Eye Conditions

and Related Need

for MedicaI Care

Among Persons

1-74 Years of

Age: United

States, 1971-72

This report presents total prevalence

estimates for selected eye conditions,

decrease in vision from eye pathology, and

related need for medical care among the

U.S. population ages 1-74 years by age,

race, sex, and selected demographic

characteristics. These estimates are based

on standardized eye examination findings

from the national probability sample of the

civilian noninstitutionalized population

examined in the first National Health and

Nutrition Examination Survey, 1971-72.

Data From the National Health

Survey

Series 11, No. 228

DHHS Publication No. (PHS) 83-1678

U.S. Department of Health and Human Services

Public Health Service

National Center for Health Statistics

Hyattsvilie, Md.

March 1983
COPYRIGHT INFORMATION

All material appear!ng In th!s report IS In the public domain and may be

reproduced or copied without permission; ckat!on as to source, however,

IS appreciated.

SUGGESTED CITATION

National Center for Health StatNlcs,J P. Ganley, J. Roberts: Eye

conditions and related need for medtcal care among persons 1-74 years

ofage, United States, 1971-72. Vira/and Heakh Statistics. Series 11, No

228 DHHSPub. No (PHS) 83-1678 Public Health Servtce. Washington

U.S. Government Prmtmg Office, March 1983

Library of Congress Cataloging in Publication Data

Ganley, James P

Cve conditions and related need for med}cal care among persons

1-74 year< L)nlted States.

(Vnal and health statistics. Series 11, Data from the nat!onal health

survey; no 228) (DHHSpubllcat!on, no. (PHS) 83-1678)

Includes bibliographical references

Supt. of Dots. no.: HE 20.6029:11/228

1 Eye—Disease anddefects—Untted States—StatMlcs 2.Vision

disorders—UnKed States-Statlstlcs I Roberts, Jean. 11.National Center

for Health Statmtlcs (U.S.)lll. Title. lV Series V. Series: DHHS

publication no. (PHS)83-1678. [DNLM 1 Eyedlseases—Occurrence—

Un!ted States W2AN148vkno. 228]

RA4073.A347 no.228[RE48] 312’0973s 82-6C0196

ISBN 0-8406 -0260-X

[61 45’997]

For sdebythe Superintendent of~owments, u.S. Government I>rintir]g Office, JVasl]ington, D. C. 20402
National Center for Health Statistics

MANNING FEINLEIB, M.D., Dr.P.H., Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Direczorfor Ana@sis

and Epidemiology

GARRIE J. LOSEE, Associate Director,for Data Processing

and Services

ALVAN O. ZARATE, Ph.D., Assistant Directorfor

International Statistics

E. EARL BRYANT, Associate Directorfor Interview and

Examination Statistics

ROBERT L. QUAVE, Acting Associate Director.for

Management

GAIL F. FISHER, Ph.D., Acting Associate Director for

ProgramPlanning, Evaluation, and Coordination

MONROE G. SIRKEN, Ph.D., Associate Directorfor

Research and Methodology

PETER L. HURLEY, Associate Directorfor Vital and Health

Care Statistics

ALICE HAYWOOD, Information Qtjficer

Interview and Examination Statistics Program

E. EARL BRYANT, Associate Direc~or

MARY GRACE KOVAR, Dr. P.H., Special Assistantfor Data

Policy and Ana!vsis

Division of Health Examination Statistics

ROBERT S. MURPHY, Director

JEAN ROBERTS, ChieJ Medical Statistics Branch

SIDNEY ABRAHAM, C’hieJNutrition Statistics Branch

KURT R. MAURER, Chief Survey Planning and

Development Branch

RITA WEINBERGER, ChieJ Programming Stafl

Data Processing and Services Program

GARRIE J. LOSEE, Associate Director

ALAN K. KREGER, Chie$ Computer UsersStafl

Division of Data Services

JAMES C. JACKS, Ph.D., Director

PHILLIP R. BEATTIE, Deputy Director

DA,VID L. LARSON, Chie$ Health Examination Field

Operations Branch

—

Cooperation of the US. Bureau of the Census and Centers for Dkease Control

IJnder the legislation establishing the National Health Survey, the Public

Health Service is authorized to use, insofar as possible, the services or facilities

of other Federal, State, or private agencies, In accordance with specifications

established by the National Center for Health Statistics, the U.S. Bureau of the

Census participated in the design and selection of the sample rmd carried out

the household interview stage of the data colktion and certain parts of the

statistical processing.

The Centers for Dksw Control acted as laboratory consultants and

perfcmned a series of biochemical, hematological, and serological assessments on

blomi specimens of persons participating in the survey.
Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The survey program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmologyexamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . .

Classification ofdisease and other pathologic conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Qualitycontrol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total prevalenceof eyepathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Types of eye pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vision decrease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Needfortreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Intraocular pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The total eye problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Geographic region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Population density . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Comparison with previous studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofdetailedtables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2

3

5

5

5

7

7

7

11

12

14

14

15

16

16

16

18

19

20

Appendixes

L Statistical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Il. Ophthalmology examination and recording forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Ill. Diagnosed eye conditions bytype, site, etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

IV. Eye pathology classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

V. Demographic and socioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Listoftextfigures

1. Prevalence ratesfor eye conditions and the proportion of the population withone or moretypes ofeye pathology

among persons ages l-74years byage United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2. Prevalenceratesforeyeconditions affectingtheretinaandcorneaamong personsagesl-74yearsbyage:United

statf3S, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

...

Ill
3.

4.

5.

6.

7.

8.

9.

10.

11.

Prevalence rates for eye conditions affecting the lids and neuromuscular system of the eyes among persons

ages 1-74 years by age: United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates for selected noninflammatory conditions of the eyes—cataracts, corneal opacities and

ptergium–among persons ages 1-74 years by age: United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates for the principal types of eye conditions among persons 1-74 years of age: United

States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates for selected types of eye conditions among persons ages 1-74 years by age: United States,

1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates for eye pathology (one or more conditions), eye pathology causing vision decrease, and need

for medical treatment of eye condition(s) among persons ages 1-74 years by age: United States, 1971-72 . . . .

Prevalence rates for eye pathology causing vision decrease among persons ages 1-74 years, by age and sex:

United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..<!..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates for eye pathology needing (but not now receiving) medical treatment among persons ages

1-74 years, by age and sex: United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates (age-adjusted) for eye pathology, eye conditions needing but not receiving medical treatment,

and eye conditions for which care is being received among white and black persons 1-74 years of age: United

States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..s . . . . . . . . . . . . . . . . .

