Overview and Definitions

Overview

This website presents estimates of the economic burden of vision loss nationally and by state for the year 2017. Such costs could potentially be mitigated through reductions in vision loss and blindness. Vision loss and related costs are captured using federally funded, population-based representative surveys. We used data measured in each state when possible. The analysis captures the incremental costs that result from vision loss regardless of the cause of this vision loss. This analysis does not include economic costs of eye care and eye disorders that have not yet resulted in vision loss.

Categories of costs captured in this analysis include medical expenditures, nursing home and long-term care, productivity losses, and supportive services costs that result from vision loss. Additionally, we present subcategories of costs for medical care, productivity losses, and supportive services. We present each category and subcategory of cost for all patients and by gender (female/male) and age group (0 to 18, 19 to 64, and 65+), and present each of these costs in aggregate and per person with vision loss nationally, and for each US state and the District of Columbia.

Data Sources

We used evidence from federally funded national surveys and databases, including the American Community Survey (ACS), the State and National Health Expenditure Accounts (SHEA and NHEA), the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the Centers for Medicare & Medicaid Services Minimum Data Set (MDS). Additional data is based on the published literature and federal data reports and budgets.

Data Sources

We used evidence obtained from federally funded national surveys and databases, including the American Community Survey (ACS), the State and National Health Expenditure Accounts (SHEA and NHEA), the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the Centers for Medicare and Medicaid Services Minimum Data Set (MDS). Additional data is based on the published literature and federal data reports and budgets.

Definitions:

Vision Loss

Vision loss is defined in this report as a response of “yes” to the question, “Are you blind or do you have serious difficulty seeing, even with glasses?” This question comes from the ACS, an annual survey performed by the US Census Bureau, with adequate sample size to measure responses by gender and age group at the state level. The question, or a close form of the question, is also included in surveys such as the MEPS and NHIS, which are used for different portions of this analysis. This allows the estimation of the effect of an analogous measure of vision loss on costs, productivity losses, and quality-of-life impacts. Other conceptual definitions of vision loss may result in different estimates than the one used in this study. The definition of vision loss used in this study may exclude people who do not know they have vision loss or have mild vision loss that they do not consider to be serious. This measure also does not allow us to differentiate vision loss across common categories such as vision impairment and blindness. Some categories of costs (productivity losses and supportive costs) required us to differentiate estimates of blindness from the total estimate of vision loss. Methods for estimations of blindness are included in the technical documentation.

Prevalence

Prevalence is the number of people to answer “yes” to the ACS question: “Are you blind or have difficulty seeing …………” multiplied by the ACS sampling weights. Prevalence rate is defined as the prevalence divided by the total number of people in the sample. The estimated total prevalence nationally is 7,535,300 people, and the prevalence rate is 2.17%.

Total costs, per-person costs

All costs are reported as total and per-person. Per-person costs are based on people with vision loss. Per-person costs are calculated as total costs divided by the prevalence of vision loss, by each age, sex, and state group.

Medical Costs

Medical costs are defined as all payments exchanged for medical services, and has three subcategories:

1. Inpatient. Inpatient services include all services provided by hospitals to patients. These include room and board, ancillary charges, services of resident physicians, inpatient pharmacy, hospital-based nursing home and home health care, and any other services billed by hospitals in the United States.
2. Ambulatory. Ambulatory (outpatient) services include physician and clinical services provided in establishments operated by an M.D. or O.D., outpatient care centers, and laboratory services billed independently of a hospital. These also include services provided by an M.D. or O.D. in a hospital setting if these costs were billed independently of a hospital. Also included in this category are services billed by health providers other than physicians and dentists, such as optometrists, private-duty nurses, or occupational therapists.
3. Prescription. Prescriptions include retail drugs, biologics, and diagnostics that are available by prescription only.
4. Other Medical. Other Medical services combine services from four categories: (1) Durable medical equipment, which includes the costs of eyeglasses, contact lenses, and other ophthalmic products; (2) Home health care, which includes medical care provided in the home by freestanding home health agencies; (3) Other health, residential, and personal care, which includes the cost of Medicaid home and community based waivers, and ambulance services; and (4) Dental care.

Nursing Home Costs

Nursing Home costs include services provided by nursing homes and continuing care retirement communities. These services are generally provided for an extended period of time by registered or licensed practical nurses and other staff.

Productivity Losses

Productivity Losses include the monetary value of five mutually exclusive subcategories:

1. Absenteeism. Absenteeism refers to days of work missed because of vision loss.
2. Loss of Household Productivity. Household Productivity refers to the value of reductions in unpaid work performed in the home for tasks such as housekeeping, meal preparation, and child care due to vision loss.
3. Reduced Labor Force Participation. Labor Force Participation includes the value of forgone income because people did not work due to vision loss.
4. Informal Care. Informal Care refers to the value of additional effort provided by unpaid caregivers of children and older adults with vision loss.
5. Reduced Wages. Reduced Wages refers to the value of decreased wage earnings due to vision loss among people with vision loss who worked.

Supportive Services Costs

Supportive Services Costs include four subcategories of programs and other non-medical services for people with vision loss.

1. Federal Programs.We include the budgetary cost of several federally funded assistance programs for the blind, including (1) the American Printing House for the Blind (APH) which prints and provides low-vision and braille textbooks, (2) National Library Service for the Blind and Physically Handicapped (NLS), which provides braille and audio books for blind people, (3) the Committee for Purchase (CFP) program which provides employment opportunities for blind people, and (4) the Independent Living Services for Older Individuals who are Blind (OIB) program, which provides grants to state assistance programs.
2. School Screening. School Screening programs identify children with vision loss who need glasses, and children with certain eye disorders that may cause vision loss including amblyopia or strabismus (lazy eye). With early detection these eye disorders can often be successfully treated in children, preserving or restoring their vision.
3. Special Education. Special Education refers to services provided in accordance with the Individuals with Disabilities Education Act which requires states to provide education and intervention services for children and young adults who meet eligibility criteria due to blindness from birth through age 21.
4. Vision Rehabilitation. Vision Rehabilitation includes privately purchased or funded services such as vision rehabilitation, occupational therapy, low-vision adaptations and devices, guide dogs, employment programs and other services to assist people with vision loss.