Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 87 Records) |
Query Trace: Saaddine J[original query] |
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Prevalence of diagnosed diabetes among U.S. Adults aged ≥18 years with disabilities, 2021-2022
Bardenheier BH , Omura JD , Saaddine JB , Hora I , McKeever Bullard K . Diabetes Care 2025 OBJECTIVE: To compare the prevalence of diagnosed diabetes among U.S. adults with and without disabilities, overall and by subgroups. RESEARCH DESIGN AND METHODS: We used data on adults aged ≥18 years from the cross-sectional 2021-2022 National Health Interview Survey to report the prevalence of diagnosed diabetes by functional disability status and for each disability type (hearing, seeing, mobility, cognition, self-care, and communication) separately. With use of the Washington Group Short Set on Functioning indicator, disability was defined according to the categories of milder (reporting some difficulty), moderate (reporting a lot of difficulty), and severe (cannot do at all) by disability type. Crude prevalence and age-standardized prevalence of diabetes were also calculated for adults with any difficulty with any disability by age, sex, race/ethnicity, education, insurance, and poverty-to-income ratio. RESULTS: Diabetes prevalence increased with number of disability types, was lower among adults with no disability (5.8%) than among those with milder (9.5%) or moderate to more severe (18.3%) disability, and was 4.0-10.3 percentage points higher among those with moderate to more severe disability than among those with milder disability for vision, hearing, mobility, and cognitive disabilities. Diabetes prevalence was similar for adults with milder and moderate to more severe self-care and communication disabilities. CONCLUSIONS: Prevalence of diabetes was higher among adults with any functional disability than without and increased with increasing number of disability types. Adults with multiple disability types, or those who have difficulty with self-care or communication or other moderate to more severe disabilities, may benefit from diabetes prevention programs. |
Prevalence of glaucoma among US adults in 2022
Ehrlich JR , Burke-Conte Z , Wittenborn JS , Saaddine J , Omura JD , Friedman DS , Flaxman AD , Rein DB . JAMA Ophthalmol 2024 ![]() IMPORTANCE: Glaucoma is the leading cause of irreversible blindness worldwide and, in the US, disproportionately affects people from racial and ethnic minority groups. Glaucoma prevalence has not been estimated for the US in more than a decade, and state- and county-level estimates are not available. OBJECTIVE: To estimate glaucoma and vision-affecting glaucoma prevalence by demographic factors and US state and county for the Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System (VEHSS). DATA SOURCES: This meta-analysis used data from the National Health and Nutrition Examination Survey (2005-2008), Medicare fee-for-service claims (2019), IBM MarketScan commercial insurance claims (2016), population-based studies of eye disease (1985-2003), and 2022 population estimates from the US Census Bureau. STUDY SELECTION: PubMed was searched for population-based studies of glaucoma prevalence published between 1991 and 2016. DATA EXTRACTION AND SYNTHESIS: Bayesian meta-regression methods were used to estimate the prevalence of glaucoma and vision-affecting glaucoma stratified by age, undifferentiated sex/gender (a measure that captures an unclear mix of aspects of sex and or gender), race and ethnicity, and US county and state. MAIN OUTCOMES AND MEASURES: Prevalence of any type of glaucoma (open or closed angle) among people 18 years or older and vision-affecting glaucoma, defined as glaucoma and a visual field abnormality. RESULTS: For 2022, an estimated 4.22 million people (95% uncertainty interval [UI], 3.46 million to 5.23 million) in the US were living with glaucoma, with a prevalence of 1.62% (UI, 1.33%-2.00%) among people 18 years or older and 2.56% (UI, 2.10%-3.16%) among people 40 years or older. An estimated 1.49 million people (UI, 1.17 million to 1.90 million) were living with vision-affecting glaucoma, with a prevalence of 0.57% (UI, 0.45%-0.73%) among people 18 years or older and 0.91% (UI, 0.71%-1.16%) among people 40 years or older. Prevalence of glaucoma among people 18 years or older ranged from 1.11% (UI, 0.89%-1.40%) in Utah to 1.95% (UI, 1.57%-2.39%) in Mississippi. Black adults had a prevalence of 3.15% (UI, 2.32%-4.09%) compared with 1.42% (UI, 1.10%-1.85%) among White adults; adults in the Hispanic and all other racial and ethnic categories combined had a prevalence of 1.56% (UI, 1.13%-2.06%). CONCLUSIONS AND RELEVANCE: This meta-analysis found that an estimated 2.56% of people 40 years or older have glaucoma, slightly more than estimated by previous studies. Black individuals are disproportionately affected. Prevalence estimates at the state and county level can help guide public health planning. |
Sociodemographic characteristics distinguished from social determinants of health
Alfaro Hudak KM , Saaddine J , Rein DB . JAMA Ophthalmol 2023 We appreciate the commentary from Kemper et al,1 who raise 2 points that we would like to clarify. The commenters stress the importance of differentiating between social risk factors and sociodemographic characteristics and note that researchers should be careful not to equate social determinants of health (SDOH) with membership in a minoritized racial or ethnic group. For those reasons, our study2 distinguished between the sociodemographic characteristics, including race and ethnicity, and the SDOH that we included in our analyses. Although we mistakenly referred to race and ethnicity as an SDOH along with other factors in one sentence, in the subsequent methods, results, and discussion sections, we differentiated between SDOH and sociodemographic characteristics, such as race and ethnicity. We agree with—and would like to underscore here—Kemper and colleagues’ statement that “racism, rather than race, is one of the main SDOH that drives disparities in wealth and power and leads to inequities in health outcomes.”1 | | Second, Kemper et al mention that community-level SDOH (eg, the availability of local greenspace and air quality) likely influence vision health and note that we were unable to include such measures in our study.2 Unfortunately, data sources that include detailed geographic identifiers that would facilitate such important community-level analyses typically lack measures of vision loss. It is essential to establish the correlation between self-reported and evaluated measures if researchers are to use self-reported vision loss to study important topics, such as health disparities. A primary purpose of our study was to assess whether measures of association between SDOH and clinically evaluated vision loss correspond to associations found using self-reported vision loss in survey data. Our finding such a correspondence unlocks the potential to link vision loss data in the American Community Survey at the zip code or census tract level to the types of community-level SDOH data cited by Kemper et al. |
Trends in the diagnosed prevalence and incidence of major eye diseases in Medicare Part B fee-for-service beneficiaries aged 68 years or older
