Life Stage Differences in Vision Difficulty and Receipt of a Past-Year Eye Examination Among Midlife and Older Adults: Analysis of a National Sample

Objectives: We examined the association between self-reported vision difficulty and receipt of an annual eye examination among US adults aged ≥45 years and assessed differences by age. Methods: We used 2022 and 2023 National Health Interview Survey data for 34 350 adults aged ≥45 years. The outcome was self-reported eye examination in the past year, and the key independent variable was self-reported vision difficulty. We used multivariable logistic regression with an interaction term to assess whether associations varied by age group (45-64 vs ≥65 y). We estimated predicted probabilities from fully adjusted models. Results: Adults with vision difficulty (vs adults without vision difficulty) were more likely to be female, have lower educational attainment, have lower income, and report more chronic conditions ( P < .001). Among adults aged 45 to 64 years, vision difficulty was associated with a lower probability of receiving a past-year eye examination (50.3% vs 57.7%; 7.4 percentage points; P < .001). Among adults aged ≥65 years, the gap was smaller (68.8% vs 70.1%; 1.3 percentage points; P < .001). Gaps in a past-year eye examination were greater among midlife adults than among older adults ( P < .001). Conclusions: Self-reported vision difficulty is not consistently linked to receiving routine eye examinations, especially during midlife, when structural, financial, and behavioral barriers converge. Public health strategies should address the factors underlying the age differences, reduce barriers to care, and integrate vision care into routine preventive health services to improve vision health and reduce the risk of vision loss.