Key Points
Question
How many older adult Medicare beneficiaries reported using eyeglasses in 2015?
Findings
This cross-sectional study estimated the number of older Medicare beneficiaries (aged ≥65 years) and found that approximately 40.5 million used eyeglasses for either distance or near vision correction. Differences in sociodemographics were noted between those who did and those who did not report eyeglass use.
Meaning
Innovative public policy solutions are needed to address the potential sociodemographic disparities in eyeglass use among the large number of Medicare beneficiaries who use eyeglasses.
Abstract
Importance
Medicare benefits do not include coverage for eyeglasses except after cataract surgery. Understanding the implications of a change to this policy would require knowing the number of Medicare beneficiaries who use eyeglasses, but no recent estimates are available.
Objective
To estimate the number of older adults with Medicare who use eyeglasses.
Design, Setting, Participants
This cross-sectional study used data from the 2015 US National Health and Aging Trends Study. Nationally representative data from 7497 respondents were reviewed and sample weights were applied so that the data represented 43.9 million Medicare beneficiaries aged 65 years or older. The estimates were based on the following 4 groupings of beneficiaries: (1) number who used eyeglasses for distance vision correction and had distance vision impairment, (2) number who did not use eyeglasses for distance vision correction and had distance vision impairment, (3) number who used eyeglasses for near vision correction and had near vision impairment, and (4) number who did not use eyeglasses for near vision correction and had near vision impairment. The prevalence of self-reported use of glasses was estimated using the results of this survey and the Medicare enrollment file. Data were analyzed from July 12, 2017, to November 30, 2017.
Main Outcomes and Measures
Self-reported use of eyeglasses or contact lenses.
Results
Of the estimated 43.9 million Medicare beneficiaries aged 65 years or older in 2015, approximately 40.5 million (92.4%; 95% CI, 91.6%-93.1%) reported using eyeglasses for either distance or near vision correction. Differences in sociodemographics were observed between those who reported using eyeglasses. Individuals who were older, were nonwhite, had lower educational levels, were less affluent, and had prior cataract surgery were significantly less likely to use eyeglasses. Approximately 27 million beneficiaries (61.7%; 95% CI, 60.3%-63.1%) used eyeglasses for distance vision correction, and approximately 37.2 million beneficiaries (84.8%; 95% CI, 83.8%-85.8%) used eyeglasses for near vision correction.
Conclusions and Relevance
Potential sociodemographic disparities in eyeglass use by age, race/ethnicity, educational level, and income were identified. This finding suggests that innovative public policy solutions are needed to address these disparities among the large number of Medicare beneficiaries who use eyeglasses.
This cross-sectional study examines data from the US National Health and Aging Trends Study to estimate the prevalence of corrective lenses use among Medicare beneficiaries who are 65 years or older.
Introduction
Medicare benefits do not include coverage for eyeglasses except after cataract surgery. A national discussion to change this policy is in progress.1 Understanding the implications of a change to this policy would require knowing the number of Medicare beneficiaries who use eyeglasses. The most recent estimate of the number of older adults in the United States who use eyeglasses was published in 2001.2 Updated estimates are needed given the rapidly aging US population and advances in cataract and refractive surgery. We analyzed data from the 2015 National Health and Aging Trends Study (NHATS) to estimate the number of Medicare beneficiaries who use eyeglasses.
Methods
The University of Michigan institutional review board deemed this study exempt as a secondary data analysis. The original NHATS investigators obtained informed consent from study participants. The NHATS is a nationally representative survey of Medicare beneficiaries aged 65 years or older. Participants in the NHATS are asked a variety of questions, including if they use eyeglasses or contact lenses for distance vision correction; use glasses or contact lenses for near vision correction; and have difficulty with either distance or near vision, even when using corrective lenses.1,2,3 In 2015, a total of 7576 individuals participated in the NHATS, 79 of whom did not respond to the questions about eyeglasses.
