Costs of refractive correction of distance vision impairment in the United States, 1999-2002

Objective: Correctable vision impairment caused by refractive error is common in the United States population. We estimated the direct costs of providing eyeglasses to all Americans (age >= 12) who need refractive correction to achieve good distance vision. Design: Cross-sectional study of a nationally representative sample of United States citizens. Participants: Participants in the 1999-2002 National Health and Nutrition Examination Survey (NHANES), age >= 12 years. The NHANES examines a nationally representative sample of the U.S. non institutionalized, civilian population. Methods: Presenting and corrected visual acuity data were obtained using an autorefractor from 13 211 (93.0%) of the 14 203 participants who visited the NHANES Mobile Examination Center in 1999 through 2002. Need for refractive correction was defined by current use of corrective lenses for distance vision, improvement to good visual acuity following autorefractor correction (using several cutpoints to define good visual acuity), or both. Main Outcome Measures: Estimates of direct cost for refractive correction (1 pair of complete eyeglasses and a refraction examination) were computed based on Centers for Medicare & Medicaid Services fee schedules for 2000 and also based on expenditure data from the Medical Expenditure Panel Survey. Results: The NHANES results indicate that > 110 million Americans could or do achieve normal vision with refractive correction. The annual direct cost of correcting distance vision impairment is at least $3.8 billion. Of this amount, $780 million represents the annual cost of providing distance vision correction for persons > age 65. Conclusions: Correctable vision impairment due to refractive error is common in the United States population. These cost estimates provide useful information for public health endeavors aimed at provision of refractive correction to those who need it.