Legal Blindness More Common Among Black Patients

Individuals who are Black or who have public or no insurance are overrepresented among blind patients in the IRIS Registry.

Legal blindness from low visual acuity (VA) is more common in patients of Black ethnicities, as well as those who smoke, live in a rural area, have public or no health insurance, and are 75 years of age or older, according to study findings published in Ophthalmology. Researchers utilized the data from the Intelligent Research In Sight (IRIS®) Registry to determine health disparities in US ophthalmic care.

The researchers identified legal blindness (20/200 or worse) and visual impairment (VI) of worse than 20/40 best-corrected distance acuity in the better seeing eye and stratified the data by patient characteristics. They used multivariable logistic regression models to evaluate blindness and visually impaired associations. Blindness was mapped by state and compared with population characteristics, and eye care utilization was analyzed by comparing population demographics with US Census estimates, with proportional demographic representation among legally blind/VI patients vs a nationally representative US population sample.

Researchers found that, of IRIS® Registry patients, VI was present in 6.98% (n=1,364,935) and legal blindness in 0.98% (n=190,817). Adjusted odds of legal blindness were highest among patients 85 years of age or older (95% CI, 10.33-13.59), vs patients 0-17 years. Blindness was also positively associated with smoking (95%CI, 1.08-1.17), rural location (95% CI, 1.04-1.14) and Medicaid (95% CI, 3.57-4.15), Medicare (95% CI, 1.53-1.82), or no insurance (95% CI, 1.37-2.27) vs commercial insurance.

Black patients (95%CI, 1.63-1.84) had the highest odds of blindness, followed by those who were Hispanic (95%CI, 1.46-1.74).

There was higher proportional representation in the IRIS® Registry relative to the US Census for White than Hispanic or Black patients (P <.001).

The researchers explained that, according to their findings, racial and ethnic minorities appear to be underrepresented in ophthalmology clinics and overrepresented among legally blind patients relative to US Census. They highlighted that this demands attention due to the increased risks associated with poor vision.

“Identifying and addressing the underlying reasons for disproportionately low utilization of eye care and disproportionately high prevalence of blind patients in vulnerable populations will be a critical public health priority,” the study authors note. Visual impairment has been associated with reduced quality of life as well as adverse health outcomes that include injury, falls in elderly, depression, and increased mortality, according to the report.

Study limitations include missing data on reported race/ethnicity in electronic health records; and the inability to calculate patients’ distance from their eye care provider.


Brant A, Kolomeyer N, Goldberg AL, et al. US population disparities in ophthalmic care: blindness and visual impairment in the IRIS registry. Ophthalmol. Published online June 16, 2023. doi:10.1016/j.ophtha.2023.06.011