Racial Variations in Causes of Vision Loss in Nursing Homes: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) Study

Objective To determine the prevalence and causes of low vision in a large sampleof nursing home residents. Methods Twenty-eight nursing homes on the Eastern Shore of Maryland and Delawarewere enrolled in a clinical trial to assess the impact of vision restoration/rehabilitationon nursing home residents. Visual acuity was measured using both recognitioncharts and preferential looking techniques. An ophthalmologist examined allresidents with visual acuity worse than 20/40 in the better-seeing eye anddetermined the primary cause for decreased vision. Results are reported forthe better-seeing eye. Results Of 2544 eligible residents, 1591 (63%) participated, but 286 residentswere unable to respond to visual acuity testing. Of the remaining 1307 residents,496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeingeye. Causes were ascribed for 412 subjects. Rates of low vision were similarbetween African American subjects and white subjects (39% and 38%, respectively;age-adjusted P = .18). Cataract was the leading causeof low vision, responsible for 37% of low vision among white subjects and54% of low vision among African American subjects. Macular degeneration wasresponsible for 29% of low vision among white subjects but only 7% among AfricanAmerican subjects. Glaucoma caused low vision in 4% of white subjects and10% of African American subjects. Refractive error was not a frequent causeof low vision in nursing home residents. Conclusions Low vision is highly prevalent among nursing home residents, with 37%having visual acuity worse than 20/40 in the better-seeing eye. Differencesin causes of low vision between African American subjects and white subjectswere noted, with African American subjects more likely to have vision losson the basis of cataract, a readily treated condition. Appropriate interventionsfor nursing home residents, who face significant obstacles in accessing eyecare services, have the potential to improve the quality of life of this at-riskolder population.