Does vision of the future look dim?

America's aging population could spell a twofold increase in vision impairment and blindness over the next three decades, claims a new study that underscores the need for bolstered low-vision services.

Published in JAMA Ophthalmology, the Johns Hopkins University study determined that the annual incidence and prevalence of new low vision and blindness cases among Americans 45 years of age or older would double between 2017 and 2050. Such estimates are necessary for illustrating the debilitating toll that visual impairment will have on elderly Americans, study authors say, and help policymakers make decisions to prepare in the decades ahead.

"Low vision and blindness affect a substantial portion of the older population in the United States," authors conclude. "Estimates of the prevalence and annual incidence of visual impairment assist policy planners in allocating and developing resources for this life-changing loss of function."

This study reviewed data from the 2007-08 National Health and Nutrition Examination Survey of 6,016 participants, ranging in age from 18 to 45, to estimate prevalence rates among age groups.

Researchers defined low vision as best-corrected visual acuity (BCVA) in the higher-functioning eye at less than 20/60—commonly recognized by the World Health Organization and Medicare—and less than 20/40—a level generally agreed to create visual limitations. Blindness was defined as BCVA of 20/200 or less, the definition for legal blindness defined by the U.S. Social Security Administration.

Data indicate the estimated prevalence of low vision (BCVA 20/40) would increase among the 45-and-older group from 3.8 million in 2017 to 7.5 million by 2050, while another metric (BCVA 20/60) would increase from more than 183,600 in 2017 to more than 383,500 by 2050. Blindness would increase from 1 million in 2017 to 2.1 million by 2050.

Furthermore, researchers determined the annual incidence of low vision (BCVA 20/40) would climb from nearly 482,000 new cases in 2017 to 1 million by 2050, while the annual incidence of low vision (BCVA 20/60) would increase from 183,600 in 2017 to 383,500 by 2050. The number of annual new cases of blindness was estimated to increase from 134,000 in 2017 to 279,900 by 2050.

Bhavani Iyer, O.D., AOA Vision Rehabilitation Committee chair, says this study clearly shows a need for more vision rehabilitation services in the coming years, and in turn, more doctors willing and able to provide care for low-vision patients.

"Vision rehabilitation doctors have always known the high value of the services they provide," Dr. Iyer says. "However, it has been difficult to get more doctors to go into this field due to chair time and issues of staying profitable as a practice."

Bright light in the dark?

Despite these findings, a separate study claims that a significant contributing diagnosis to visual impairment—age-related macular degeneration (AMD)—could be on the decline.

Published in the same edition of JAMA Ophthalmology, the University of Wisconsin-Madison study found the AMD risk for each successive generation of Americans has declined by about 60% with Baby Boomers less likely to develop the condition than 'Silent' or 'Greatest' generations.

Analyzing data from the Beaver Dam Eye Study (1987-1995) and Beaver Dam Offspring Study (2005-2008, 2010-2013), researchers graded fundus images of individuals, and later their children, finding 4,819 participants at risk for AMD development. Among these individuals, the five-year incidence of AMD was almost 9% for members of the Greatest Generation, 3% in the Silent Generation, 1% in the Baby Boom Generation and 0.3% among Generation X."

These results suggest that the current epidemic of AMD among the current older population may wane over time and that future research may uncover opportunities for primary prevention of this vision-threatening disorder," study authors concluded.

Seeking low-vision care

The National Eye Institute estimates more than 135 million people worldwide suffer from low vision, defined as visual impairment not correctable with standard refraction. Low vision interferes with a person's ability to perform everyday activities and stems from common aging concerns, such as AMD, cataracts, glaucoma and diabetic retinopathy. Lost vision cannot be restored, but with proper treatment and vision rehabilitation, low vision can be managed.

That's where doctors of optometry who specialize in low-vision rehabilitation come into play. These specialists examine, treat and manage the care of patients with visual impairments that can't fully be treated by medicine, surgical or conventional eyewear. Each patient's low-vision challenge is unique, requiring a different therapeutic approach that can range from prescription devices to enhancing the remaining visual abilities.

Are you a vision rehabilitation doctor? Make the most of AOA membership by updating your myAOA profile on AOA's website with your vision rehabilitation emphasis. This allows local individuals searching AOA's "Find a Doctor" search tool to connect with the vital, specialized services you provide. This search feature also makes it easier for doctors of optometry to receive referrals from other doctors and become more integrated with treatment and coordinate services.

Click here to update your myAOA profile today.