The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.
SMJ // Article
Original Article
Factors Influencing Vision Health and Eye Care among Older Adults in Northeast Tennessee
Abstract
Objectives: The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults.Methods: A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations.
Results: In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08–6.75; AOR 2.82, 95% CI 1.05–7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02–5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85–29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15–9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97–9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis.
Conclusions: This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.
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References
1. Centers for Disease Control and Prevention. Enhancing public health surveillance of visual impairment and eye health in the United States. http://www.cdc.gov/visionhealth/pdf/surveillance_background.pdf. Published 2012. Accessed April 4, 2023.
2. Centers for Disease Control and Prevention. CDC launches the nation’s first vision and eye health surveillance system. https://www.cdc.gov/media/releases/2018/a0726-vision-health.html. Published July 23, 2018. Accessed March 16, 2023.
3. Varma R, Vajaranant TS, 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;134:8022013;809.
4. World Health Organization. World report on vision. https://www.who.int/publications/i/item/9789241516570. Published October 8, 2019. Accessed March 28, 2024.
5. Administration for Community Living. 2020 profile of older Americans. https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2020ProfileOlderAmericans.Final_.pdf. Published May 2021. Accessed March 31, 2023.
6. Lundeen EA, Saydah S, Ehrlich JR, et al. Self-reported vision impairment and psychological distress in U.S. adults. Ophthalmic Epidemiol 2022;29: 1712013;181.
7. VanNasdale DA, Jones-Jordan LA, Hurley MS, et al. Association between vision impairment and physical quality of life assessed using national surveillance data. Optom Vis Sci 2021;98:10632013;1069.
8. World Health Organization. Blindness and vision impairment. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment. Published October 13, 2022. Accessed July 24, 2023.
9. Burton MJ, Ramke J, Marques AP, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021;9:e4892013;e551.
10. Flaxman AD, Wittenborn JS, Robalik T, et al. Prevalence of visual acuity loss or blindness in the US: a Bayesian meta-analysis. JAMA Ophthalmol 2021;139:7172013;723.
11. Crews JE, Chou CF, Sekar S, et al. The prevalence of chronic conditions and poor health among people with and without vision impairment, aged ≥65 years, 2010–2014. Am J Ophthalmol 2017;182:182013;30.
12. Centers for Disease Control and Prevention. Vision impairment and chronic health conditions. https://www.cdc.gov/visionhealth/living/index.html. Published December 19, 2022. Accessed July 24, 2023.
13. Bourne RRA, Steinmetz JD, Saylan M, et al. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health 2021;9: e1442013;e160.
14. American Academy of Ophthalmology. Frequency of ocular examinations – 2015. https://www.aao.org/education/clinical-statement/frequency-of-ocular-examinations. Published March 2015. Accessed August 14, 2023.
15. Klein R, Klein BEK. The prevalence of age-related eye diseases and visual impairment in aging: current estimates. Invest Ophthalmol Vis Sci 2013;54: ORSF52013;ORSF13.
16. Swenor BK, Ehrlich JR. Ageing and vision loss: looking to the future. Lancet Glob Health 2021;9:e3852013;e386.
17. Bryar PJ, Wang A, Eichinger SE, et al. Health care disparities in diabetes and diabetic retinopathy. Ophthalmic Epidemiol 2023;30:4532013;461.
18. Pollard K, Srygley S, Jacobsen LA; Population Reference Bureau. The Appalachian region: a data overview from the 2017-2021 American Community Survey Chartbook. https://www.arc.gov/wp-content/uploads/2023/05/PRB_ARC_Chartbook_ACS_2017-2021_FINAL_2023-06.pdf. Published June 2023. Accessed April 25, 2023.
19. Heffernan M, Papanikolaou M, Meit M. Appalachian diseases of despair, 2022. https://www.arc.gov/report/appalachian-diseases-of-despair-november-2022/. Published November 30, 2022. Accessed April 25, 2023.
