Study Finds Economic Hardship, Race Associated With Correctable Visual Impairment in Women

A cross-sectional study of women found that race, economic hardship, and education were associated with visual impairment that could be improved with optical correction.

A study published in Seminars in Ophthalmology found that race, economic hardship, and education were associated with the likelihood of presenting with visual impairment (VI) in women—but these disparities were not present when only examining visual acuity once corrected through tools such as glasses.

This study used the Study of Women’s Health Across the Nation (SWAN) longitudinal cohort study for data on visual impairment in the participants, and the investigators conducted this cross-sectional analysis among women who presented to the southeastern Michigan SWAN site to estimate the prevalence of VI, eye disorders, and optical correction.

Vision assessments included measurement of presenting distance visual acuity (VA) and best-corrected VA (BCVA); the investigators also noted use of eyeglasses for distance vision. Vision impairment was defined as a VA of 20/40 or worse in the better-seeing eye. All participants were also examined by an ophthalmologist.

There were 254 women who were eligible for this study; 158 (62.2%) of the participants were African American and 96 (37.8%) were White, and the population had a mean (SD) age of 66.0 (2.7) years. About one-third (35.8%) of women reported some difficulty paying for basics and one-quarter (25.6%) had completed college or had postcollege education.

The prevalence of VI based on presenting VA was 11.0% (95% CI, 7.5%-15.5%). Burden of VI was greater in African American women than in White women (13.9% vs 6.3%) and in women reporting some difficulty paying for basics vs none (18.7% vs 6.8%). There was an inverse association between education and VI defined by presenting VA.

The prevalence of VI declined to 2.8% (95% CI, 1.1%-5.6%) after correction, which suggested that three-quarters of the VI in the population is correctable. There were no significant differences in BCVA-defined VI by sociodemographic characteristics.

In models that included age, race/ethnicity, difficulty paying for basics, and education, economic strain was associated with presenting VI (odds ratio [OR], 3.05; 95% CI, 1.28-7.26).

There were 179 (71%) women in the cohort who were not wearing the correct vision prescription, with only 7% of women with VI wearing the correct prescription.

The most common ocular condition in the women studied was hypertensive retinopathy (30.2%), followed by dense cataract affecting vision (8.3%), diabetic retinopathy (6.4%), glaucoma (4.8%), and age-related macular degeneration (3.3%). There were 14.2% of the population who had already had cataract surgery and 28.6% who had suspect glaucoma.

Age was significantly associated with cataract, with a 1-year increase in age associated with 35% higher odds of having a visually significant cataract (OR, 1.35; 95% CI, 1.12-1.64). Women with some difficulty paying for basics had 2.5-fold higher odds (95% CI, 1.37-4.55) of having hypertensive retinopathy and 4-fold higher odds (OR, 4.39; 95% CI, 1.41-13.65) of having diabetic retinopathy.

Women with a high school degree or less had 7-fold higher odds (OR, 7.04; 95% CI, 1.26-39.35) of visually significant cataracts.

There were some limitations to this study. The investigators could not assess temporality of association and causation. The narrow age range included (61.6-72.9 years) may have limited their ability to fully examine the effect of age on VI and ocular disorders. The findings may also not be able to be generalized to men or to women in other areas, as the study population included only women from 1 geographic location.

The researchers concluded that their study had identified the prevalence of correctable VI in women, with race, economic hardship, and education representing important correlates of VI before but not after optical correction.

“We posit that our findings support a need for regular eye examination among similar populations of women during early late adulthood, given the high proportion of participants needing new glasses and the detection of ocular conditions that were previously unknown to many participants,” the authors wrote.


Karvonen-Gutierrez CA, Hood MM, Moroi S, Musch DC, Kumar N, Wood SD. Disparities in vision impairment and eye diseases among early late-life women: the Study of Women’s Health Across the Nation, Michigan site. Semin Ophthalmol. Published online May 25, 2022. doi:10.1080/08820538.2022.2072689