We used the 2015 NHATS survey-weighted data and the Medicare enrollment file using the methodology described by the NHATS study team.3 This methodology involved estimating the age- and sex-specific percentages of the study sample who reported using eyeglasses,1 multiplying these percentages by the age- and sex-specific numbers of Medicare beneficiaries in the Medicare enrollment file that made up the sampling frame for the 2015 NHATS,2 and summing these age- and sex-specific population estimates to calculate the standardized number of Medicare beneficiaries who reported using eyeglasses.3 Data were analyzed from July 12, 2017, to November 30, 2017. We estimated the number of beneficiaries who used eyeglasses for distance vision correction and had distance vision impairment, who did not use eyeglasses for distance vision correction and had distance vision impairment, who used eyeglasses for near vision correction and had near vision impairment, and who did not use eyeglasses for near vision correction and had near vision impairment. We calculated the descriptive statistics of participants who did and did not report the use of eyeglasses as well as the proportion of beneficiaries who reported prior cataract surgery. Differences were determined with Pearson χ2 tests, using Stata version 14 (StataCorp LLC).
Results
Nationally representative data from 7497 respondents to the 2015 NHATS survey were reviewed and sample weights were applied so that the data represented 43.9 million Medicare beneficiaries aged 65 years or older. All data are reported as estimates. Approximately 40.5 million (92.4%; 95% CI, 91.6%-93.1%) of the estimated 43.9 million Medicare beneficiaries in 2015 reported using eyeglasses for either distance or near vision correction. Differences in sociodemographics were observed between those who reported the use of eyeglasses and those who did not (Table). Individuals who were older, were nonwhite, had lower educational levels, were less affluent, and had prior cataract surgery were significantly less likely to use eyeglasses. Approximately 27 million (61.7%; 95% CI, 60.3%-63.1%) Medicare beneficiaries used eyeglasses for distance vision correction. Of these 27 million beneficiaries, approximately 2.7 million (6.1%; 95% CI, 4.2%-8.7%) reported difficulty with distance vision.
Table. Characteristics of Participants and Self-reported Use of Eyeglasses in the 2015 National Health and Aging Trends Studya.
| Variable | % (95% CI) | P Valuec | |
|---|---|---|---|
| Self-reported Use of Eyeglassesb | Self-reported Nonuse of Eyeglassesb | ||
| All participants | 92.4 (91.6-93.1) | 7.5 (6.8-8.3) | |
| Age, y | <.001 | ||
| 65-69 | 93.7 (92.3-94.8) | 6.2 (5.1-7.6) | |
| 70-74 | 93.6 (91.9-95.0) | 6.3 (4.9-8.0) | |
| 75-79 | 91.9 (90.2-93.4) | 8.0 (6.5-9.7) | |
| 80-84 | 91.6 (89.7-93.2) | 8.3 (6.7-10.2) | |
| 85-89 | 90.0 (87.2-92.2) | 10.0 (7.7-12.7) | |
| ≥90 | 85.4 (81.6-88.4) | 14.5 (11.5-18.3) | |
| Sex | .51 | ||
| Male | 92.1 (90.7-93.3) | 7.8 (6.6-9.2) | |
| Female | 92.6 (91.7-93.4) | 7.3 (6.5-8.2) | |
| Race/ethnicity | <.001 | ||
| White | 93.8 (92.9-94.6) | 6.1 (5.3-7.0) | |
| Black | 87.6 (85.1-89.8) | 12.3 (10.2-14.8) | |
| Hispanic | 85.9 (81.6-89.2) | 14.0 (10.7-18.3) | |
| Other | 88.6 (84.5-91.8) | 11.3 (8.1-15.4) | |
| Educational level | <.001 | ||
| <High school diploma | 86.4 (84.7-87.9) | 13.5 (12.0-15.2) | |
| High school diploma | 93.9 (92.4-95.1) | 6.0 (4.8-7.5) | |
| >High school diploma | 93.8 (92.9-94.6) | 6.1 (5.3-7.1) | |
| Income, quartiled | <.001 | ||
| 1st | 87.6 (84.8-89.9) | 12.3 (10.0-15.1) | |
| 2nd | 90.3 (87.7-92.4) | 9.6 (7.5-12.2) | |
| 3rd | 93.8 (91.6-95.4) | 6.2 (4.5-8.3) | |
| 4th | 94.1 (92.1-95.6) | 5.8 (4.3-7.8) | |
| Prior cataract surgery | .002 | ||
| Yes | 91.7 (90.8-92.6) | 8.3 (7.5-9.2) | |
| No | 94.6 (93.1-95.7) | 5.4 (4.3-6.9) | |
Data are presented as the weighted proportions of the US population of Medicare beneficiaries aged 65 years or older, according to the study design of the 2015 National Health and Aging Trends Study.
