By Linda Carroll

(Reuters Health) – The proportion of U.S. adults at high risk for blindness has grown over a 15-year period and so has the share who say they cannot afford eyeglasses, according to a new study.

Between 2002 and 2017, the number of people at high risk for vision loss – seniors, people with diabetes and those with eye disorders – rose from 65 million to 93 million, but 40% of adults said they hadn’t been getting yearly eye exams, researchers report in JAMA Ophthalmology.

Nearly 1 in 10 also said they couldn’t afford eyeglasses.

“We have a large number of adults at high risk for vision loss and at high risk for not receiving recommended eye care,” said study leader Sharon Saydah of the Centers for Disease Control and Prevention. “The solution is to really improve access, awareness and the affordability of eye care.”

Saydah and colleagues looked at nationally-representative surveys of 31,000 adults in 2002 and nearly 33,000 adults in 2017.

The proportion at increased risk for vision loss grew between the two surveys: adults over age 65 rose from about 51% to 53% of the total, and those with a diabetes diagnosis rose from about 21% to 25%.

People reporting vision problems or eye diseases such as age-related macular degeneration, glaucoma, diabetic retinopathy, or eye injury grew from 9% in 2002 to almost 11% in 2017, the study found.

Among all adults, the proportion who said they couldn’t afford eyeglasses rose from 8.3% in 2002 to 8.7% in 2017.

While not having corrective lenses won’t lead to vision damage, it can lead to injury, Saydah said. “Having poor vision and not being able to see properly can contribute to falls and can lead to other disabilities,” she said.

A major factor leading to vision loss in seniors is high blood sugar, Saydah said. “But if diabetes is managed properly and blood sugar levels are controlled, that can help reduce vision loss,” she added.

While U.S. seniors are covered by Medicare, the original version of the federal health insurance program for those 65 and older doesn’t cover regular eye exams unless the patient has diabetes or is at high risk for glaucoma.

In 2017, among adults at high risk of blindness, 57% reported visiting an eye care professional annually and 60% had received a dilated eye examination.

“This study highlights critical gaps in eye care access and affordability in the United States, and indicates these gaps have persisted despite shifts in our health insurance landscape,” Bonnielin Swenor, of the Wilmer Eye Institute and the Johns Hopkins Bloomberg School of Public Health in Baltimore, said in an email.

“This study is not examining a question about improving eye conditions, but instead focuses on access and affordability of eyeglasses,” said Swenor, who wasn’t involved in the study. “Currently most medical insurance and Medicare do not cover the costs of eyeglasses, which this data support as an important gap for the American population.”

Unless something changes, the problem is likely to get worse, said Dr. Syed Mahmood Ali Shah, an associate professor of ophthalmology at the University of Pittsburgh School of Medicine.

While there was a slight increase over the past 15 years in the percentage of patients getting examined, the number of elderly with diabetes is expected to double by 2040, said Shah, who was not involved in the new research.

Shah suspects cost is the big reason for patients skipping eye exams. Even among those with some coverage, there can be a significant copay, he said, which “not everyone can afford.”

SOURCE: JAMA Ophthalmology, online March 12, 2020.