Ehrlich JR , Andes LJ , Eisenberg A , Saaddine J , Lundeen EA . Ophthalmology 2023 130 (12) 1240-1247 PURPOSE: To study contemporary trends in the diagnosed prevalence and incidence of age-related eye diseases among Medicare fee-for-service (FFS) beneficiaries. DESIGN: Analysis of Medicare administrative claims data. PARTICIPANTS: Medicare FFS beneficiaries aged 68 and older from 2005-2020. Those included were continuously enrolled in both Part A and Part B for 3 years, including the index year and 2-year lookback period. METHODS: Annual cross-sectional diagnosed prevalence and incidence rates were calculated. Age-standardization was performed using the direct standardization method to account for changes in the age-structure of the study population. Rates stratified by demographics (age, sex, race, and ethnicity) were also calculated. MAIN OUTCOME MEASURES: Annual prevalence and incidence of diagnosed age-related macular degeneration (AMD), diabetic retinopathy (DR) (among those with diabetes), and glaucoma. RESULTS: At baseline, in 2005, 60% of included beneficiaries were female, 20% were aged ≥85, 86% were non-Hispanic White, and one-quarter had diabetes. From 2005-2019, the prevalence of a diagnosis of any of the conditions studied increased from 15.0% (N=3,312,812) to 17.9% (N=3,731,281). Diagnosed incidence decreased over this period from 4.7% (N=917,846) in 2005 to 4.2% in 2019 (N=757,696). The diagnosed prevalence of AMD increased from 6.8% (N=1,504,770) to 9.4% (N=1,965,176); the diagnosed prevalence of any DR among those with diabetes decreased from 9.3% (N= 504,135) to 9.0% (N=532,859), though the diagnosed prevalence of vision-threatening DR increased from 2.0% to 3.4%; and the diagnosed prevalence of any diagnosed glaucoma decreased from 8.8% (N= 1,951,141) to 8.1% (N= 1,692,837). In 2020, the diagnosed prevalence and incidence of all diagnoses decreased. During the study period we detected demographic differences in the prevalence and incidence of diagnosis of each condition. CONCLUSIONS: This study presents updated data on the prevalence and incidence of diagnosed major chronic, age-related eye diseases among Medicare FFS beneficiaries. Compared to older epidemiological estimates, we found that the diagnosed prevalence of each condition studied was higher in more recent years. These findings may inform public health and policy planning and resource allocation to address the eye health of an increasingly older US population. |
Prevalence of diabetic retinopathy in the US in 2021
Lundeen EA , Burke-Conte Z , Rein DB , Wittenborn JS , Saaddine J , Lee AY , Flaxman AD . JAMA Ophthalmol 2023 ![]() IMPORTANCE: Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the US. OBJECTIVE: To update estimates of DR and vision-threatening diabetic retinopathy (VTDR) prevalence by demographic factors and US county and state. DATA SOURCES: The study team included data from the National Health and Nutrition Examination Survey (2005 to 2008 and 2017 to March 2020), Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 to 2016), 2 studies of diabetes in youth (2021 and 2023), and a previously published analysis of diabetes by county (2012). The study team used population estimates from the US Census Bureau. STUDY SELECTION: The study team included relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System. DATA EXTRACTION AND SYNTHESIS: Using bayesian meta-regression methods, the study team estimated the prevalence of DR and VTDR stratified by age, a nondifferentiated sex and gender measure, race, ethnicity, and US county and state. MAIN OUTCOMES AND MEASURES: The study team defined individuals with diabetes as those who had a hemoglobin A1c level at 6.5% or more, took insulin, or reported ever having been told by a physician or health care professional that they have diabetes. The study team defined DR as any retinopathy in the presence of diabetes, including nonproliferative retinopathy (mild, moderate, or severe), proliferative retinopathy, or macular edema. The study team defined VTDR as having, in the presence of diabetes, severe nonproliferative retinopathy, proliferative retinopathy, panretinal photocoagulation scars, or macular edema. RESULTS: This study used data from nationally representative and local population-based studies that represent the populations in which they were conducted. For 2021, the study team estimated 9.60 million people (95% uncertainty interval [UI], 7.90-11.55) living with DR, corresponding to a prevalence rate of 26.43% (95% UI, 21.95-31.60) among people with diabetes. The study team estimated 1.84 million people (95% UI, 1.41-2.40) living with VTDR, corresponding to a prevalence rate of 5.06% (95% UI, 3.90-6.57) among people with diabetes. Prevalence of DR and VTDR varied by demographic characteristics and geography. CONCLUSIONS AND RELEVANCE: US prevalence of diabetes-related eye disease remains high. These updated estimates on the burden and geographic distribution of diabetes-related eye disease can be used to inform the allocation of public health resources and interventions to communities and populations at highest risk. |
Validity of administrative claims and electronic health registry data from a single practice for eye health surveillance
Wittenborn JS , Lee AY , Lundeen EA , Lamuda P , Saaddine J , Su GL , Lu R , Damani A , Zawadzki JS , Froines CP , Shen JZ , Kung TH , Yanagihara RT , Maring M , Takahashi MM , Blazes M , Rein DB . JAMA Ophthalmol 2023 IMPORTANCE: Diagnostic information from administrative claims and electronic health record (EHR) data may serve as an important resource for surveillance of vision and eye health, but the accuracy and validity of these sources are unknown. OBJECTIVE: To estimate the accuracy of diagnosis codes in administrative claims and EHRs compared to retrospective medical record review. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study compared the presence and prevalence of eye disorders based on diagnostic codes in EHR and claims records vs clinical medical record review at University of Washington-affiliated ophthalmology or optometry clinics from May 2018 to April 2020. Patients 16 years and older with an eye examination in the previous 2 years were included, oversampled for diagnosed major eye diseases and visual acuity loss. EXPOSURES: Patients were assigned to vision and eye health condition categories based on diagnosis codes present in their billing claims history and EHR using the diagnostic case definitions of the US Centers for Disease Control and Prevention Vision and Eye Health Surveillance System (VEHSS) as well as clinical assessment based on retrospective medical record review. MAIN OUTCOME AND MEASURES: Accuracy was measured as area under the receiver operating characteristic curve (AUC) of claims and EHR-based diagnostic coding vs retrospective review of clinical assessments and treatment plans. RESULTS: Among 669 participants (mean [range] age, 66.1 [16-99] years; 357 [53.4%] female), identification of diseases in billing claims and EHR data using VEHSS case definitions was accurate for diabetic retinopathy (claims AUC, 0.94; 95% CI, 0.91-0.98; EHR AUC, 0.97; 95% CI, 0.95-0.99), glaucoma (claims AUC, 0.90; 95% CI, 0.88-0.93; EHR AUC, 0.93; 95% CI, 0.90-0.95), age-related macular degeneration (claims AUC, 0.87; 95% CI, 0.83-0.92; EHR AUC, 0.96; 95% CI, 0.94-0.98), and cataracts (claims AUC, 0.82; 95% CI, 0.79-0.86; EHR AUC, 0.91; 95% CI, 0.89-0.93). However, several condition categories showed low validity with AUCs below 0.7, including diagnosed disorders of refraction and accommodation (claims AUC, 0.54; 95% CI, 0.49-0.60; EHR AUC, 0.61; 95% CI, 0.56-0.67), diagnosed blindness and low vision (claims AUC, 0.56; 95% CI, 0.53-0.58; EHR AUC, 0.57; 95% CI, 0.54-0.59), and orbital and external diseases (claims AUC, 0.63; 95% CI, 0.57-0.69; EHR AUC, 0.65; 95% CI, 0.59-0.70). CONCLUSION AND RELEVANCE: In this cross-sectional study of current and recent ophthalmology patients with high rates of eye disorders and vision loss, identification of major vision-threatening eye disorders based on diagnosis codes in claims and EHR records was accurate. However, vision loss, refractive error, and other broadly defined or lower-risk disorder categories were less accurately identified by diagnosis codes in claims and EHR data. |
