Near visual acuity in an inner city Hispanic community: understanding the barriers and benefits of correction

Presbyopia is age-related loss of accommodation that gradually impairs near vision. Few studies have examined the burden of presbyopia in the United States of America (USA)1,2 and none have examined it in economically disadvantaged or minority populations, in which there are increased rates of visual impairment and decreased use of eye care services.3,4 In our study, individuals ≥35 years of age who attended an employment fair sponsored by the Illinois Department of Employment Services (IDES) in the Pilsen neighborhood of Chicago were invited to undergo testing of their near vision and to be fitted with reading spectacles, if needed. Individuals with bilateral visual impairment or blindness, as determined by both a history and a screening examination with a penlight (to exclude gross abnormalities) were given information and instructed to seek an eye examination. In the remaining individuals, near acuity was measured at 40 cm, and 133 people were identified as having functional presbyopia (i.e., near acuity could be improved by at least one line by placing a plus lens in front of either eye).5 After this intervention, the 133 individuals with presbyopia were invited to complete a questionnaire based on the National Eye Institute’s Visual Function Questionnaire. They were asked about the benefits to them of correcting near vision and about what they considered to be the barriers to having their near vision corrected. All 133 completed the questionnaires. The 133 respondents ranged in age from 36 –85 years old. Their average age was 55 years and 57% were female (74 out of 133). Over 70% (n=96, 50 male participants and 46 female participants) were unemployed. The average uncorrected near acuity was 20/50 (6/15). After receiving reading spectacles, 80% achieved a near acuity of ≥20/25 (6/7.5). Uncorrected near acuity <20/50 (6/15) was associated with greater difficulty reading print (p<0.02) and perceived worse eyesight (p<0.0001) compared to those with uncorrected near visual acuity of ≥20/50. More than 98 per cent of respondents stated they could read. An improved ability to read was cited as the most important benefit of reading spectacles, with minimal impact perceived on other daily tasks (Table 1). Those who stated that reading spectacles would impact the task of reading print only to some degree or not at all were younger (50±6 years versus 56±9 years: p<0.01) and had better uncorrected near visual acuity (>6/12 versus <6/15: p<0.05). Similar associations were observed between uncorrected near vision and the perceived impact of reading spectacles on other tasks such as preparing meals, using hand tools or sewing, as well as grooming, shaving, or applying makeup. Neither employment status nor gender had a statistically significant impact on the perceived benefits of reading spectacles. With regards to barriers to obtaining near vision correction, 49 per cent (n=64) of the respondents said that the cost of spectacles was a disincentive and 48 per cent (n=63) said that the lack of availability of an eye care professional greatly impeded them from obtaining spectacles (Table 1). Considering that a store selling reading spectacles for US $1 was located next to the IDES office, this distribution of responses most likely reflects a lack of knowledge about the condition and its readily accessible treatment. Many people who require near vision correction can benefit from readymade or 'over-the-counter' reading spectacles. These individuals should, however, undergo a full eye examination EXCHANGE