Introduction

John Wittenborn presents the Future of Vision report at the Focus on Eye Health Summit, June 18, 2014
at the National Press Club in Washington, D.C.

Forecasting the Prevalence and Costs of Vision Problems

In The Future of Vision report, we use a prevalence-based approach to generate projections of the future prevalence and costs of vision problems based on the US Census Bureau’s national population projections from the year 2014 to 2050. Prevalence projections are based on current per-person prevalence rates from Vision Problems in the U.S.. Cost projections are based on current per-person cost estimates from The Cost of Vision Problems and projected changes in inflation, medical costs, wage growth, healthcare utilization and medical intensity. This report details the data, methods and results of this analysis, and shows the potential impacts of projected changes and trends in visual health and the population.

Important Trends in Visual Health

These projections starkly show the potential impacts of looming changes to the landscape of visual health driven largely through demographic shifts that will occur in the coming decades. The most critical aspect is the aging of the baby-boomer generation. Currently, the leading edge of this generation is aging into the Medicare program, while simultaneously beginning to reach the ages at which the prevalence rate of many vision problems quickly escalates. By the year 2032, the baby-boomer population will have almost fully moved into the Medicare ranks and the rapid growth of the population from ages 65 to the mid 80’s will cause dramatic increases in the prevalence and costs of vision problems. In the following decades, the confluence of the aging baby-boomers’ numbers and increased longevity will drive spectacular growth in the elderly population, which will lead to the age group of persons 90 and older exhibiting by far the highest rates of growth in the prevalence of vision loss and eye disease of any age group.

In addition to the aging of the baby-boomers, the coming decades will see transformational shifts in the racial composition of the US population, as the population of non-Hispanic whites actually will decrease while the population of minority groups will grow at high rates, none more so than Hispanics, whose population will double by 2050. This demographic shift will be evident in visual health as the prevalence and costs of vision problems will shift towards conditions more prevalent among minorities, particularly glaucoma and diabetic retinopathy.

The growth and shifts in visual health prevalence will be evident in their resulting costs, with real costs expressed in constant 2014 dollars expected to grow from $145 billion in 2014 to $247 billion in 2032, and reach $376 billion by 2050. Nominal expenditures, representing inflation-adjusted dollars spent per year will reach $385 billion by 2032 and over $700 by 2050. As with disease prevalence, the costs of vision are also forecast to shift to older ages, yielding huge increases in costs among patients aged 65-89 by 2032, followed by a spike in costs among those aged 90 and older by the year 2050.

Major Results

Vision Loss Prevalence:

We estimate that the current population with vision loss includes nearly 3.1 million impaired and almost 1.4 million blind in 2014. We project these populations will grow substantially in the future; by 2032 we estimate that the visually impaired population aged 40 and older will increase by 66% to nearly 5.1 million and the blind population will increase 59% to 2.2 million. By 2050, the impaired and blind populations are projected to reach 7.3 million (2.4 times higher than in 2014) and 3.1 million (2.3 times higher than in 2014), respectively. The number of impaired or blind among the population aged 90 and older is forecast to increase nearly 3.5 fold by 2050.

Eye Disease Prevalence:

We estimate that in the year 2014, 25.7 million Americans currently have cataracts, 8.1 million live with diabetic retinopathy, 2.9 million have glaucoma and 2.2 million suffer from advanced stages of age related macular degeneration (AMD). We project that the total number of cases of these four diseases will increase by 50% by 2032. By 2050, the number of Americans with advanced-stage AMD will double to 4.4 million, glaucoma prevalence will increase 93% to 5.5 million, cataract will grow by 78% to 45.6 million, and the prevalence of diabetic retinopathy will increase by 63% to 13.2 million.

Cost of Vision Problems:

The growth and shifts in vision loss and eye disease prevalence will be evident in their resulting costs, with real costs expressed in constant 2014 dollars expected to grow from $145 billion in 2014 to $247 billion in 2032, and reach $376 billion by 2050. Nominal expenditures, which include the impacts of inflation and represent actual dollars spent per year, will reach $385 billion by 2032 and $717 by 2050.

As with disease prevalence, the costs of vision problems are also forecast to shift to older ages. By 2032, with the baby-boomer population reaching Medicare, the costs for those aged 65-89 are projected to increase by 111% while costs for those aged 90 and older are projected to grow by 85%. From 2032 to 2050, as the baby-boomers age into the oldest age groups, the rate of cost growth among those aged 65-89 is projected to slow, yielding a 37% increase in costs. However, from 2032-2050 the costs among those aged 90 and older is projected to increase by 163%. In total, costs among persons aged 90 and older are projected to increase nearly 5-fold from 2014 to 2050, costs among those aged 65-89 will nearly triple, while costs for persons younger than 65 will increase by 60%.

Forecasts do not show us the future, they show us where we are headed

In forecasting, we are essentially trying to predict a future by looking at the past. However, assuming that any forecast can truly predict the future is a fallacy, as the future is inherently unpredictable. What forecasts can do however is show the direction we are likely headed based on what we know of our current position and recent trends. In the Future of Vision, we integrate information on the current epidemiology and costs of vision problems with emerging population patterns to show how the complex interaction of these trends will drive future growth in vision problem prevalence and cost. While these projections cannot tell us exactly what will happen in the future, they can be used to help identify trends and areas of need that will likely arise in the future, and together with Vision Problems in the U.S. and The Cost of Vision Problems, these forecasts can help guide the discussion about “what can we do to help reduce the toll of vision problems”.