Prevalence, progression, and modifiable risk factors for diabetic retinopathy in youth and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes In Youth Study
Jensen ET , Rigdon J , Rezaei KA , Saaddine J , Lundeen EA , Dabelea D , Dolan LM , D'Agostino R , Klein B , Meuer S , Mefford MT , Reynolds K , Marcovina SM , Mottl A , Mayer-Davis B , Lawrence JM . Diabetes Care 2023 46 (6) 1252-1260 OBJECTIVE: To determine the prevalence, progression, and modifiable risk factors associated with the development of diabetic retinopathy (DR) in a population-based cohort of youth-onset diabetes. RESEARCH DESIGN AND METHODS: We conducted a multicenter, population-based prospective cohort study (2002-2019) of youth and young adults with youth-onset type 1 diabetes (n = 2,519) and type 2 diabetes (n = 447). Modifiable factors included baseline and change from baseline to follow-up in BMI z score, waist/height ratio, systolic and diastolic blood pressure z score, and A1C. DR included evidence of mild or moderate nonproliferative DR or proliferative retinopathy. Prevalence estimates were standardized to estimate the burden of DR, and inverse probability weighting for censoring was applied for estimating risk factors for DR at two points of follow-up. RESULTS: DR in youth-onset type 1 and type 2 diabetes is highly prevalent, with 52% of those with type 1 diabetes and 56% of those with type 2 diabetes demonstrating retinal changes at follow-up (mean [SD] 12.5 [2.2] years from diagnosis). Higher baseline A1C, increase in A1C across follow-up, and increase in diastolic and systolic blood pressure were associated with the observation of DR at follow-up for both diabetes types. Increase in A1C across follow-up was associated with retinopathy progression. BMI z score and waist/height ratio were inconsistently associated, with both positive and inverse associations noted. CONCLUSIONS: Extrapolated to all youth-onset diabetes in the U.S., we estimate 110,051 cases of DR developing within ∼12 years postdiagnosis. Tight glucose and blood pressure management may offer the opportunity to mitigate development and progression of DR in youth-onset diabetes. |
Association between social determinants of health and examination-based vision loss vs self-reported vision measures
Alfaro Hudak KM , Wittenborn JS , Lamuda PA , Lundeen EA , Saaddine J , Rein DB . JAMA Ophthalmol 2023 IMPORTANCE: Recent evidence suggests that social determinants of health (SDOH) affect vision loss, but it is unclear whether estimated associations differ between clinically evaluated and self-reported vision loss. OBJECTIVE: To identify associations between SDOH and evaluated vision impairment and to assess whether these associations hold when examining self-reported vision loss. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional comparison included participants 12 years and older in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), participants of all ages (infants and older) in the 2019 American Community Survey (ACS), and adults 18 years and older in the 2019 Behavioral Risk Factor Surveillance System (BRFSS). EXPOSURES: Five domains of SDOH that are based on Healthy People 2030: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. MAIN OUTCOMES AND MEASURES: Presenting vision impairment of 20/40 or worse in the better-seeing eye (NHANES) and self-reported blindness or serious difficulty seeing, even with glasses (ACS and BRFSS). RESULTS: Of 3 649 085 included participants, 1 873 893 were female (51.1%) and 2 504 206 were White (64.4%). SDOH across domains of economic stability, educational attainment, health care access and quality, neighborhood and built environment, and social context were significant predictors of poor vision. For example, higher income (poverty to income ratio [NHANES]: OR, 0.91; 95% CI, 0.85-0.98; [ACS]: OR, 0.93; 95% CI, 0.93-0.94; categorical income [BRFSS:<$15 000 reference]: $15 000-$24 999; OR, 0.91; 95% CI, 0.91-0.91; $25 000-$34 999: OR, 0.80; 95% CI, 0.80-0.80; $35 000-$49 999: OR, 0.71; 95% CI, 0.71-0.72; ≥$50 000: OR, 0.49; 95% CI, 0.49-0.49), employment (BRFSS: OR, 0.66; 95% CI, 0.66-0.66; ACS: OR, 0.55; 95% CI, 0.54-0.55), and owning a home (NHANES: OR, 0.85; 95% CI, 0.73-1.00; BRFSS: OR, 0.82; 95% CI, 0.82-0.82; ACS: OR, 0.79; 95% CI, 0.79-0.79) were associated with lower odds of vision loss. The study team identified no differences in the general direction of the associations when using either clinically evaluated or self-reported vision measures. CONCLUSIONS AND RELEVANCE: The study team found evidence that associations between SDOH and vision impairment track together when using either clinically evaluated or self-reported vision loss. These findings support the use of self-reported vision data in a surveillance system to track trends in SDOH and vision health outcomes within subnational geographies. |
Comparing telephone survey responses to best-corrected visual acuity to estimate the accuracy of identifying vision loss: Validation study
Wittenborn J , Lee A , Lundeen EA , Lamuda P , Saaddine J , Su GL , Lu R , Damani A , Zawadzki JS , Froines CP , Shen JZ , Kung TH , Yanagihara RT , Maring M , Takahashi MM , Blazes M , Rein DB . JMIR Public Health Surveill 2023 9 e44552 BACKGROUND: Self-reported questions on blindness and vision problems are collected in many national surveys. Recently released surveillance estimates on the prevalence of vision loss used self-reported data to predict variation in the prevalence of objectively measured acuity loss among population groups for whom examination data are not available. However, the validity of self-reported measures to predict prevalence and disparities in visual acuity has not been established. OBJECTIVE: This study aimed to estimate the diagnostic accuracy of self-reported vision loss measures compared to best-corrected visual acuity (BCVA), inform the design and selection of questions for future data collection, and identify the concordance between self-reported vision and measured acuity at the population level to support ongoing surveillance efforts. METHODS: We calculated accuracy and correlation between self-reported visual function versus BCVA at the individual and population level among patients from the University of Washington ophthalmology or optometry clinics with a prior eye examination, randomly oversampled for visual acuity loss or diagnosed eye diseases. Self-reported visual function was collected via telephone survey. BCVA was determined based on retrospective chart review. Diagnostic accuracy of questions at the person level was measured based on the area under the receiver operator curve (AUC), whereas population-level accuracy was determined based on correlation. RESULTS: The survey question, "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" had the highest accuracy for identifying patients with blindness (BCVA ≤20/200; AUC=0.797). The highest accuracy for detecting any vision loss (BCVA <20/40) was achieved by responses of "fair," "poor," or "very poor" to the question, "At the present time, would you say your eyesight, with glasses or contact lenses if you wear them, is excellent, good, fair, poor, or very poor" (AUC=0.716). At the population level, the relative relationship between prevalence based on survey questions and BCVA remained stable for most demographic groups, with the only exceptions being groups with small sample sizes, and these differences were generally not significant. CONCLUSIONS: Although survey questions are not considered to be sufficiently accurate to be used as a diagnostic test at the individual level, we did find relatively high levels of accuracy for some questions. At the population level, we found that the relative prevalence of the 2 most accurate survey questions were highly correlated with the prevalence of measured visual acuity loss among nearly all demographic groups. The results of this study suggest that self-reported vision questions fielded in national surveys are likely to yield an accurate and stable signal of vision loss across different population groups, although the actual measure of prevalence from these questions is not directly analogous to that of BCVA. |
