1. Copyright restrictions may apply JAMA Ophthalmology Journal Club Slides: Visual Impairment and Blindness in US Adults 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. Published online May 19, 2016. doi:10.1001/jamaophthalmol.2016.1284.

2. Copyright restrictions may apply Introduction The number of individuals with visual impairment and blindness is increasing in the United States and around the globe as a result of the shifting demographics and aging populations. Objectives –To determine the demographic and geographic variations in visual impairment and blindness in adults in the US population and to estimate the projected prevalence through 2050.

3. Copyright restrictions may apply Study Design –Population-based, cross-sectional study in which data were pooled from 6 major population-based studies on visual impairment and blindness in the United States. Participants –Adults aged 40 years and older who were African American, Asian, Hispanic, non-Hispanic white, and other minorities (racial groups). Data Analysis –Prevalence of visual impairment and blindness were reported by age, sex, race/ethnicity, and per capita prevalence by state using the US Census projections from January 1, 2015, through December 31, 2050. Methods

4. Copyright restrictions may apply In 2015, a total of 1.02 million persons in the United States were legally blind and approximately 3.22 million persons in the United States were visually impaired based on best-corrected visual acuity in the better-seeing eye. By 2050, the numbers of these conditions are projected to double to approximately 2.01 million persons with blindness and 6.95 million persons with visual impairment. Results

5. Copyright restrictions may apply The highest numbers of visual impairment in 2015 were among non-Hispanic white individuals (2.28 million), women (1.84 million), and older adults (1.61 million), and these groups will remain the most affected through 2050. However, African American individuals experience the highest prevalence of visual impairment and blindness. By 2050, the highest prevalence of visual impairment among minorities will shift from African American individuals (15.2% in 2015 to 16.3% in 2050) to Hispanic individuals (9.9% in 2015 to 20.3% in 2050). Results

6. Copyright restrictions may apply From 2015 to 2050, the states projected to have the highest per capita prevalence of visual impairment are Florida (2.56% in 2015 to 3.98% in 2050) and Hawaii (2.35% in 2015 to 3.93% in 2050). The states projected to have the highest projected per capita prevalence of blindness are Mississippi (0.83% in 2015 to 1.25% in 2050) and Louisiana (0.79% in 2015 to 1.20% in 2050). Results

7. Copyright restrictions may apply In 2015, the estimated numbers of people with visual impairment and blindness due to uncorrected refractive error were 8.24 (95% CI, 4.52 million to 17.77 million) and 290 000 (95% CI, 20 000 to 4 200 000), respectively. In 2050, the numbers with visual impairment and blindness due to uncorrected refractive error are projected to increase to 16.4 million (95% CI, 8.76 million to 25.84 million) and 529 000 (95% CI, 40 000 to 4 380 000), respectively. The expected prevalence of visual impairment will increase across the country, with the projected prevalence reaching 10% or more in 15 states by 2050. Results

8. Copyright restrictions may apply Estimated Number of Persons With Visual Impairment and Blindness in the United States by Race/Ethnicity (All Persons) and Year Results Visual ImpairmentBlindness

9. Copyright restrictions may apply Per Capita Prevalence of Visual Impairment in the United States in 2015 Results

10. Copyright restrictions may apply Per Capita Prevalence of Visual Impairment in the United States in 2050 Results

11. Copyright restrictions may apply These data suggest that vision screening for refractive error and early eye disease may reduce or prevent a high proportion of individuals from experiencing unnecessary vision loss and blindness, decrease associated costs to the US economy for medical services and lost productivity, and contribute to better quality of life. Targeted education and screening programs for non-Hispanic white women and minorities should become increasingly important because of the projected growth of these populations and their relative contribution to the overall numbers of these conditions. Comment

12. Copyright restrictions may apply If you have questions, please contact the corresponding author: –Rohit Varma, MD, MPH, USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1450 San Pablo St, Room 4900, Los Angeles, CA 90033 (rvarma@usc.edu). Funding/Support This study was supported by grants K23EY022949-01 (Dr Vajaranant, principal investigator) and U10EY017337-05 (Dr Varma, principal investigator) from the National Eye Institute, National Institutes of Health, Bethesda, Maryland, and Research to Prevent Blindness, New York, New York. Conflict of Interest Disclosures All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Contact Information