Prevalence rates (age-adjusted) for eye pathology, eye conditions causing decrease in vision, eye conditions

8

9

10

11

72

12

13

13

needing but not receiving medical treatment, and eye conditions for which care is being received among

persons ages 1-74 years, by annual family income: United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Text table

A. Prevalence rates and prevalence of eye pathology, eye pathology causing vision decrease, and defective visual

acuity (20/50 or worse) among persons 1-74 years of age, by sex: United States, 1971-72 . . . . . . . . . . . . . . . . . . . 15

Symbols

. . . Data not available

. . . Categorv not applicable

Quantity zero

0.0 Quantity more than zero but lessthan

0.05

z Quantity more than zero but lessthan

500 where numbers are rounded to

thousands

●

Figure does not meet standards of

reliability or precision (more than

30 percent relative standard error)

# Figure suppressedto cc~mply with

confidentiality requirements

iv
Eye Conditions and

Related Need for

MedicaI Care

by James P. Ganley, M.D., Dr.P.H., Louisiana State

University Medical Center, Shreveport, La., and Jean

Roberts, M.S., Division of Health Examination

Statistics

Introduction Statistics are based on findings from the standardized

ophthahnology examination given the national probaThis report contains estimates of the total provability sample of persons examined in the National

lence of the various types of eye abnormalities, the Health and Nutrition Examination Survey of 1971–72.

need for related medical care, and vision decrease from The findings from this cross-sectional study are anasuch pathology among the civilian noninstitutionalized lyzed with respect to age, sex, race, and other

population of the United States, 1-74 years of age. socioeconomic and demographic factors as well as

These estimates from the National Center for Health related medical history.

1
The principal findings from this eye examination in

the National Health and Nutrition Examination Survey of 1971–72 include:

●

●

●

●

An estimated 70.5 per 1,000 persons ages 1–74

years in the United States were found to have

treatable eye conditions so severe or potentially

severe that they either are or should be receiving

medical care.

About half of those in need of medical care for eye

conditions were receiving such treatment.

An estimated 72.7 per 1,000 of the population ages

1–74 years had a type of eye pathology found to be

causing a decrease in visual acuity.

The principal conditions causing decrease in vision

were cataract and/or aphakia, esotropia or exotropia, macular degeneration, glaucoma, and corneal

opacities. Those for which treatment was needed

but not being received were blepharitis, cataract,

glaucoma, esotropia or exotropia, conjunctivitis,

retinal vascular changes, pterygium and benign or

malignant neoplasms.

●

●

●

●

The prevalence of eye pathology causing decrease

in vision and the need for medical treatment of eye

conditions were observed (but not statistically

:signiiicant) to be greater among persons in the

lowest income bracket (under $5,000 per year)

than among the more affluent.

Urban residents were observed to be more likely

than those living in rural areas to have eye

pathology causing decrease in vision and to need

treatment for such conditions.

Black persons were significantly more likely than

white persons to need medical care for eye pathology and were observed to be more likely also to have

eye pathology causing vision decrease.

Those living in the South were significantly more

likely than persons in other parts of the country to

have some eye pathology causing decrease in

vision, although the need for care was no greater in

the South than elsewhere.
The survey program

The National Health and Nutrition Examination

Survey (NHANES I), through which these data were

obtained, is one of the major programs of the National

Center for Health Statistics that was authorized under

the National Health Survey Act of 1956 by the 84th

Congress.l

In the National Health Examination Survey programs, health data are collected by direct standardized(usually single-visit) examinations of probability

samples of the population.2-s From these examinations,

tests, and measurements, data are obtained on the

prevalence of medically defined illness-known as well

as previously unknown or undiagnosed conditions—

and on the distributions of a variety of health-related

physical, physiological, and behavioral measurements.

From these, normative data as well as appropriate

cutoff points for abnormalities can be determined. Also

collected are medical histories and demographic and

socioeconomic data on the sample population under

study with which the examination findings can be

interrelated.

The first National Health and Nutrition Examination Survey was designed to measure the nutritional

status of the U.S. population ages 1–74 years and to

obtain information on other selected aspects of

health-including dental, skin, and eye-of the entire

age group as well as more detded tiormation on

health status and medical care needs of adults ages

25-74 years in the civilian noninstitutionalized population. A description of the specific content and plan of

operation, including sample design and the data

collection forms, has been published.G

The U.S. Bureau of the Census participated in

designing the national sample and in the initial

interviewing in the eligible households in the selected

primary sampling units (PSU’S) in various parts of the

country. Members of the mobile exarninin g center staff

did further interviewing and explaining of the examination portion of the program. The sample persons for

whom appointments could be made were brought into

the specially constructed mobile examination centem

that were moved into a central location in each of the

PSU’S. The team that traveled to the survey locations

throughout the country included profmsional and

paraprofessional medical and dental examiners along

with technicians, interviewers, and management

SM.

The probability sample design used in the survey

provided for oversampling at predetermined rates

among the poor, preschool children, women of childbearing ages, and the elderly, so that the nutritional

status of these high-risk groups could be more accurately estimated. It fmher provided for a nationally

representative subset of 35 of the initially planned

PSU’S throughout the United States so that some

preliminary national iindings on the nutritional status

of the population could be published before the total

survey was completed. This also made possible estimates from those parts of the examination which were

included only in this 35-PSU subsample.

During the planning for NHANES I, the National

Eye Institute (NEI) indicated an interest in obtig

more definitive information than was available on the

prevalence and distribution of specific eye diseases and

related conditions throughout the United States as an

aid in setting goals and priorities for emphasis in NEI

programs. Consistent with the overall objectives of the

survey, an evaluation of the treatment needs also was

incorporated into the examination.

Two senior ophthalmologists from NEI, Drs.

James P. Gardey and Arthur J. Garcia, developed the

examination form and standardized protocol for the

ophthahnic examination. They were responsible for

recruiting and training the ophthalmologists in the

examination methodology to minimize interobserver

variations as well as for ver@ing the resultant diagnoses and for other aspects of quzdity control related to

special equipment used in this examination.

