Spencer Center for Vision Research, Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University, Palo Alto, California.
Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmology. 2023 Nov;130(11):1121-1137. doi: 10.1016/j.ophtha.2023.06.011. Epub 2023 Jun 17.
To evaluate associations of patient characteristics with United States eye care use and likelihood of blindness.
Retrospective observational study.
Patients (19 546 016) with 2018 visual acuity (VA) records in the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight).
Legal blindness (20/200 or worse) and visual impairment (VI; worse than 20/40) were identified from corrected distance acuity in the better-seeing eye and stratified by patient characteristics. Multivariable logistic regressions evaluated associations with blindness and VI. Blindness was mapped by state and compared with population characteristics. Eye care use was analyzed by comparing population demographics with United States Census estimates and proportional demographic representation among blind patients versus a nationally representative US population sample (National Health and Nutritional Examination Survey [NHANES]).
Prevalence and odds ratios for VI and blindness; proportional representation in the IRIS® Registry, Census, and NHANES by patient demographics.
Visual impairment was present in 6.98% (n = 1 364 935) and blindness in 0.98% (n = 190 817) of IRIS patients. Adjusted odds of blindness were highest among patients ≥ 85 years old (odds ratio [OR], 11.85; 95% confidence interval [CI], 10.33-13.59 vs. those 0-17 years old). Blindness also was associated positively with rural location and Medicaid, Medicare, or no insurance vs. commercial insurance. Hispanic (OR, 1.59; 95% CI, 1.46-1.74) and Black (OR, 1.73; 95% CI, 1.63-1.84) patients showed a higher odds of blindness versus White non-Hispanic patients. Proportional representation in IRIS Registry relative to the Census was higher for White than Hispanic (2- to 4-fold) or Black (11%-85%) patients (P < 0.001). Blindness overall was less prevalent in NHANES than IRIS Registry; however, prevalence in adults aged 60+ was lowest among Black participants in the NHANES (0.54%) and second highest among comparable Black adults in IRIS (1.57%).
Legal blindness from low VA was present in 0.98% of IRIS patients and associated with rural location, public or no insurance, and older age. Compared with US Census estimates, minorities may be underrepresented among ophthalmology patients, and compared with NHANES population estimates, Black individuals may be overrepresented among blind IRIS Registry patients. These findings provide a snapshot of US ophthalmic care and highlight the need for initiatives to address disparities in use and blindness.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
评估患者特征与美国眼科保健使用和失明概率之间的关联。
回顾性观察性研究。
2018 年视力（VA）记录在美国眼科学会的 IRIS®注册中心（智能研究视力）的 19546016 名患者。
从较好眼的矫正远视力中确定法定失明（20/200 或更差）和视力障碍（VI；视力差于 20/40），并按患者特征进行分层。多变量逻辑回归评估与失明和 VI 的关联。根据州和人口特征绘制失明地图，并与全国人口普查估计值进行比较，并在盲患者与全国代表性美国人口样本（国家健康和营养检查调查 [NHANES]）中比较代表性。
VI 和失明的患病率和优势比；IRIS®注册中心、人口普查和 NHANES 中按患者人口统计学特征的代表性比例。
IRIS 患者中 VI 的患病率为 6.98%（n=1364935），失明的患病率为 0.98%（n=190817）。在≥85 岁的患者中，失明的调整后优势比最高（优势比 [OR]，11.85；95%置信区间 [CI]，10.33-13.59 与 0-17 岁的患者相比）。失明也与农村地区以及医疗补助、医疗保险或无保险与商业保险呈正相关。与白人非西班牙裔患者相比，西班牙裔（OR，1.59；95%CI，1.46-1.74）和黑人（OR，1.73；95%CI，1.63-1.84）患者的失明风险更高。与人口普查相比，IRIS 登记处的白人比例高于西班牙裔（2 至 4 倍）或黑人（11%-85%）患者（P<0.001）。NHANES 中的整体失明患病率低于 IRIS 登记处；然而，在 NHANES 中，60 岁以上的黑人参与者的失明患病率最低（0.54%），而在 IRIS 中可比的黑人成年人中，失明患病率第二高（1.57%）。
在 IRIS 患者中，VA 较低导致的法定失明占 0.98%，与农村地区、公共或无保险以及年龄较大有关。与美国人口普查估计值相比，少数民族在眼科患者中的代表性可能不足，与 NHANES 人口估计值相比，黑人患者在盲 IRIS 登记患者中可能过多。这些发现提供了美国眼科保健的概况，并强调需要采取措施解决使用和失明方面的差异。
在本文的脚注和披露中可能发现专有或商业披露。