Eyeglass use for either distance or near vision.
P values are unadjusted and calculated using Pearson χ2 test.
The National Health and Aging Trends Study team provided imputed values for missing income data.
Of the Medicare beneficiaries who reported not using eyeglasses for distance vision correction, more than 900 000 (2.0%; 95% CI, 1.7%-2.4%) reported difficulty with distance vision. Approximately 37.2 million (84.8%; 95% CI, 83.8%-85.8%) Medicare beneficiaries used eyeglasses for near vision correction. Of these beneficiaries, approximately 1.2 million (2.7%; 95% CI, 1.7%-4.5%) reported difficulty with near vision. Of the Medicare beneficiaries who did not have eyeglasses for near vision correction, more than 650 000 (1.4%; 95% CI, 1.2%-1.8%) reported difficulty with near vision.
Discussion
Most older adults in the United States use eyeglasses. Previous studies indicate that this prevalence rate has been constant in the past 4 decades.2,4,5,6 According to reports from the US Department of Health and Human Services, 92.1% of individuals older than 65 years wore eyeglasses or contact lenses in 1971 and 92.1% used eyeglasses or contact lenses between 1979 and 1980; these reports did not distinguish use between near vision and distance vision correction. A 2001 report for the National Center for Health Statistics found that 93.0% of US individuals older than 70 years used eyeglasses, but the report did not explore the association of eyeglass use with sociodemographic factors and did not examine that usage for near or distance vision correction.2 Zeberdast and colleagues7 analyzed data from the 1999 to 2008 National Health and Nutrition Examination Survey and found that 79.2% of individuals older than 50 years reported using eyeglasses for near vision correction. The current study confirms that the prevalence of eyeglass use among the Medicare population has been stable, despite the advances in cataract and refractive surgery. A smaller proportion of those who had previously undergone cataract surgery reported using eyeglasses, compared with those who had not had cataract surgery; however, the proportion of eyeglass use was high for both groups (91.7%; 95% CI, 90.8%-92.6% vs 94.6%; 95% CI, 93.1%-95.7%; P = .002).
Maximizing visual acuity potential is vital for the health of older adults because of the strong associations between visual impairment and falls, cognition, depression, and quality of life.8 We found potential sociodemographic disparities in eyeglass use by age, race/ethnicity, educational level, and income. Given these findings, policy discussions about Medicare coverage of eyeglasses should continue. However, coverage for the 40.5 million Medicare beneficiaries who currently use eyeglasses could be expensive.9 Policymakers will need to develop creative but appropriate solutions to this problem. Vouchers that pay for a portion of the cost, targeted coverage for high-risk individuals, and efforts to decrease the cost are possible approaches. Some of the cost of providing eyeglasses could potentially be offset by reductions in falls, depression, and cognitive decline in older adults.8
To explore the number of beneficiaries who reported using eyeglasses but could benefit from a new prescription or replacement, we evaluated the number of Medicare beneficiaries who reported eyeglass use and vision impairment (approximately 2.7 million beneficiaries for distance vision and 1.2 million for near vision). To understand the number of beneficiaries who did not report eyeglass use but could benefit from eyeglasses, we looked at the proportion of Medicare beneficiaries who did not report eyeglass use but did report visual impairment (approximately 900 000 beneficiaries for distance vision and 650 000 for near vision). These individuals could benefit from wearing eyeglasses, but their vision impairment might be associated with conditions that would not improve with the use of eyeglasses.
Limitations
This study is limited by the use of self-reported data, although previous studies have shown that self-reported data on eyeglass use, vision impairment, and cataract surgery history are reasonably accurate.10,11,12 This study lacked eye examinations that accompany the questionnaire and assess refractive error and presence of other eye conditions. The results presented here should be interpreted as prevalence of self-reported eyeglass use and not prevalence of refractive error, although the prevalence of each is important for public policy development. Our data do not directly address the prevalence of refractive error, but it is reasonable to assume that the prevalence of refractive error is higher than the prevalence of eyeglass use because individuals without refractive error are unlikely to use eyeglasses and some individuals with refractive error likely do not have eyeglasses.
Conclusions
We observed potential sociodemographic disparities in eyeglass use by age, race/ethnicity, educational level, and income. These findings suggest innovative policy solutions are needed to address these disparities.
References
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