The National Center for Health Statistics and NEI

jointly decided that the ophthalmology examination

would be discontinued after the completion of examinations at 35 locations because of the difficulty of

3
securing ophthalmologist examiners. Although the size

of the sample was not as large as originally planned,

these unique national eye examination findings did

provide the basis for the analysis needed to meet many

of the original purposes of this part of the examination.

Howeverj the examined sample is too small to provide

reliable national estimates for conditions of low prevalence and the degree of demographic-socioeconomic

detail that would have been desirable for planning

purposes related to medical care needs in this area.

For the 35 locations at which the ophthalmology

examination was given during April 1971 through

October 1972, a national probability sample of 14,147

persons was selected to represent the 192.7 million in

the target population ages 1-74 years. Those under the

age of 1 year were excluded from the sample as were

persons 75 years or over because of the difficulties of

arranging to bring them into the examining units.

Despite intensive efforts, only 10,126 of the sample

persons came in for examination. This represents an

equivalent of 72.8 percent of the sample persons

selected when adjustments are made for the differential

sampling rates for the age-sex-income-defined population subgroups. The unadjusted overall response rate

was 71.6 percent.T Of the 10,126 examined, 9,878 were

given the ophthalmology component. This specialty

examination was missed for 244 persons because of

illness of the ophthalmologist examiners or complications in other parts of the examination.

National estimates in this report are based on

weighted observations; that is, the data obtained for

each examined person are inflated to the size of the

total population of which the sample was representative using the reciprocal of the sampling ratio for the

original selection and adjustment for nonresponse.

This assumes that the examined person in each of the

age-sex-income classes is a random subsample of the

sample persons in the same class (appendix I). Although there is evidence from the earlier examination

survey and medical history data from the National

Health and Nutrition Examination Survey that these

are not unreasonable approximations, it is clear t!hat

some estimates may be subject to considerable bias

when more than one-fourth of the sample persons in a

particular age-sex-income class were not examined.

The characteristics of examined and nonexamined

persons were reviewed. From this review of what is

known about nonrespondents and the nature of nonresponse, the likelihood of sizable bias is believed to be

small.

]Findingsthat are statistically significant as Well as

observed differences (not statistically significant at the

5-percent probability level) that may be of interest are

discussed. Statistically significant diRerences at the 5-

percent probability level are pointed out.

Statistical notes on the sample design, reliability of

the data, and sampling and measurement error are

included in appendix I. The ophthalmology examination protocol is described in appendix H, which also

includes the recording form used. Data based on the

six-digit National Eye Institute codes, including those

too unreliable for use in the text or detailed tables, lmay

be found in appendix 111 to show more complete

infcmnation on the precise conditions causing vision

decrease or needing car% definitions of the demographic amd socioeconomic terms used are in appendix V.

The correspondence of the eye conditions identified by

site and type from this examination under this NEI

system with the principal types in the Eighth Revision

International Classljication of Diseases, Adapted for

UM in the United States (lCDA-8)8 as used in this

report are included in appendix IV.
Ophthalmology examination

At each of the 35 selected locations throughout the

country, 10 sample persons were scheduled to come or

be brought into the specifically designed mobile center

for each of the morning, afternoon, and evening

examination sessions. Examinees included two adults

(25-74 years of age) selected to be given the detailed

examination in addition to the more limited examination for the nutrition sample. The ophthalmology

examination, one of the first procedures scheduled in

each session, was similar for persons in the nutrition

sample and those in the detailed sample except that a

more complete refraction was given the latter group.

The standardized eye examination for all examinees included taking an ocular history regarding known

eye disorders or previous surge~, determination of

monocular distance visual acuity with usual correction, if any, and with a pinhole test to measure

correctability for those with acuity less than 20/2Q

determination by inspection and standard testing of

the type of motility defects; measurement of prescriptions in present glasses; dilatation and, within 20 to 70

minutes thereafter among those with acuity less than

20/40, retinoscopy for detailed examinees and spherical trial lens tests for nutrition examinees; applanation

tonometry on examinees ages 20 years and oveq and

examination of the pupils, lids, globes, conjunctival,

sclera, corneas, anterior chambers, irides, and lenses.

The pupils were dilated (except in persons determined

on careful examination to have narrow angle glaucoma

in which the angle was 10° or narrower) for the

spherical refraction and retinoscopy and for the

examination of the vitreous and retina.

The methods used for visual acuity testing, mobility testing, pinhole testing, and refraction have been

described in the two Series 11 reports analyzing these

tindings from the NHANES I survey.$’~loThe special

procedures used in the various parts of the eye

examination are described in appendix II.

Classification of disease or other

pathologic conditions

The eye conditions diagnosed in this ophthalmic

examination were classified using a six-digit

Ophthalmic Disease Code adapted for use in this

survey by the National Eye Institute. The first two

digits refer to the anatomical site of the disease or

injury except for the digits 61, which refer to refractive

errors. The second two show the nature or type of

disease, injury, or surgical or nonsurgical treatment.

The last two identify the etiology of the disease, agent

of injury, nonsurgical or surgical treatment indicator,

and postoperative state indicator. Data from the entire

six-digit NEI diagnoses codes for all conditions occurring at least 10 times and for all conditions decreasing

vision, in need of but not receiving medical care, as well

as those under medical care are included in appendix

HI. These are included for reference purposes to show

more precisely the specific eye conditions causing

vision decrease or needing care, although many of

these estimates are not sufficiently reliable for inclusion

in the tables and text because of the small numbers of

individuals identified with rare conditions and the

excessively large sampling variabilityy.

Tables 3-5 contain the prevalence of eye conditions identified from the first four digits of the NEI

codes—showing site and type of disease-under the

NEI system (table 3) and after conversion to ICDA-8

(tables 4 and 5). These tables are included to give an

idea of the various types of eye problems in the

population needing care or causing vision decrease

although, because of the small sample for which these

data are available, they contain more than the usual

number of cells with estimates that do not meet the

standard of reliability and precision used for statements and the major tables in this report.

Quality control

Procedural manuals for the ophthalmological examination were available to the examiner in each

location, as an aid in maintaining standard protocol.

In addition, the senior ophthalmologists from NEI

developed a protocol for supervised testing, to ensure

the accuracy of the ophthalmology examination data

and to aid in maintaining uniformity in the examination procedures.