Trends in the prevalence and treatment of diabetic macular edema and vision-threatening diabetic retinopathy among commercially insured adults aged <65 years
Lundeen EA , Kim M , Rein DB , Wittenborn JS , Saaddine J , Ehrlich JR , Holliday CS . Diabetes Care 2023 46 (4) 687-696 OBJECTIVE: Examine the 10-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes. RESEARCH DESIGN AND METHODS: We analyzed the 10-year trend (2009-2018) in health care claims for adults aged 18-64 years using the IBM MarketScan Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on one or more inpatient or two or more different-day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with one or more claims for 1) any DME, 2) either DME or VTDR, and 3) antivascular endothelial growth factor (anti-VEGF) injections and laser photocoagulation treatment, stratified by any DME, VTDR with DME, and VTDR without DME. We calculated the average annual percent change (AAPC). RESULTS: From 2009 to 2018, there was an increase in the annual prevalence of patients with DME or VTDR (2.1% to 3.4%; AAPC 7.5%; P < 0.001) and any DME (0.7% to 2.6%; AAPC 19.8%; P < 0.001). There were sex differences in the annual prevalence of DME or VTDR and any DME, with men having a higher prevalence than women. Annual claims for anti-VEGF injections increased among patients with any DME (327%) and VTDR with DME (206%); laser photocoagulation decreased among patients with any DME (-68%), VTDR with DME (-54%), and VTDR without DME (-62%). CONCLUSIONS: Annual claims for DME or VTDR and anti-VEGF injections increased whereas those for laser photocoagulation decreased among commercially insured adults with diabetes. |
Health care access and use among adults with and without vision impairment: Behavioral Risk Factor Surveillance System, 2018
Cheng Q , Okoro CA , Mendez I , Lundeen EA , Saaddine JB , Stein R , Holbrook J . Prev Chronic Dis 2022 19 E70 INTRODUCTION: Adults with vision impairment may have unique needs when accessing health care to maintain good health. Our study examined the relationship between vision status and access to and use of health care. METHODS: We analyzed data on adults aged 18 years or older who participated in the 2018 Behavioral Risk Factor Surveillance System. Vision impairment was identified by a yes response to the question "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" Survey questions assessed health care access over the past year (having health insurance coverage, a usual health care provider, or unmet health care needs because of cost) and use of health care during that period (routine checkup and dental visit). We estimated age-adjusted prevalence of our outcomes of interest and used bivariate analyses to compare estimates of the outcomes by vision impairment status. RESULTS: The prevalence of self-reported vision impairment was 5.3%. Compared with adults without impaired vision, adults with vision impairment had a lower prevalence of having health insurance coverage (80.6% vs 87.6%), a usual health care provider (71.9% vs 75.7%), or a dental visit in the past year (52.9% vs 67.2%) and a higher prevalence of having an unmet health care need in the past year because of cost (29.2% vs 12.6%). CONCLUSION: Adults with vision impairment reported lower access to and use of health care than those without. Further research can better identify and understand barriers to care to improve access to and use of health care among this population. |
Engagement in the MI-SIGHT Glaucoma Screening Program: Comparing the effect of clinic versus community-based recruitment strategies
Elam AR , Mobolaji I , Flaharty K , Niziol LM , Woodward MA , Zhang J , Musch DC , Johnson L , Kershaw M , Bicket A , Saaddine J , John D , Newman-Casey PA . Ophthalmol Glaucoma 2022 PURPOSE: To determine the effectiveness of adding community-based recruitment to clinic-based recruitment to engage participants in a glaucoma detection program. DESIGN: Prospective cohort study. SUBJECTS: Anyone ≥ 18 years of age who do not meet exclusion criteria METHODS: The Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) Program tests a novel way of improving glaucoma detection in communities with populations at high risk for disease, including people who identify as Black and Hispanic and those living with low socio-economic status. The MI-SIGHT program is conducted in a free clinic (Ypsilanti, MI) and in a federally qualified health center (FQHC; Flint, MI). Community-engagement methods were used to identify outreach strategies to enhance recruitment. Participants were asked "How did you hear about the MI-SIGHT program?" and responses were summarized overall and by clinic and compared between clinic-based and community-based recruitment strategies. MAIN OUTCOME MEASURES: Proportion recruited by location, within or outside of the clinic. RESULTS: 647 participants were recruited in the first eleven months of the study, 356 (55.0%) at the free clinic over 11 months and 291 (45.0%) at the FQHC over 6 months. Participants were on average 54.4 years old (SD=14.2), 60.9% female, 45.6% Black, 37.8% White, 9.6% Hispanic, and 10.9% had < high school education. Participants reported hearing about the MI-SIGHT program from a clinic phone call (n=168, 26.1%), a friend (n=112, 17.4%), non-medical clinic staff (n=100, 15.5%), a clinic doctor (n=77, 11.9%), an in-clinic brochure or flyer (n=51, 7.9%), a community flyer (n=44, 6.8%), the clinic website or social media (n=28, 4.3%), or an "other" source (n=65, 10.1%). Recruiting from the community outside the medical clinics increased participation by 265% at the free clinic and 46% at the FQHC. CONCLUSIONS: The Community Advisory Board recommendation to use community-based recruitment strategies in addition to clinic-based strategies for recruitment resulted in increased program participation. |
Cardiovascular disease risk factors in US adults with vision impairment
