Vision loss in the older adult population in New York City

• Based on the 2000 census and applied prevalence rates, the New York State Commission for the Blind and Visually Handicapped (CBVH) reports that in New York City there are 34,280 legally blind people aged 65 and over. There are 164,962 visually impaired people aged 65 and over.

• Based on the 2000 census, the total elderly in New York City declines slightly between 1990 and 2000, from 1.28 million to 1.25 million. However, the number of persons in the very oldest age group of 85 years and over, increased by 18.7 percent over the decade. In this age group, disability is more prevalent (Annual Plan Summary, April 1, 2007-March 31, 2008; September 2006 New York City Department for the Aging).

• Poverty is on the rise and is expected to increase dramatically, particularly affecting the oldest and frailest, women, minorities, seniors living alone and elderly with disabilities. Individuals who became functionally impaired during their working lives are more likely to suffer from poverty during retirement. It is likely that physical disabilities will be a greater cause of poverty among tomorrow’s elderly than in the past (Annual Plan Summary, April 1, 2007-March 31, 2008; September 2006 New York City Department for the Aging).

• There are indications that disability among the elderly population increased significantly between 1990 and 2000. In the 2000 census there were over 417,000 elderly people in New York City who reported some kind of disability level. They represented over 46 percent of the total elderly population aged over 65 and over in the civilian non-institutionalized population or nearly one person in two. (Annual Plan Summary, April 1, 2007-March 31, 2008; September 2006 New York City Department for the Aging).

• Poverty is associated with disability. The elderly with disabilities reported higher poverty rates compared with the elderly without disabilities. (Annual Plan Summary, April 1, 2007-March 31, 2008; September 2006 New York City Department for the Aging)

• It is estimated that over 21 percent of the elderly in New York State age 65 and above have a self-reported vision impairment (Annual Plan Summary, April 1, 2007-March 31, 2008; September 2006 New York City Department for the Aging).

• With the aging of the population, the number of Americans with major eye diseases is increasing and vision loss is becoming a major public health problem. A 2004 study conducted by the Eye Disease Prevalence Research Group reports that low vision blindness increases significantly with age, particularly in people over age 65. People 80 years of age, account for 69 percent of blindness. The study identifies age-related macular degeneration (AMD), glaucoma, cataract, and diabetic retinopathy as the most common eye diseases in Americans age 40 and over. (Annual Plan Summary, April 1, 2007-March 31, 2008; September 2006 New York City Department for the Aging)

• According to the Center for Disease Control and Prevention, the use of vision rehabilitation services was low among females and males at 1.4 % and 1.5% respectfully and stated that increasing the use of vision rehabilitation services is a public health priority.

Most common causes of vision loss in the elderly

• Age-related macular degeneration is the leading cause of visual impairment among persons age 75 and older and the most common cause of new cases of visual impairment among persons age 65 and older (Prevent Blindness America).

• Approximately 6% of people over the age of 65 have glaucoma, according to The Glaucoma Foundation. Almost 6% of African-Americans age 40 and over are reported to have glaucoma, compared to approximately 2% of Caucasians and others (Prevent Blindness America).

• According to the Framingham Eye Study, cataracts were found in 5% of people age 55-64, 18% of people age 65-74, and 46% of people age 75-84. The National Center for Health Statistics reported that 28.5% of people age 65-74 had lens opacities accompanied by a decrease of visual acuity (20/25 or worse). Of Americans age 40 and older, 16.8% of females have cataracts as compared to 9.7% of males (Prevent Blindness America).

• An estimated 4.8 million Americans age 40 and older have diabetic retinopathy (Prevent Blindness America). Diabetes is the leading cause of new cases of legal blindness among adults age 20-74 with African-Americans being twice as likely to suffer from diabetic-related legal blindness (American Diabetes Association).

How vision loss is defined and reported

• Total blindness is the inability to see anything with either eye. This is a relatively rare occurrence.

• Legal blindness is defined as a visual acuity of 20/200 or worse in the better eye with best correction, or a total loss of 20 degrees or more in the field of vision. This is an arbitrary definition used primarily to establish eligibility for a government benefit.

• Vision impairment is often defined as a visual acuity of 20/70 or worse in the better eye with best correction, or a total field loss of 140 degrees or more in the field of vision. In addition to acuity and field, vision impairment is sometimes defined in terms of contrast sensitivity, night versus day vision impairment, sensitivity to glare, etc. Vision impairment is functionally defined as difficulty in reading regular newsprint, even with vision corrected by regular eyeglasses or contact lenses, or difficulty managing daily living or work related tasks due to vision loss.

• Clinically diagnosed vision loss is determined by a health care professional (such as an optometrist or ophthalmologist) using standard measurement tools and dilated eye examinations.

• Self-reported vision loss is determined by anecdotal information from individuals based on their perceived vision ability and effect on the individual’s ability to function.