Beyond individual clinical risk factors, a growing body of research suggests that the places people live may play an important role in vision health. Neighborhood measures of disadvantage have been linked with diagnosis of proliferative diabetic retinopathy, pediatric vision screening outcomes, and severity of both glaucoma and microbial keratitis presentation – but is it also associated with downstream measures of vision outcomes such as visual difficulty and blindness? A new cross-sectional study published in Eye suggests that neighborhood disadvantage is associated with census tract level visual difficulty and blindness.
The study used data from two national, publicly available sources: the National Neighborhood Data Archive and the American Community Survey. The authors analyzed more than 83,000 census tracts across the United States with available visual difficulty and blindness and neighborhood disadvantage using data from 2018 to 2022.
Neighborhood disadvantage is a measure that incorporates economic indicators such as the proportion of families with incomes below $40,000, the proportion of people living below the poverty level, and the proportion of households receiving public assistance or food stamps. Meanwhile, “visual difficulty and blindness” was based on the self-reported response to the question: “Are you blind, or do you have serious difficulty seeing even when wearing glasses?”
The findings of the study were clear: there was an association between increasing census tract neighborhood disadvantage and higher prevalence of visual difficulty and blindness; after adjusting for census tract demographics, each 0.01-unit increase in neighborhood disadvantage was associated with a 2.9 percent increase in the odds of visual difficulty and blindness.
The research team also highlights the National Neighborhood Data Archive neighborhood disadvantage measure, which can be used at the census tract level and is also available at the ZIP code level. Many previous vision and eye care studies have used the Area Deprivation Index, which is validated at the census block group level. However, public health and clinical data are not always available at such a granular geographic scale, and so census tract or ZIP code-level measures may be more practical for researchers, clinicians, and policymakers.
While this study adds to the vision health and place-based research literature, it does also highlight several limitations, including the use of five-year summary data that may only be generalizable to that timeframe, reliance on self-reported visual difficulty and blindness rather than clinical visual acuity testing, and the exclusion of census tracts with missing visual difficulty and blindness measures, which may limit generalizability to those areas.
In spite of this, the findings suggest that neighborhood disadvantage may help identify communities at higher risk for vision problems and where targeted screening, early detection, and access-to-care interventions may have the greatest impact. Many causes of vision loss can be prevented or treated when detected early, thus it is important to understand the associated neighborhood-level factors impacting vision. This research adds to the growing evidence that vision health is shaped not only within the clinic, but also by the social and economic conditions of the communities patients call home.