Examinations of all sample persons in the first two

5
sessions at 24 of the 35 stands were observed and Aclditional diagnoses showing site and type (but not

partially replicated by the senior ophthalmologists etiology, vision decrease, or need for medical care)

from NEI, who then evaluated the methods and were added during medical review at NEI using

findings of the examiners and made recommendations criteria as consistent as possible with those used by the

when needed. The extent of examiner variabilityy, examining ophthalmologists. This was done to ensure

which cannot be separated from the sampling variabili- uniforrnity in interpretaticm of the diagnostic criteria

ty inherent in the survey, is discussed in appendix I. throughout the study.
Total prevalence

More than one-third (381 per thousand) of the

population ages 1-74 years in this country, or an

estimated 73.5 million persons in 1971–72 had, some

abnormality in one or both eyes, either physiologic or

pathologic, excluding those limited to refractive errors,

arcus senilis, conjunctival melanosis, concretions, pinguecula, inclusions, follicles, and nonsymptomatic

phorias (table 1). These conditions ranged from minor

ones that do not and may never interfere with normal

functioning to more serious types causing visual loss or

requiring treatment.

These abnormalities do not necessarily reflect

significant abnormalities, but include any changes—

benign, pathologic, or physiologic— from the norm of

ocular morphology, structure, or function. For example, an individual was considered to have refractive

changes in the eye whether conditions were minor or

insignificant, such as a myopic cup, conus or crescent

or the more significant pigmentary changes in myopic

macula.

The prevalence rates of eye pathology increased

with successive age groups from 105 per 1,000 preschool children ages 1-5 years to 854 per 1,000 adults

ages 65–74 years (figure 1). Females were about as

likely as males to have some type of eye patholog~ the

prevalence rates were 374 and 389 per 1,000 population, respectively (table 1). Across age groups 6-54

years, the prevalence of eye pathology among males

was observed to consistently exceed that among

females; among the preschool-age population and

older adults ages 55–74 years, the rates for females

were about the same as for males.

Among the population with eye pathology, the

majority (57 percent) had only one type of condition,

23 percent had two, and the remainder had as many as

12 per person. The total prevalence of eye conditions

was 677 per 1,000 population ages 1–74 years. The

increase with successive age group in the prevalence of

eye conditions was substantially more rapid from ages

250

r

200

1

150

50

/’

— /

)

Eye conditions

/

/

/’

/

Personswith one or

more types of eye

o

20 ●4O 60 80

Age in years

Figure 1. Prevalence rates for eye conditions and the proportion of the

population with one or more types of eye pathology among persons

ages 1-74 years by age United States, 1971-72

35–74 years than that shown for the proportion of the

population affected in any degree, reflecting the increase in the multiple eye conditions with age.

Types of eye pathology

Parts of the eye most frequently affected by these

physiologic and pathologic conditions were the retina

7
(126.0 per 1,000 population ages 1-74 years), the

crystalline lens (116.6 per 1,000), the cornea (111.3 per

1,000), the lids (71.4 per 1,000), and the neuromuscular system of the eye (56.9 per 1,000).

The prevalence of conditions affecting the retina,

crystalline lens, and cornea increased rapidly with age

(table 2 and figure 2), while the prevalence for those

Meeting the lids and neuromuscular system of the eye

showed no consistent age-related trend until 35 years

of age (figure 3). Amblyopia (poor vision in one eye

that appears to have no organic disease or one that

could be identified by the examiner) is more prevalent

among adults ages 25–74 years than among children

and younger adults. “Refractive” conditions, which

showed no consistent trend with age (table 2), are

structural changes of the eye secondary to a refractive

700

600

[

500

1

200

100

I

~ Lens

/’

20 40 60 80

Age in years

Figure 2. Prevalence rates for eye conditions affecting the retina and

cornea among persons ages 1-74 years by age United States, 1971-72

20 40 60 80

Age in years

Figure 3. Prevalence rates for eye conditions affectinc! the fids and

neuromuscular system of the eyes among persons ag& 1-74 years

by age United States, 1971-72

error such as myopic disc or Fuchs’ spot; these

changes refer exclusively to myopic refraction, because

hyperopia is not associated with structural changes

other than small cornea or globe.

Conditions affecting the cornea were observed to

be more prevalent among males than females (128.0

per 1,000 males compared with 95.6) as were those

affecting the lids (80.3 per 1,000 males compared with

613.0).Females were about as likely as males to have

conditions affecting the crystalline lens (123.0 per

1,000 females compared with 109.8 per 1,000 males).

~4mblyopia occurred significantly more frequently in

females than males (32. 1 per 1,000 females and 17.4

per 1,000 males).

Across successive age groups, the prevalence of eye

pathology affecting the cornea was greater among

males than females with differences in rates large

enough to be statistically significant at ages 1–5 and

:12-44 years. Also across ages to 65 years, amblyopia

was observed to occur more frequently in females than

males. The estimated prevalence of neuromuscular eye

pathology was consistently (but not significantly)

greater among females than males across the age range

of 1–74 years; the sex difference trend with age in the

prevalence of abnormal conditions affecting the lids

and crystalline was less consistent.

The principal types of eye pathology (table 3),

using the NEI classification system, were changes

:tiecting retinal vessels (84.7 per 1,000 population),

opacity or sclerosis of the crystalline lens (56.6 per

1,000 population), corneal opacities (33.5 per 1,000

population), cataract (33.4 per 1,000 population),

{drusen (29.6 per 1,000 population), blepharitis (24.3

:per 1,000 population), amblyopia (significant

difference in refractive error of the two eyes, usually

secondary to strabismus or anisometropia—25.0 per

1,000 population), exotropia (21.3 per 1,000 population), and pterygium (16.0 per 1,000 population).

8
Corneal opacities and pterygium were more frequently found among males than females and more

frequently among adults ages 45–74 years than younger adults or children, although the increase in

prevalence across successive age groups was not

consistent.

The prevalence of the other more frequently

occurring types of eye pathology generally increased

across successive age groups, the trend being most

consistent for retinal vascular changes, opacities and

cataract of the lens, and drusen of the choroid. Sex

differences and age trends in the prevalence of these

conditions were not marked enough to be statistically

significant at the 5-percent probability level.