Mendez I , Kim M , Lundeen EA , Loustalot F , Fang J , Saaddine J . Prev Chronic Dis 2022 19 E43 INTRODUCTION: Adults with vision impairment (VI) have a higher prevalence of cardiovascular disease (CVD) compared with those without VI. We estimated the prevalence of CVD and CVD risk factors by VI status in US adults. METHODS: We used nationally representative data from the 2018 National Health Interview Survey (N = 22,890 adults aged 18 years). We estimated the prevalence of self-reported diagnosis of CVD (coronary heart disease [including angina and myocardial infarction], stroke, or other heart disease) by VI status. We used separate logistic regression models to generate adjusted prevalence ratios (aPRs), controlling for sociodemographic covariates, for those with VI (reference group, no VI) for CVD and CVD risk factors: current smoking, physical inactivity, excessive alcohol intake, obesity, hypertension, high cholesterol, and diabetes. RESULTS: Overall, 12.9% (95% CI, 12.3-13.5) of the sample had VI. The prevalence of CVD was 26.6% (95% CI, 24.7-28.6) in people with VI versus 12.2% (95% CI, 11.7-12.8) in those without VI (aPR = 1.65 [95% CI, 1.51-1.80]). Compared with adults without VI, those with VI had a higher prevalence of all risk factors examined: current smoking (aPR = 1.40 [95% CI, 1.27-1.53]), physical inactivity (aPR = 1.14 [95% CI, 1.06-1.22]), excessive alcohol intake (aPR = 1.29 [95% CI, 1.08-1.53]), obesity (aPR = 1.28 [95% CI, 1.21-1.36]), hypertension (aPR = 1.29 [95% CI, 1.22-1.36]), high cholesterol (aPR = 1.21 [95% CI, 1.14-1.29]), and diabetes (aPR = 1.54 [95% CI, 1.38-1.72]). CONCLUSION: Adults with VI had a higher prevalence of CVD and CVD risk factors compared with those without VI. Effective clinical and lifestyle interventions, adapted to accommodate VI-related challenges, may help reduce CVD risk in adults with VI. |
County-level variation in the prevalence of visual acuity loss or blindness in the US
Lundeen EA , Flaxman AD , Wittenborn JS , Burke-Conte Z , Gulia R , Saaddine J , Rein DB . JAMA Ophthalmol 2022 140 (8) 831-832 This cross-sectional study evaluates vision loss and blindness prevalence in the US at the county level. |
Trends in prevalence and treatment of diabetic macular edema and vision-threatening diabetic retinopathy among Medicare Part B fee-for-service beneficiaries
Lundeen EA , Andes LJ , Rein DB , Wittenborn JS , Erdem E , Gu Q , Saaddine J , Imperatore G , Chew EY . JAMA Ophthalmol 2022 140 (4) 345-353 IMPORTANCE: While diabetes prevalence among US adults has increased in recent decades, few studies document trends in diabetes-related eye disease. OBJECTIVE: To examine 10-year trends (2009-2018) in annual prevalence of Medicare beneficiaries with diabetes with a diagnosis of diabetic macular edema (DME) or vision-threatening diabetic retinopathy (VTDR) and trends in treatment. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study using Centers for Medicare & Medicaid Services research identifiable files, data for patients 65 years and older were analyzed from claims. Beneficiaries were continuously enrolled in Medicare Part B fee-for-service (FFS) insurance for the calendar year and had a diagnosis of diabetes on 1 or more inpatient claims or 2 or more outpatient claims during the calendar year or a 1-year look-back period. MAIN OUTCOMES AND MEASURES: Using diagnosis and procedure codes, annual prevalence was determined for beneficiaries with 1 or more claims for (1) any DME, (2) either DME or VTDR, and (3) anti-vascular endothelial growth factor (VEGF) injections, laser photocoagulation, or vitrectomy, stratified by any DME, VTDR with DME, and VTDR without DME. Racial and ethnic disparities in diagnosis and treatment are presented for 2018. RESULTS: In 2018, 6 960 823 beneficiaries (27.4%) had diabetes; half were aged 65 to 74 years (49.7%), half (52.7%) were women, and 75.7% were non-Hispanic White. From 2009 to 2018, there was an increase in the annual prevalence of beneficiaries with diabetes who had 1 or more claims for any DME (1.0% to 3.3%) and DME/VTDR (2.8% to 4.3%). Annual prevalence of anti-VEGF increased, particularly among patients with any DME (15.7% to 35.2%) or VTDR with DME (20.2% to 47.6%). Annual prevalence of laser photocoagulation decreased among those with any DME (45.5% to 12.5%), VTDR with DME (54.0% to 20.3%), and VTDR without DME (22.5% to 5.8%). Among all 3 groups, prevalence of vitrectomy in 2018 was less than half that in 2009. Prevalence of any DME and DME/VTDR was highest among Hispanic beneficiaries (5.0% and 7.0%, respectively) and Black beneficiaries (4.5% and 6.2%, respectively) and lowest among non-Hispanic White beneficiaries (3.0% and 3.8%, respectively). Among those with DME/VTDR, anti-VEGF was most prevalent among non-Hispanic White beneficiaries (30.3%). CONCLUSIONS AND RELEVANCE: From 2009 to 2018, prevalence of DME or VTDR increased among Medicare Part B FFS beneficiaries alongside an increase in anti-VEGF treatment and a decline in laser photocoagulation and vitrectomy. |
Diabetes self-management education and association with diabetes self-care and clinical preventive care practices
Mendez I , Lundeen EA , Saunders M , Williams A , Saaddine J , Albright A . Sci Diabetes Self Manag Care 2022 48 (1) 26350106211065378 PURPOSE: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. METHODS: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (18years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. RESULTS: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). CONCLUSIONS: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care. |
The Economic Burden of Vision Loss and Blindness in the United States
Zhang P , Lundeen EA , Saaddine J . Ophthalmology 2021 129 (4) 369-378 PURPOSE: To estimate the economic burden of vision loss (VL) in the United States and by state. DESIGN: Analysis of secondary data sources (American Community Survey [ACS], American Time Use Survey, Bureau of Labor Statistics, Medical Expenditure Panel Survey [MEPS], National and State Health Expenditure Accounts, and National Health Interview Survey [NHIS]) using attributable fraction, regression, and other methods to estimate the incremental direct and indirect 2017 costs of VL. PARTICIPANTS: People with a yes response to a question asking if they are blind or have serious difficulty seeing even when wearing glasses in the ACS, MEPS, or NHIS. MAIN OUTCOME MEASURES: We estimated the direct costs of medical, nursing home (NH), and supportive services and the indirect costs of absenteeism, lost household production, reduced labor force participation, and informal care by age group, sex, and state in aggregate and per person with VL. RESULTS: We estimated an economic burden of VL of $134.2 billion: $98.7 billion in direct costs and $35.5 billion in indirect costs. The largest burden components were NH ($41.8 billion), other medical care services ($30.9 billion), and reduced labor force participation ($16.2 billion), all of which accounted for 66% of the total. Those with VL incurred $16 838 per year in incremental burden. Informal care was the largest burden component for people 0 to 18 years of age, reduced labor force participation was the largest burden component for people 19 to 64 years of age, and NH costs were the largest burden component for people 65 years of age or older. New York, Connecticut, Massachusetts, Rhode Island, and Vermont experienced the highest costs per person with VL. Sensitivity analyses indicate total burden may range between $76 and $218 billion depending on the assumptions used in the model. CONCLUSIONS: Self-reported VL imposes a substantial economic burden on the United States. Burden accrues in different ways at different ages, leading to state differences in the composition of per-person costs based on the age composition of the population with VL. Information on state variation can help local decision makers target resources better to address the burden of VL. |
The prevalence of diagnosis of major eye diseases and their associated payments in the Medicare fee-for-service program
