
        Change in sensory functioning predicts change in cognitive functioning: Results from a 6-year follow-up in the maastricht aging study.
        J Am Geriatr Soc. 2005; 53: 374-380
        • Ehrlich J.R.
        • Hassan S.E.
        • Stagg B.C.
        Prevalence of falls and fall-related outcomes in older adults with self-reported vision impairment.
        J Am Geriatr Soc. 2019; 67: 239-245
        • Swenor B.K.
        • Lee M.J.
        • Tian J.
        • et al.
        Visual impairment and frailty: Examining an understudied relationship.
        J Gerontol A Biol Sci Med Sci. 2020; 75: 596-602
        • Dotson P.
        CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?.
        Mary Ann Liebert, Inc, New Rochelle, NY2013
        • National Eye Institute, National Institutes of Health
        Statistics and data, summary of eye disease prevalence data.
        (Available at:)
        Date accessed: February 18, 2020
        • American Optometric Association Consensus Panel on Care of the Adult Patient With Cataract
        Optometric Clinical Practice Guideline: Care of the Adult Patient with Cataract.
        American Optometric Association, St Louis, MO2004
        • Salmon J.
        Kanski's Clinical Ophthalmology: A Systemic Approach.
        9th ed. Elsevier Limited, Philadelphia, PA2020
        • Wingert T.A.
        • McAlister W.H.
        Availability of eye care services in Missouri nursing homes.
        J Am Optom Assoc. 1999; 70: 470-474
      2. Andersson R. Justifying the need for mandated comprehensive eye care in nursing homes. PhD dissertation, Salus University, 2018.

        • Wang J.J.
        • Mitchell P.
        • Cumming R.G.
        • Smith W.
        Visual impairment and nursing home placement in older Australians: The Blue Mountains Eye Study.
        Ophthalmic Epidemiol. 2003; 10: 3-13
        • Evans J.R.
        • Smeeth L.
        • Fletcher A.E.
        Risk of admission to a nursing home among older people with visual impairment in Great Britain.
        Arch Ophthalmol. 2008; 126: 1428-1433
        • Abdelhafiz A.H.
        • Austin C.A.
        Visual factors should be assessed in older people presenting with falls or hip fracture.
        Age Ageing. 2003; 32: 26-30
        • Thibault L.
        • Kergoat H.
        Eye care services for older institutionalised individuals affected by cognitive and visual deficits: A systematic review.
        Ophthalmic Physiol Opt. 2016; 36: 566-583
        • Koch J.M.
        • Datta G.
        • Makhdoom S.
        • Grossberg G.T.
        Unmet visual needs of Alzheimer's disease patients in long-term care facilities.
        J Am Med Dir Assoc. 2005; 6: 233-237
        • Lamoureux E.L.
        • Fenwick E.
        • Moore K.
        • et al.
        Impact of the severity of distance and near-vision impairment on depression and vision-specific quality of life in older people living in residential care.
        Invest Ophthalmol Vis Sci. 2009; 50: 4103-4109