In terms of the more widely used ICDA–8 as

shown in table 4, the most prevalent types of eye

pathology among the U.S. population ages 1–74 years

were cataracts (rate of 93.9 per 1,000 population),

arteriosclerotic changes affecting the retinal vessels

(84.7 per 1,000), strabismus (40.9 per 1,000), comeal

opacities (35.2 per 1,000), blepharitis (26.4 per 1,000),

pterygium (16.3 per 1,000), conjunctivitis (13.3 per

1,000), and congenital abnormalities of the eyes other

than strabismus (9.7 per 1,000). Estimates for these

conditions cannot be derived from the data based on

the NEI classification shown in table 3 because in that

table conditions with very low prevalence (less than

0.5 per 1,000) have been grouped with “all other” for

the part of the eye affected.

Cataracts

The prevalence of cataracts, defined here as any

loss of transparency of the Iensll which mayor may not

be associated with loss of vision, increased with

successive age groups from a rate of 4.5 per 1,000

preschool age children 1-5 years to 576.4 per 1,000

adults 65-74 years (figure 4). The rate of increase was

most rapid from ages 45 years on. Proportionately

more females than males had evidence of a cataract

(figure 5); the rates were 103.3 and 83.8, respectively (a

difference large enough to be statistically significant at

the 5-percent probability level).

Changes tiecting retinal vessels

These conditions also showed a rapid generally

significant increase in prevalence with age from 8.7 per

1,000 among preschool children ages 1–5 years to

364.2 per 1,000 among adults ages 65–74 years (figure

6). The most rapid rates of increase were among adults

from ages 35 years on. Such conditions were observed

to be only slightly more prevalent among females than

males (87.7 compared with 81.6 per 1,000, respectively).

Strabismus

Strabismus (heterophoria or cross-eyes), which

includes conditions of congenital and acquired origin,

600

500

c 400

.-0

5

3

3

a

8 300 0.

z

Q

al

~ 200

100

o 20 40 60 80

Age in years

Figure 4. Prevalence rates for selected noninflammatory conditions of

the eyes-cataracts, corneal opacities and pterygiubmong persons ages 1-74 years by age: United States, 1971-72

was more prevalent among adults ages 55-64 years

and less prevalent among preschool children ages 1-5

years than at other ages. The rates also were observed

to be somewhat higher among teenagers ages 12–17

years, adults ages 45-54 years and those ages 65–74

years than younger children or younger adults, although there was no consistent age-related trend.

Females were more likely than males to have such a

condition (rates of 49.9 and 31.2 per 1,000, respectively).

Opacities

The prevalence of opacities resulting from healed

corneal injuries, infections, or other causes ranged

from 2.7 per 1,000 among preschool children ages 1-5

years to 70.3 per 1,000 adults ages 65-74 years. The

rates were observed to be higher among adults ages

45-74 years and those ages 18-24 years than younger

adults or children but showed no consistent increase

with age. Males were significantly more likely to have

such conditions than females; the rates were 49.6 and

21.9 per 1,000, respectively. This would be expected,

because injuries are a major cause, and men would

have been more likely than women to engage in

9
120

100

80

c

.g

~

3

g

~ 60

0-

k

n

%

z

E

40

20

0

Cataract Corneal Pterygium Neoplasms Bkpharitis Conjunctivitis Strabismus Circulatory Congenital

opacity of eyes or (Arterio- eye

lids sclerosis) conditions’

1Excludes strabismus.

Figure 5. Prevalence rates for the principal types of eye conditions among persons 1-74 years of age: United States, 1971-72

occupations or strenuous sports where such accidents

frequently occur.

Blepharitis

Inflammation of the margin of the eyelids caused

by bacteria or seborrheal] had observed prevalence

rates at a minimum of 14.6 per 1,000 for ages 1–5 years

and a maximum of 41.9 per 1,000 among the oldest

adults in the study, 65–74 years, with no consistent

age-related trend. The prevalence was significantly

higher among males (32.2 per 1,000) than females

(20.9 per 1,000).

Neoplasms

The prevalence rates of malignant and benign or

unspecified neoplasms affecting the eye and surround10

ing tissue generally were observed to increase with

successive age groups from 1.9 per 1,000 preschool

children ages 1-5 years to 63.5 per 1,000 adults ages

65–74 years. Males were observed to be slightly more

likely than females to be afkted with rates of 27.9,

compared with 22.3 per 1,000, respectively.

Pterygium

This condition, in which a triangular fold of bulbar

conjunctival advances over the cornea, occurs most

frequently among persons exposed to chronic ccmjunctival irritation from wind and sunlight. 11The condition

was found only among adults ages 18 years and over.

The prevalence rates generally were observed to

increase with successive age groups from 3.0 per 1,000

among young adults ages 18–24 years to over 40.0 per
c

g

Conjunctivitis

Neoplasms. L

m

jj o 20 40 60 80

Age in years

/

/

/’Circulatory

I

,4’

,1’

,{ Strabismus

~ Congenital, other

*&.~A’ -----

than strabismus

----- --

0 20 40 60 80

Age in years

Figure 6. Prevalence rates for selected types of eye conditions amen

persons 1-74 years of age, by age United States, 1971-72

1,000 among adults 55-74 years of age. More than

three times as many males as females were affected, the

rates being 25.4 and 7.6 per 1,000, respectively.

Conjunctivitis

This inflammation of the lining of the posterior

surface of the eyelids and anterior surface of the globe

caused by infection, allergy, or other irritant,l 1showed

no consistent age-related trend. The prevalence was at

a maximum for ages 12-17 years (20.0 per 1,000) and a

minimum for ages 55–64 years (7.2 per 1,000). Males

were significantly more likely to be affected than

females (rates of 16.4 and 10.3 per 1,000, respectively).

Congenital eye conditions

Excluding strabismus, congenital eye conditions

showed no consistent trend with age. The prevalence

rates ranged from a minimum of 6.8 per 1,000 persons

ages 35+4 years to a maximum of 13.1 among youths

12-17 years. Males were observed to be slightly more

likely than females to have such eye conditions; the

respective rates were 11.2 and 7.9 per 1,000.

Causes of blindness

Among these various types of eye pathology, the

principal causes of blindness are cataract, glaucoma,

diabetic retinopathy, and macular degeneration.

The most prevalent of such conditions were

cataracts, which were found among an estimated 18

million persons, or 93.9 per 1,000 population, ages

1–74 years (table 4). Nearly three-fourths of those

persons showed substantial evidence of cataract on

examination ranging from immature to mature conditions. aphakia, and lens opacities. Macular degeneration was identified in an estimated 2.5 million persons or

13.1per 1,000population (table 3).

