Association of vision loss and work status in the United States.

IMPORTANCE: Working is critical to personal health and well-being. We examine the association of vision measured objectively with work status using a nationally representative sample of working-age Americans. OBSERVATION: A total of 19 849 participants from the 1999-2008 National Health and Nutrition Examination Survey completed a vision examination and employment/demographic questionnaires. Employment rates for men with visual impairment, uncorrected refractive error, and normal vision were 58.7%, 66.5%, and 76.2%, respectively; employment rates for women with visual impairment, uncorrected refractive error, and normal vision were 24.5%, 56.0%, and 62.9%, respectively. In multivariable models adjusting for age, sex, race/ethnicity, and chronic disease status, both uncorrected refractive error (odds ratio [OR], 1.36; 95% CI, 1.15-1.60) and visual impairment (OR, 3.04; 95% CI, 1.93-4.79) were associated with a higher likelihood of not working. Subgroups in which visual impairment was associated with even higher odds of not working included women (OR, 4.9; 95% CI, 2.5-9.6), participants younger than 55 years (OR, 4.3; 95% CI, 2.9-6.5), and diabetic individuals (OR, 14.8; 95% CI, 5.8-37.3). CONCLUSIONS AND RELEVANCE: Decreased vision is associated with a significantly higher likelihood of not working. Visually impaired diabetic individuals, women, and those younger than 55 years have a particularly high risk of not working. Further investigation is warranted to understand barriers for employment in individuals with decreased vision.

Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006-2010.

OBJECTIVE We examine barriers to receiving recommended eye care among people aged ≥40 years with diagnosed diabetes. RESEARCH DESIGN AND METHODS We analyzed 2006-2010 Behavioral Risk Factor Surveillance System data from 22 states (n = 27,699). Respondents who had not sought eye care in the preceding 12 months were asked the main reason why. We categorized the reasons as cost/lack of insurance, no need, no eye doctor/travel/appointment, and other (meaning everything else). We used multinomial logistic regression to control for race/ethnicity, education, income, and other selected covariates. RESULTS Among adults with diagnosed diabetes, nonadherence to the recommended annual eye examinations was 23.5%. The most commonly reported reasons for not receiving eye care in the preceding 12 months were "no need" and "cost or lack of insurance" (39.7 and 32.3%, respectively). Other reasons were "no eye doctor," "no transportation" or "could not get appointment" (6.4%), and "other" (21.5%). After controlling for covariates, adults aged 40-64 years were more likely than those aged ≥65 years (relative risk ratio [RRR] = 2.79; 95% CI 2.01-3.89) and women were more likely than men (RRR = 2.33; 95% CI 1.75-3.14) to report "cost or lack of insurance" as their main reason. However, people aged 40-64 years were less likely than those aged ≥65 years to report "no need" (RRR = 0.51; 95% CI 0.39-0.67) as their main reason. CONCLUSIONS Addressing concerns about "cost or lack of insurance" for adults under 65 years and "no perceived need" among those 65 years and older could help improve eye care service utilization among people with diabetes.