20. VisionServe Alliance. Tennessee’s older population and vision loss: a briefing. https://visionservealliance.org/big-data-insights/. Published 2022. Accessed April 25, 2023.
21. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Questionnaire. https://www.cdc.gov/brfss/questionnaires/pdf-ques/2021-brfss-questionnaire-1-19-2022-508.pdf. Published 2021. Accessed March 28, 2024.
22. Centers for Disease Control and Prevention. CDC HRQOL–14 “Healthy Days Measure”. https://archive.cdc.gov/www_cdc_gov/hrqol/hrqol14_measure.htm. Published 2018. Accessed July 24, 2023.
23. US Department of Agriculture. Rural-Urban commuting area codes.https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes. Published March 22, 2023 Accessed July 24, 2023.
24. Bursac Z, Gauss CH, Williams DK, et al. Purposeful selection of variables in logistic regression. Source Code Biol Med 2008;3:17.
25. Lang PO, Meyer N, Heitz D, et al. Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people. Eur J Epidemiol 2007;22:6212013;630.
26. Baghi H, Noorbaloochi S, Moore JB. Statistical and nonstatistical significance: implications for health care researchers. Qual Manag Health Care 2007;16:1042013;112.
27. Wong CW, Lamoureux EL, Cheng CY, et al. Increased burden of vision impairment and eye diseases in persons with chronic kidney disease – a population-based study. EBioMedicine 2016;5:1932013;197.
28. Bhatnagar A, Skrehot H, Ahmed M. County-level analysis of eye exam access and utilization in the United States. Ophthalmic Epidemiol 2024;31: 1522013;158.
29. Patel AJ, Vanner EA, Chou B, et al. Prevalence of visual impairment and availability of eye care providers in Florida. Am J Ophthalmol 2023;253: 2152013;223.
30. Grover B, Channa R, Bahrainian M. Reported barriers to obtaining eye exams among patients with diabetes in the All of Us dataset. Invest Ophthalmol Vis Sci 2023;64:22782013;2278.
31. Rowe LW, Scheive M, Tso HL, et al. A seven-year analysis of the role and impact of a free community eye clinic. BMC Med Educ 2021;21:596.
32. Lu H, Wang Y, Liu Y, et al. County-level geographic disparities in disabilities among US adults, 2018. Prev Chronic Dis 2023;20:E37.
33. Elam AR, Tseng VL, Rodriguez TM, et al. Disparities in vision health and eye care. Ophthalmology 2022;129:e892013;e113.
34. Saydah SH, Gerzoff RB, Saaddine JB, et al. Eye care among US adults at high risk for vision loss in the United States in 2002 and 2017. JAMA Ophthalmol 2020;138:4792013;489.
35. Elliott AF, Heskett M, Spiker C, et al. Low rates of eye care utilization among visually impaired subsidized senior housing residents. Aging Ment Health 2021;25:3602013;366.
36. Lundeen EA, Wittenborn J, Benoit SR, et al. Disparities in receipt of eye exams among Medicare Part B Fee-for-Service beneficiaries with diabetes — United States, 2017. MMWR Morb Mortal Wkly Rep 2019;68: 10202013;1023.
37. Winkelman TNA, Segel JE, Davis MM. Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity —United States, 2008-2014. Health Serv Res 2019;54:2972013;306.
38. Scott AW, Bressler NM, Ffolkes S, et al. Public attitudes about eye and vision health. JAMA Ophthalmol 2016;134:11112013;1118.
39. Capó H, Edmond JC, Alabiad CR, et al. The importance of health literacy in addressing eye health and eye care disparities. Ophthalmology 2022;129: e1372013;e145.
40. Benjamin RM. Improving health by improving health literacy. Public Health Rep 2010;125:7842013;785.
41. Swenor BK, Lee MJ, Varadaraj V, et al. Aging with vision loss: a framework for assessing the impact of visual impairment on older adults. Gerontology 2020;60:9892013;995.