Definite or probable glaucoma conditions were

found among an estimated 1.3 million persons, or 6.4

per 1,000 of the population. An additional 2.4 per

1,000 persons had conditions considered suspect of

glaucoma—with evidence of open or wide angle,

narrow angle or angle closure, or substantially increased intraocular pressure. Approximately one-third

of those with definite or probable glaucoma and onefifth of those with suspect conditions showed physical

evidence of glaucomatous cupping in the disc. Because

visual fields were not tested in NHANES, these rates

for glaucoma will probably be underestimates of the

total prevalence.

Diabetic refinopathy was identified among an

estimated 1.9 per 1,000 population. About one-fourth

of these were observed to show definite evidence of

diabetic involvement of the macula and an additional

one-fourth, microaneurisms or neovascularization

and/or hard or waxy exudates on the retina. These

latter proportions, because of the smallness of the

available national sample, do not meet the standards

for reliability and precision used in this report.

Vision decrease

An estimated 72.7 persons per 1,000 population

ages 1-74 years had one or more types of eye

abnormalities causing a decrease in visual acuity, as

observed by the examining ophthalmologist in the

1971–72 NHANES. The prevalence of conditions

causing visual impairment increased from 11.0 per

1,000 children ages 1–5 years to 363.7 per 1,000 adults

ages 65–74 years; the rate of increase was most rapid

among older adults ages 55–74 years (figure 7). Males

were somewhat less likely than females to have such

conditions; the rates were 65.7 and 79.2 per 1,000 ages

1–74 years, respectively. The trend with age was

similar for both sexes, and the rates for males generally

remained lower than those for females across ages

(table 6, figure 8).

The principal conditions causing vision decrease

were cataract and/or aphakia (affecting an estimated

29.3 per 1,000 persons ages 1–74 years), esotropia or

exotropia (6.6 per 1,000), macular degeneration (5.4

11
900 r

800

700

600

300

200

100

0

Vision decrease

from eye pathology

I

o 20 40 60 80

Age in years

Figure 7. Prevalence rates for eye pathology (one or more conditions),

eye pathology causing vision decrease, and need for medical

treatment of eye condition (s) among persons 1-74 years of age, by

age: United States, 1971-72

per 1,000), glaucoma (3.0 per 1,000), and corneal

opacities (1.7 per 1,000).

Among those with eye pathology, about one out of

five had conditions causing vision decreasq the proportion varied between 10 and 13 percent at ages 1-44

years, then increased rapidly with age to 43 percent at

65–74 years (figure 8). This age-related trend was

generally similar for males and females. The conditions

most likely to cause vision decrease were detached

retina (62 percent of those with such pathology),

glaucoma (47 percent), other conditions of the retina

including macular degeneration (46 percent), cataracts

(31 percent), symptomatic conditions affecting the

eyes (23 percent), inflammatory conditions of the

12

400

300

c

.:

~

2

0

; 200

0.

k

a

da

‘%

u

100

o 20 40 60 80

Age in years

Figure 8. Prevalence rates for eye pathology causing vision decrease

among persons ages 1-74 years, by age and sex United States,

1971-72

uveal tract (20 percent), strabismus (16 percent,), and

the inflammatory condition of keratosis (14 percent)

(table 5).

Need for treatment

The proportion of the population needing treatment for one or more types of eye pathology was

estimated at 34.2 per 1,000 population ages 1-74.years,

based on the evaluation of the examining ophthalmologists in the 1971-72 NHANES. The prevalence of

need for treatment was nearly 25 per 1,000 population

across ages 1-44 years (varying between 16.5 :at ages

6+11 years to 30.7 at 25-34 years) then increased

consistently with age to 98.2 per 1,000 population at

65-74 years (table 6, figure 9).

Males ages 1–74 years were about as likely as

females to need treatment for an eye condition; the

rates were 33.8 and 34.6 per 1,000 population, respectively. The trend with age was similar for males and

females except among the oldest age group (65-74

years), where the rate was significantly higher among

men (120.9 per 1,000) than women (81.2 per 1,000).

The principal conditions needing treatment were
o~

o 20 40 60 80

Age in years

Figure 9. Prevalence rates for eye patholgy needing (but not now

500 r

h

= White

D Black

- 95-percent

confidence limit for

400 estimated role

c

o.-

jj

s

n

0

: 300

8

--

Some eye Vision Treatment Under

pathology decrease needed-not care for

from eye received eye

pathology for eye pathology

pathology

receiving) medical treatment among persons ages 1-74 years, by age

and sex: United States 1971-72

Figure 10. Prevalence rates (age-adjusted) for eye pathology, eye

conditions causing decrease in vision, eye conditions needing but

not receivina medical treatment, and eve conditions for which care

blepharitis (affecting an estimated 5.4 per 1,000 persons 1–74 years), cataract (4.5 per 1,000), glaucoma

(3.6 per 1,000), esotropia or exotropia (2.8 per 1,000),

conjunctivitis (2.6 per 1,000), retinal vascular changes

(1.6 per 1,000), pterygium (1.6 per 1,000), and benign

or malignant neoplasms (1.5 per 1,000).

Nearly 9 percent of those with some type of eye

pathology needed treatment and were not receiving it.

The proportion was highest among preschool children

ages 1–5 years (20 percent) but otherwise showed no

consistent age-related trend, varying between a low of

6 percent at ages 35-44 years and 11 percent at 12–17

and 65-74 (figure 10). This pattern was generally

similar among males and females except at 65–74 years

where among those with eye pathology, the proportion

of men needing treatment was approximately twice

that among women (18.9 percent and 9.5 percent,

respectively).

Among those with eye pathology, the conditions

most likely to need treatment as determined in the

examination, were glaucoma (56 percent), hordeolum

or styes (25 percent), blepharitis (20 percent), conjuncis being rec&ed among white and black persons 1-74 years of age:

United States, 1971-72

tivitis (20 percent), inflammatory conditions of the

uveal tract (11 percent), and pterygium (10 percent).

Under care

In addition to the 34.2 per 1,000 population ages

1–74 years who were in need of but not receiving

treatment for eye pathology, 36.3 per 1,000 were

receiving care at the time of the survey for one or more

eye conditions (table 6). Therefore, about half (52

percent) of the total population needing treatment for

eye pathology was receiving it.