Wittenborn JS , Gu Q , Erdem E , Ahmed F , Zhang P , Saaddine J , Lundeen EA , Rein DB . Ophthalmic Epidemiol 2021 1-13 PURPOSE: To estimate the prevalence of diagnosis of major eye disorders and their associated payments, in total and per-person diagnosed, among Medicare fee-for-service (FFS) beneficiaries in 2018. METHODS: We analyzed 100% Medicare Part B FFS claims and Part D Events among beneficiaries continuously enrolled for 12 months in 2018 to calculate the proportion of beneficiaries with ≥1 claim indicating age-related macular degeneration (AMD), cataract, diabetic retinopathy (DR), or glaucoma, and their associated payments, including Medicare and patient out-of-pocket. Eye disease and eye care services were identified using case definitions from the Centers for Disease Control and Prevention's (CDC) Vision & Eye Health Surveillance System (VEHSS). Outcomes are reported by disease overall and by age group (0-39, 40-64, 65-84, 85+ years), sex, race/ethnicity, and U.S. state. RESULTS: Among nearly 30 million Medicare Part B FFS beneficiaries in 2018, over 41% (12.4 million) had a claim containing a diagnosis of at least one of the four eye disorders; 33.7% with cataract, 13.3% with glaucoma, 9.2% with AMD and 3.2% with DR. Payments for eye care services and drugs associated with these four conditions were $10.1billion; $3.6 billion for cataract, $3.5 billion for AMD, $2.2 billion for glaucoma and $0.8 billion for DR. The average cost per beneficiary diagnosed was $816: $1,290 for AMD, $781 for DR, $543 for glaucoma, and $360 for cataract. CONCLUSIONS: Major eye disorders are common among Medicare FFS beneficiaries and account for approximately 4.3% of Medicare Part B and 1% of Medicare Part D spending. |
Prevalence of Visual Acuity Loss or Blindness in the US: A Bayesian Meta-analysis
Flaxman AD , Wittenborn JS , Robalik T , Gulia R , Gerzoff RB , Lundeen EA , Saaddine J , Rein DB . JAMA Ophthalmol 2021 139 (7) 717-723 ![]() IMPORTANCE: Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US. OBJECTIVE: To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state. DATA SOURCES: Data from the American Community Survey (2017), National Health and Nutrition Examination Survey (1999-2008), and National Survey of Children's Health (2017), as well as population-based studies (2000-2013), were included. STUDY SELECTION: All relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System were included. DATA EXTRACTION AND SYNTHESIS: The prevalence of visual acuity loss or blindness was estimated, stratified when possible by factors including US state, age group, sex, race/ethnicity, and community-dwelling or group-quarters status. Data analysis occurred from March 2018 to March 2020. MAIN OUTCOMES OR MEASURES: The prevalence of visual acuity loss (defined as a best-corrected visual acuity greater than or equal to 0.3 logMAR) and blindness (defined as a logMAR of 1.0 or greater) in the better-seeing eye. RESULTS: For 2017, this meta-analysis generated an estimated US prevalence of 7.08 (95% uncertainty interval, 6.32-7.89) million people living with visual acuity loss, of whom 1.08 (95% uncertainty interval, 0.82-1.30) million people were living with blindness. Of this, 1.62 (95% uncertainty interval, 1.32-1.92) million persons with visual acuity loss are younger than 40 years, and 141 000 (95% uncertainty interval, 95 000-187 000) persons with blindness are younger than 40 years. CONCLUSIONS AND RELEVANCE: This analysis of all available data with modern methods produced estimates substantially higher than those previously published. |
Self-Reported Vision Impairment and Psychological Distress in U.S. Adults
Lundeen EA , Saydah S , Ehrlich JR , Saaddine J . Ophthalmic Epidemiol 2021 29 (2) 1-11 Purpose: Examine the relationship between vision impairment and psychological distress in adults ≥18 years.Methods: Using the 2016-2017 cross-sectional, U.S. National Health Interview Survey, we analyzed self-reported data (n = 57,644) on: Kessler psychological distress scores; general vision impairment (GVI), defined as difficulty seeing even when wearing glasses or contacts; and visual function impairment (VFI), measured using six visual function questions. Multinomial logistic regression was used to estimate adjusted odds ratios (aOR) for mild/moderate and serious psychological distress, by GVI and VFI status, and identify predictors of psychological distress among those with GVI or VFI.Results: Among adults, 10.6% (95% CI: 10.2, 11.0) had GVI; 11.6% (CI: 11.1, 12.0) had VFI. One in four adults with GVI had psychological distress (14.9% [CI: 13.8, 16.0] reported mild/moderate and 11.2% [CI: 10.2, 12.3] reported serious). Individuals with GVI, versus those without, had higher odds of mild/moderate (aOR = 2.24; CI: 2.00, 2.52) and serious (aOR = 3.41; CI: 2.96, 3.93) psychological distress; VFI had similar findings. Among adults with GVI, odds of serious psychological distress were higher for those aged 18-39 (aOR = 4.46; CI: 2.89, 6.90) or 40-64 (aOR = 6.09; CI: 4.33, 8.57) versus ≥65 years; smokers (aOR = 2.45; CI: 1.88, 3.18) versus non-smokers; physically inactive (aOR = 1.61; CI: 1.22, 2.11) versus active; and with arthritis (aOR = 2.18; CI: 1.66, 2.87) or chronic obstructive pulmonary disease (aOR = 1.65; CI: 1.15, 2.37) versus without.Conclusion: Adults with self-reported vision impairment had higher odds of psychological distress. These findings may inform screening interventions to address psychological distress, particularly among younger working-age adults vision impairment. |
Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results
Hark LA , Tan CS , Kresch YS , De Moraes CG , Horowitz JD , Park L , Auran JD , Gorroochurn P , Stempel S , Maruri SC , Besagar S , Saaddine JB , Lambert BC , Pizzi LT , Sapru S , Price S , Williams OA , Cioffi GA , Liebmann JM . Curr Eye Res 2021 46 (10) 1597-1604 PURPOSE/AIM: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care. MATERIALS AND METHODS: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers. RESULTS: Participants (n=42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n=33) failed vision screening. Of those who failed, 84.8% (n=28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses. CONCLUSION: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes. |
Alabama Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (AL-SIGHT): Study design and methodology
Rhodes LA , Register S , Asif I , McGwin GJr , Saaddine J , Nghiem VTH , Owsley C , Girkin CA . J Glaucoma 2021 30 (5) 371-379 PRCIS: This paper presents the methods and protocol of a community-based telemedicine program to identify glaucoma and other eye diseases. PURPOSE: To describe the study rationale and design of the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine (AL-SIGHT) project. METHODS: The study will implement and evaluate a telemedicine-based detection strategy for glaucoma, diabetic retinopathy, and other eye diseases in at-risk patients seen at federally qualified health centers located in rural Alabama. The study will compare the effectiveness of the remote use of structural and functional ocular imaging devices to an in-person exam. Study participants will receive a remote ocular assessment consisting of visual acuity, intraocular pressure, visual field testing, and imaging of the retina and optic nerve with spectral domain optical coherence tomography, and the data will be reviewed by an ophthalmologist and optometrist. It will also compare the effectiveness of financial incentives along with a validated patient education program versus a validated patient education program alone in improving follow-up adherence. Finally, cost and cost-effectiveness analyses will be performed on the telemedicine program compared to standard in-person care using effectiveness measured in numbers of detected eye disease cases. CONCLUSIONS: The study aims to develop a model eye health system using telemedicine to prevent vision loss and address eye health among underserved and at-risk populations. |
Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology.
