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Stephanie Choi, AB; Brian C. Stagg, MD; Joshua R. Ehrlich, MD, MPH

Disparities in Low-Vision Device Use Among Older US Medicare Recipients

publication date
December 2018
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Importance:  Low-vision assistive devices are not covered by Medicare and many private insurers, although there is evidence that they can improve functioning and quality of life. Little is known about whether sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries.

Objective: To determine if sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries.

Design, Setting, and Participants: Cross-sectional population-based survey. The National Health Interview Survey is an annually administered nationally representative US survey. Data used in this study were from the 2002, 2008, and 2016 National Health Interview Survey vision supplement. Participants who were Medicare beneficiaries 65 years and older with self-reported vision impairment were included.

Main Outcomes and Measures: Multivariable logistic regression was performed to evaluate if sociodemographic or economic factors were associated with self-reported use of low-vision devices or low-vision rehabilitation among Medicare beneficiaries 65 years and older who self-reported vision impairment.


Results: There were 3058 participants included in the study. The survey weighted proportion of participants who were men was 37.9% (95% CI, 35.8%-40.0%), while 79.1% (95% CI, 77.2%-80.9%) were non-Hispanic white, 10.2% (95% CI, 9.0%-11.5%) were non-Hispanic black, 6.7% (95% CI, 5.6%-8.1%) were Hispanic, and 4.0% (95% CI, 3.2%-5.0%) identified with another race/ethnicity. The weighted proportion who reported using low-vison devices and low-vision rehabilitation were 26.1% (95% CI, 24.2%-28.1%) and 3.5% (95% CI, 2.8%-4.3%), respectively. In a model adjusted for ocular diagnoses, Hispanic individuals (odds ratio, 0.61; 95% CI, 0.39-0.97) and individuals from other races/ethnicities (odds ratio, 0.39; 95% CI, 0.19-0.80), but not black individuals, were significantly less likely to report using low-vision devices than white individuals. In the model that was not adjusted for ocular diagnoses, black individuals (odds ratio, 0.73; 95% CI, 0.54-0.99) were also significantly less likely to report using low-vision devices. There were no significant racial/ethnic disparities for reported use of low-vision rehabilitation.

Conclusions and Relevance: Additional research is needed to clarify the association between sociodemographics and use of low-vision services in the Medicare population. However, policy makers could consider expanding Medicare coverage to include low-vision devices in an effort to address significant disparities in the use of this evidence-based intervention.


Vision therapy is well worth the response, time and effort. Our Son had a hard time focusing and writing neatly. After vision therapy Seth could complete a task in half the time if previously took. His abilities to focus improved greatly and so did his handwriting.

Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.

Amanda T.

Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.

Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.

Alexa H.

Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.

He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.

It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.

Dr. McBryar , Kristen and John  are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!

Charlotte M.

Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.

Thank you!

Olivia C.

Seems much less frustrated with life

Reads non-stop and fast

Spelling abilities have been hugely improved

Seems much more confident

Thank You!!!

Kelly O.

When we first came to the practice, my son did not have huge issues, but lots of small ones- trouble with reading, sports (hitting the baseball consistently), coordination, etc- that were not easily detectable,but when put together presented issues. The staff here were all very professional and loving towards him. While I was concerned in the reading, my son was concerned with the athletic side. Seeing improvement night off the bat gave him confidence that i have nor seen in him and made him want to not only Come to therapy, but also made him want to work hard. He has surpassed his grade level and above in reading and hit his first home run this year! Thank you!!!

Alice M.
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