Among males, the additional 31.0 per 1,000 in

need treatment for an eye condition and receiving it

were slightly less than half of the total needing

treatment (64.8 per 1,000); among females, the estimated 41.1 per 1,000 under care were slightly more

than half of the total in need of such treatment (75.7

per 1,000). The principal eye conditions for which

13
medical treatment was being given were esotropia or

exotropia (6.3 per 1,000), cataracts (3.9 per 1,000),

glaucoma (2.0 per 1,000), retinal vessel changes (1.8

per 1,000), conjunctivitis (1.4 per 1,000), and pterygium (1.2 per 1,000).

Of the total population ages 1-74 years in need of

and/or receiving medical treatment for these principal

types of eye pathology, those most likely to be

receiving medical care were persons with detached

retina (84 percent), esotropia or exotropia (69 percent),

retinal vessel changes (53 percent), substantial refractive errors (50 percent), corneal opacities (47 percent),

cataracts (46 percent), and pterygium (43 percent). In

contrast, only about one-third or fewer persons with

glaucoma (36 percent), conjunctivitis (35 percent),

benign or malignant neoplasms (29 percent), and

blepharitis(11 percent) were under care.

Intraocular pressure

National estimates for the distribution of intraocular pressure levels among adults from tonometry

measurements obtained in NHANES are shown in

table 7. Although elevated intraocular pressure is one

characteristic of glaucoma, the ability of the healthy

eye to tolerate indefinitely elevated pressure of 20 mm

Hg as measured by Schiotz tonometry (the equivalent

of approximately 19 mm Hg on the applanation

readings obtained in this study) without damage to the

optic nerve is recognized. 11Persons with previously

diagnosed glaucoma who are under treatment would

be expected to have intraocular pressures maintained

at normal levels through medication. The relationship

of the diagnoses of glaucoma and the intraocular

pressure levels has not been included in this report.

Among U.S. adults 20-74 years of age, the mean

intraocular pressure (determined from the average of

the three applanation tonometry measurements) was

14.8 mm Hg. Mean levels were observed to increase

negligibly with successive age groups from 14.2 mm

Hg at ages 20-24 years to 15.8 mm Hg at 65–74 years

and were generally similar among men and women

(14.7 and 14.8 mm Hg, respectively).

Nearly one-half (46 percent) of the population ages

20-74 years had intraocular pressures of 15 mm Hg or

greateq the proportion increased with successive age

groups from 35 percent among the youngest adults

tested, ages 20-24 years, to 59 percent among those

65–74 years. At ages 20-24 years, the proportion with

this degree of pressure elevation was observed to be

slightly higher among men (38 percent) than women

(32 percent); at 65-74 years of age, the reverse was

found (55 percent of men compared with 62 percent of

women had this degree of elevation).

Elevated intraocular pressure of 20 mm Hg or

more was found among 5 percent of adults 20-74 years

of age. This proportion increased substantially with

successive age groups from 2 percent among young

aclults ages 20-24 years to 10 percent among those

ages 65-74 years. The increase in this degree of

pressure elevation with age groups was observed to be

silmilar for men and women.

The total eye problem

In summary, an estimated 381.1 per 1,000 of the

U.S. population ages 1–74 years in 1971–72 had one or

more types of eye pathology as identified in this

NHANES examination. Nearly one-fifth (18.5 percent) of these, or an estimated 13.6 million persons,

with eye pathology were either receiving or in need of

treatment for the condition (table A). Nearly om[e-half

of this grou@8. 5 percent (an estimated 6.6 million

persons)—were not receiving but needed such treatment.

Nearly one-fifth (19. 1 percent) of those with eye

pathology, or an estimated 14.0 million persons, had

an eye condition causing decrease in visual acuity.

Defective acuity of no better than 20/50 in one or

both eyes with usual correction (with corrective lenses

if worn, otherwise without), as determined in the

NHANES, was found among an estimated 61.5 per

1,000 population ages 4-74 years. (This corresponds to

the rate of 59.2 per 1,000 ages 1-74 years shown in

ta~ble B, assuming no defective acuity among those

whose vision was not tested—those 1-4 years of age).

Nearly three-fourths (74.3 percent) of persons, 1–74

years with usual visual acuity 20/50 or worse (or about

8.5 million) also had some eye pathology. Nearlly half

of them (47.8 percent), or 5.4 million persons 1-74

years, had some eye pathology causing decrease in

,, .

Vllslon.

More than three-iifths (61.1 percent) or an estimated 8.6 million persons 1-74 years of age with eye

pathology causing vision decrease still had acuity

better than 20/50 with their usual correction.

F{ace

Vision decrease

The prevalence of eye pathology causing decrease

in visual acuity was slightly, but not signMcantly

greater among the black than the white population

ages 1–74 years; the estimated rates were 78.7 and 72.1

per 1,000 population, respectively. However, when the

rates were standardized to remove the effect of

differences in the age distributions of the two populations, the rate for eye pathology causing vision

decrease was significantly greater among black persons

(95.0 per 1,000) than among white persons (70.6 per

1,000) (table 8). These racial differences were observed

among males and females.

Across age, these rates were observed to be

somewhat higher for black than white males from ages

12–74 years. Among females, the pattern of’ racial

14
Table A. Prevalence rates and prevalence of eye pathology, eye pathology causing vision decrease, and defective usual visual acuity

(20/50 or worse) among persons 1-74 years of age, by sex United States, 1971-72

Type of eye condition Total Males Females

Eye pathology, one or more &pes..........................................................................................

Eye pathologyneeding or receiving treatment ......................................................................

Treatment needed (not under care) ....................................................................................

Under care ...............................................................................................................................

Eye pathology causing vision decrease ..................................................................................

Usual visual acuity 20/50 or worse ........................................................................................

No eye pathology, usual acuity 20/50 or worse .............................................................

Eye pathology, usual acuity 20/50 or worse ....................................................................

Eye pathology causing vision decrease, usual acuity 20/50 or worse .......................

Eye pathology causing vision decrease but usual visual acuity still better than

20/50 ..........................................................................................................................................-

Eye pathology, one or more Wpes ..........................................................................................

Eye pathology needing or receiving treatment ......................................................................

Treatment needed (not under care) ....................................................................................

Under care ...............................................................................................................................

Eye pathology causing vision decrease ..................................................................................

Usual visual acuity 20/50 or worse ........................................................................................

No eye pathology, usual acuity 20/50 or worse .............................................................

Eye patholbgy, usual acui~ 20/50 or worse ....................................................................

Eye pathology causing vision decrease, usual acuity 20/50 or worse .......................