Hark LA , Kresch YS , De Moraes CG , Horowitz JD , Park L , Auran JD , Gorroochurn P , Stempel S , Maruri SC , Stidham EM , Banks AZ , Saaddine JB , Lambert BC , Pizzi LT , Sapru S , Price S , Williams OA , Cioffi GA , Liebmann JM . J Glaucoma 2021 30 (5) 388-394 PRCIS: The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. PURPOSE: To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. METHODS: This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23-29 mmHg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. If IOP is ≥30 mmHg, participants are assigned as "fast-track" and referred to ophthalmology. Participants living in seven developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in three developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. CONCLUSION: This study targets vulnerable populations where they live to ensure improved access to and utilization of eye-care services in those who are least likely to seek eye care. |
Screening and interventions for glaucoma and eye health through telemedicine (SIGHT) studies
De Moraes CG , Hark LA , Saaddine J . J Glaucoma 2021 Publish Ahead of Print (5) 369-370 The conditions into which we are born, grow, live, learn, work, and age are referred to as social determinants of health and affect a wide range of health risks and outcomes. Healthy People 2020, Health People 2030, and the World Health Organization (WHO) outline 5 key areas for improvement of social determinants of health: (i) Health and health care access and utilization, (ii) education, (iii) economic stability, (iv) neightborhood and built environment, and (v) social and community context (Fig. 1).1-3 According to the WHO, social determinants of health are mostly responsible for health inequities.3 Glaucoma adversely affects communities of color which "makes these communities particularly vulnerable to vision impairment and blindness."4,5 By targeting vulnerable populations at high-risk for glaucoma, specifically African Americans over age 40 years, Asians, older people (aged 65+ years) especially older Hispanics, those with a family history of glaucoma, and those with diabetes, we can improve detection of glaucoma. |
Variability of vision health responses across multiple national survey in the united states
Rein DB , Lamuda PA , Wittenborn JS , Okeke N , Davidson CE , Swenor BK , Saaddine J , Lundeen EA . Ophthalmology 2020 128 (1) 15-27 OBJECTIVE: Lay the groundwork for future survey validation and harmonization efforts by comparing prevalence rates of self-reported visual impairment (VI) and blindness measured across federally-funded national surveys by age-groups and to prevalence rates of presenting impairment and blindness measured by physical examination. DESIGN: Cross-sectional comparison of national surveys. PARTICIPANTS: Participants in: 2016 American Community Survey, the 2016 Behavioral Risk Factor Surveillance System, the 2016 National Health Interview Survey, the 1999-2008 National Health and Nutrition Examination Survey (NHANES), and the 2016 National Survey of Children's Health. METHODS: We estimated VI and blindness prevalence rates and confidence intervals for each survey measure and age-group using the Clopper-Pearson method. We then estimated weighted self-reported VI and blindness prevalence rates across survey measures by age-group using inverse variance weighting, fitted trend lines to age-group estimates, and used the trend-line equations to estimate the number of U.S. persons with VI and blindness in 2016. We compared these self-report estimates to those generated from NHANES physical evaluations of presenting VI and blindness. MAIN OUTCOME MEASURES: The variability of prevalence estimates of VI and blindness RESULTS: Survey response estimates of blindness varied between 0.1% and 5.6% for age-groups <65 years and between 0.6% to 16.6% for ages >=65. Estimates of VI varied between 1.6% and 24.8% for age-groups <65 years and between 2.2% and 26.6% for age-groups >=65. For summarized survey results and NHANES physical evaluation, prevalence rates for VI increased significantly with age-group. Blindness prevalence increased significantly with age-group for summarized survey responses but not for NHANES physical examination. Based on extrapolations of NHANES physical examination data to all ages, we estimated that in 2016, 23.4 million persons in the U.S. (7.2%) had VI or blindness, an evaluated visual acuity of 20/40 or worse in the better-seeing eye before correction; based on weighted self-reported surveys, we estimated 24.8 million persons (7.7%) had presenting VI or blindness. CONCLUSIONS: Prevalence rates of VI and blindness obtained from national survey measures varied widely across surveys and age-groups. Additional research is needed to validate the ability of survey self-report measures of VI and blindness to replicate results obtained through clinical exam by an eye health professional. |
Eye care among US adults at high risk for vision loss in the United States in 2002 and 2017
Saydah SH , Gerzoff RB , Saaddine JB , Zhang X , Cotch MF . JAMA Ophthalmol 2020 138 (5) 479-489 Importance: Timely eye care can prevent unnecessary vision loss. Objectives: To estimate the number of US adults 18 years or older at high risk for vision loss in 2017 and to evaluate use of eye care services in 2017 compared with 2002. Design, Setting, and Participants: This survey study used data from the 2002 (n = 30920) and 2017 (n = 32886) National Health Interview Survey, an annual, cross-sectional, nationally representative sample of US noninstitutionalized civilians. Analysis excluded respondents younger than 18 years and those who were blind or unable to see. Covariates included age, sex, race/ethnicity, marital status, educational level, income-to-poverty ratio, health insurance status, diabetes diagnosis, vision or eye problems, and US region of residence. Main Outcomes and Measures: Three self-reported measures were visiting an eye care professional in the past 12 months, receiving a dilated eye examination in the past 12 months, and needing but being unable to afford eyeglasses in the past 12 months. Adults at high risk for vision loss included those who were 65 years or older, self-reported a diabetes diagnosis, or had vision or eye problems. Multivariable logistic regression models incorporating sampling weights were used to investigate associations between measures and covariates. Temporal comparisons between 2002 and 2017 were derived from estimates standardized to the US 2010 census population. Results: Among 30 920 individuals in 2002, 16.0% were 65 years or older, and 52.0% were female; among 32 886 individuals in 2017, 20.0% were 