In the last 20 years, research focused on developing retinal imaging as a source of potential biomarkers for Alzheimer's disease and other neurodegenerative diseases, has increased significantly. The Alzheimer's Association and the Alzheimer's & Dementia: Diagnosis, Assessment, Disease Monitoring editorial team (companion journal to Alzheimer's & Dementia) convened an interdisciplinary discussion in 2019 to identify a path to expedite the development of retinal biomarkers capable of identifying This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Globally, an estimated 252.6 (95% CI, 111.4-424.5) million people live with best-corrected visual acuity of 20/60 or worse in the better-seeing eye. 1 People in the US fear losing vision more than memory, hearing, or speech, and consider visual acuity loss among the top 4 worst things that could happen to them. 2 No existing estimates appear to have used empirical data to estimate geographic differences, created estimates for persons younger than age 40 years, or accounted for increased prevalence in group quarters.Previous studies have estimated national visual acuity loss or blindness prevalence for important age ranges. The Vision Problems in the United States (VPUS) study estimated uncorrectable visual impairment and blindness for persons ages 40 years and older to occur in 4.2 million individuals (2.9%) in 2010. 3 Using similar methods and data for 2015, Varma et al 4 estimated national and state visual acuity loss or blindness prevalence for persons ages 40 years and older and arrived at a similar estimate of 4.24 million cases (2.8%). Both of these studies 3,4 are limited, since they excluded persons younger than 40 years and persons living in group quarters, such as nursing homes and prisons. Both studies 3,4 relied on metaanalytic summaries of similar selected population-based study data, and no other data sources, to estimate prevalence by age group, sex, and race/ethnicity and then calculated state-level estimates by applying these summary estimates to each state's population distribution. This method may lead to inaccuracies because the population-based study data (while of high quality) were collected 8 to 36 years in the past from locally IMPORTANCE Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US.OBJECTIVE To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state.

To examine the prevalence and correlates of visual impairment (VI) among US adults with and without diabetes mellitus.Methods: Using National Health and Nutrition Examination Surveys conducted during 1999-2004, we estimated the prevalence of presenting (correctable or uncorrectable), correctable, and uncorrectable VI among Americans 20 years or older with and without diabetes. Data were weighted to make estimates representative of the US civilian noninstitutionalized population. We used multivariate logistic regression to calculate odds ratios and corresponding 95% confidence intervals.Results: Approximately 11.0% of US adults with diabetes had some form of VI (3.8% uncorrectable and 7.2% correctable). Among those without diabetes, 5.9% had some form of VI (1.4% uncorrectable and 4.5% correctable). People with diabetes were more likely to have uncorrectable VI than those without diabetes, even after controlling for selected other factors (PϽ.05). Our findings also suggest a strong association between VI (correctable and uncorrectable) and older age, member of racial/ ethnic minorities, lower income, and lack of health insurance, all independent of diabetes status (P Ͻ.05).Conclusions: Vision loss is more common in people with diabetes than in people without diabetes. Diverse public health strategies are needed to reduce the burden of both correctable and uncorrectable VI.

To address a variety of demands from patients, providers, and policy makers, it is necessary to account for potential access and realized access measures. We need to adopt new methods in assessing the relationship between contextual characteristics and use of eye care services. Moreover, we need to better understand patients' satisfaction and their relationship with utilization and health outcomes.

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