65 years or older, and 51.8% were female. In 2017, more than 93 million US adults (37.9%; 95% CI, 37.0%-38.7%) were at high risk for vision loss compared with almost 65 million (31.5%; 95% CI, 30.7%-32.3%) in 2002, a difference of 6.4 (95% CI, 5.2-7.6) percentage points. Use of eye care services improved (56.9% [95% CI, 55.7%-58.7%] reported visiting an eye care professional annually, and 59.8% [95% CI, 58.6%-61.0%] reported receiving a dilated eye examination), but 8.7% (95% CI, 8.0%-9.5%) said they could not afford eyeglasses (compared with 51.1% [95% CI, 49.9%-52.3%], 52.4% [95% CI, 51.2%-53.6%], and 8.3% [95% CI, 7.7%-8.9%], respectively, in 2002). In 2017, individuals with lower income compared with high income were more likely to report eyeglasses as unaffordable (13.6% [95% CI, 11.6%-15.9%] compared with 5.7% [95% CI, 4.9%-6.6%]). Conclusions and Relevance: Compared with data from 2002, more US adults were at high risk for vision loss in 2017. Although more adults used eye care, a larger proportion reported eyeglasses as unaffordable. Focusing resources on populations at high risk for vision loss, increasing awareness of the importance of eye care, and making eyeglasses more affordable could promote eye health, preserve vision, and reduce disparities. |
Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract classifications following eye screening
Hark LA , Adeghate J , Katz LJ , Ulas M , Waisbourd M , Maity A , Zhan T , Hegarty S , Leiby BE , Pasquale LR , Leite S , Saaddine JB , Haller JA , Myers JS . Telemed J E Health 2019 26 (8) 992-1000 Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life. |
Disparities in receipt of eye exams among Medicare part B fee-for-service beneficiaries with diabetes - United States, 2017
Lundeen EA , Wittenborn J , Benoit SR , Saaddine J . MMWR Morb Mortal Wkly Rep 2019 68 (45) 1020-1023 Approximately 30 million persons in the United States have diabetes. Persons with diabetes are at risk for vision loss from diabetic retinopathy and other eye diseases (1). Diabetic retinopathy, the most common diabetes-related eye disease, affects 29% of U.S. adults aged >/=40 years with diabetes (2) and is the leading cause of incident blindness among working-age adults (1). It is caused by chronically high blood glucose damaging blood vessels in the retina. Annual dilated eye exams are recommended for persons with diabetes because early detection and timely treatment of diabetic eye diseases can prevent irreversible vision loss. Studies have documented prevalence of annual eye exams among U.S. adults with diabetes; however, a lack of recent state-level data limits identification of geographic disparities in adherence to this recommendation. Medicare claims from the 50 states, the District of Columbia (DC), Puerto Rico, and U.S. Virgin Islands (USVI) were examined to assess the prevalence of eye exams in 2017 among beneficiaries with diabetes who were continuously enrolled in Part B fee-for-service insurance, which covers annual eye exams for beneficiaries with diabetes. This report also examines disparities, by state and race/ethnicity, in receipt of eye exams. Nationally, 54.1% of beneficiaries with diabetes had an eye exam in 2017. Prevalence ranged from 43.9% in Puerto Rico to 64.8% in Rhode Island. Fewer than 50% of beneficiaries received an eye exam in seven states (Alabama, Alaska, Kentucky, Louisiana, Nevada, West Virginia, and Wyoming) and Puerto Rico. Non-Hispanic white (white) beneficiaries had a higher prevalence of receiving an eye exam (55.6%) than did non-Hispanic blacks (blacks) (48.9%) and Hispanics (48.2%). Barriers to receiving eye care (e.g., suboptimal clinical care coordination and referral, low health literacy, and lack of perceived need for care) might limit Medicare beneficiaries' ability to follow this preventive care recommendation. Understanding and addressing these barriers might prevent irreversible vision loss among persons with diabetes. |
Self-reported oral health status among adults age 40+ years with and without vision impairment: National Health Interview Survey, 2008
Crews JE , Chou CF , Naavaal S , Griffin S , Saaddine JB . Am J Ophthalmol 2019 210 184-191 PURPOSE: To examine self-reported oral health among adults age 40 years and older with and without vision impairment. DESIGN: Cross-sectional with a nationally representative sample. METHODS: We used publicly available data from the Oral Health Module, last administered in 2008 of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked or stained teeth; and/or bleeding gums) and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (p<0.05) between vision impairment and oral health outcomes by age-group, sociodemographic, and other explanatory variables. RESULTS: Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged >/=65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status, and 57.3 reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90% to 150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment. CONCLUSIONS: Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population. |
Vision impairment and subjective cognitive decline-related functional limitations - United States, 2015-2017
Saydah S , Gerzoff RB , Taylor CA , Ehrlich JR , Saaddine J . MMWR Morb Mortal Wkly Rep 2019 68 (20) 453-457 Vision impairment affects approximately 3.22 million persons in the United States and is associated with social isolation, disability, and decreased quality of life (1). Cognitive decline is more common in adults with vision impairment (2,3). Subjective cognitive decline (SCD), which is the self-reported experience of worsening or more frequent confusion or memory loss within the past 12 months, affects 11.2% of adults aged >/=45 years in the United States (4). One consequence of SCD is the occurrence of functional limitations, especially those related to usual daily activities; however, it is not known whether persons with vision impairment are more likely to have functional limitations related to SCD (4). This report describes the association of vision impairment and SCD-related functional limitations using Behavioral Risk Factor Surveillance System (BRFSS) surveys for the years 2015-2017. Adjusting for age group, sex, race/ethnicity, education level, health insurance, and smoking status, 18% of adults aged >/=45 years who reported vision impairment also reported SCD-related functional limitations, compared with only 4% of those without vision impairment. Preventing, reducing, and correcting vision impairments might lead to a decrease in SCD-related functional limitations among adults in the United States. |
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