Eye pathology causing vision decrease but usual visual acuity still better than

20/50 ..........................................................................................................................................

differences in these eye conditions causing vision

decrease was less consistent—the rates among white

females was the higher in age groups 1-11, 18-24, and

45–64 years.

Black males were observed to be more likely to

have eye pathology causing vision decrease than black

females (age-adjusted rates of 102.8 and 88.4 per 1,000,

respectively); the reverse was observed in the white

population, among whom the age-adjusted prevalence

rate was 62.5 per 1,000 white males, compared with

78.2 for white females.

Among the white population, the prevalence of eye

pathology causing vision decrease was substantially

lower for younger females than males from 1-34 years

of age; among black persons the pattern of sex

differences with age in such pathology was less

consistent and probably reflected no more than sampling variability:

Treatment needs

The need for

total population

treatment of eye

ages 1–74 years

pathology in the

was significantly

greatei a-mong black than white persons (age-adjusted

~ates of 59.4 &d 31.6 per 1,000, ~espective~) (table 9).

Among males and females, the relative extent of need

for such care was significantly greater among black

than white persons ages 1-74 (age-adjusted rates of

53.3 compared with 32.1 per 1,000 males and 64.9

compared with 31.2 per 1,000 females).

White males were observed to be about as likely as

white females and black females as more likely than

black males to have eye conditions needing medical

Rate per 1,000 population

381.1 388.6 374.2

70.5 64.8 75.7

34.2 33.8 34.6

36.3 31.0 41.1

72.7 65.7 79.2

59.2 55.5 62.8

15.2 5.7 22.0

44.0 49.9 40.8

28.3 27.2 29.3

44.4 38.5 49.9

Population estimates in thousands

73,448 36,331 37,117

13,587 6,068 7,519

6,591 3,160 3,431

6,996 2,908 4,088

14,011 6,148 7,863

11,409 5,148 6,225

2,929 586 2,343

8,480 4,532 3,948

5,464 2,542 2,912

8,557 3,606 4,991

care. Among adults 18-74 years, the need for eye

treatment was significantly greater for black men and

women than it was for their white counterparts (71.3

and 78.7 per 1,000 black men and women, compared

with 36.6 and 36.3 per 1,000 white men and women).

Among the population with eye pathology, the

proportion needing treatment was observed to be

greater for black than white persons, for males and

females (8 percent among white males and females, 11

percent for black males and 16 percent for black

females).

Under care

The proportion of the population with eye pathology being treated was observed to be greater among the

white than the black population ages 1-74 years (ageadjusted rates of 38.0 per 1,000 white persons and 25.0

per 1,000 black persons)(table 10).

When considered in relation to all of those needing

treatment for eye pathology, whether or not they are

now receiving it, over half the white population ages

1–74 years in need of such care were receiving it (55

percent for both sexes, 50 percent for males and 58

percent for females), compared with only slightly more

than one-fourth among the black population (28

percent for both sexes, 26 percent for males and 29

percent for females).

Among adults 18–74 years of age, nearly 79

percent of the group of white women needing eye

treatment were receiving it, compared with 51 percent

of white men, 32 percent of black women, and 28

percent of black men.

15
Geographic region Northeast and Midwest, males were about as likely as

females to be under care (53 and 54 percent, and 50

Vision decrease

Eye pathology causing decrease in vision was most

prevalent in the South and least prevalent in the West

among the total population ages 1–74 years, and

among adults 18–74 years, males and females; the

differences were large enough to be statistically significant. Age-adjusted rates ranged from 89.6 per 1,000

in the South to 53.9 per 1,000 in the West for the

population ages 1–74 years; those in the Northeast and

Midwest were similar (72. 1 and 73.9 per 1,000,

respectively)(table 8).

Treatment needs

The age-adjusted proportion of the population l–

74 years of age in need of treatment for one or more

eye conditions ranged from 40.4 per 1,000 in the West

to 29.9 per 1,000 in the Northeast, differences too

small to reflect no more than sampling variability.

Among adults, the range was from 54.6 per 1,000 in

the West to 31.6 per 1,000 in the Midwest (table 9).

Among males, the regional distribution of need for

treatment was generally similar to that shown for the

total population ages 1–74 years. The age-adjusted

rates ranged from 47.2 per 1,000 in the West to 25.0

per 1,000 in the Northeast; the differences between

these extremes were large enough to be statistically

significant.

Among females, the proportion of the population

in need of treatment for an eye condition showed

essentially no regional variation. The age-adjusted

rates for the ages 1–74 years ranged from 34.7 per

1,000 in the West to 33.5 per 1,000 in the Northeast;

among women 18–74 years, the range was from 44.7

per 1,000 in the West to 32.2 in the Midwest.

Under care

The age-adjusted proportion of the population

under care for an eye condition ranged from 41.2 per

1,000 in the South to 33.8 in the West, differences

small enough to reflect no more than sampling

variabilityy (table 10). Among males, these rates were

observed to be slightly higher in the Midwest and

lower in the West and Northeast than the South; the

proportion of the female population receiving treatment for an eye condition was highest in the South and

lowest in the Midwest.

For the total population with eye pathology who

needed or were receiving treatment for it, the proportion under care ranged from 56 percent in the South to

46 percent in the West. Females in the West and, to a

more limited extent, those in the South, were more

likely than males to be receiving such care (53 percent

compared with 38 percent in the West, 59 percent

compared with 52 percent in the South); in the

and 59 percent, respectively).

Population density

Vision decrease

Eye pathology causing decrease in vision was

observed to be more prevalent among urban than rural

residents. The respective rates were 75.4 and 67.6 per

1,000 population ages 1–74 years (table 8). Urban rates

appeared higher for males and females ages 1–74 years

and adults 18–74 years.

Such eye pathology was most prevalent among

persons living in the smaller nonurbanized communities of 25,000 or more and the least prevalent among

persons in the largest urban communities of 3 million

or more. The dMerence between these respective ageadjusted rates of 132.4 and 53.4 per 1,000 was large

enough to be statistically significant. Only in the

largest metropolitan communities were the rates of eye

pathology causing vision decrease observed to be less

than for those in rural areas.

Treatment needs

The extent of need for treatment of an eye

condition was observed to be greater among the urban

than the rural population. The respective rates were

39.7 and 23.8 per 1,000 population ages 1-74. years

(table 9). The greater need for such care was observed

to exist among males and females in urban communities.

In rural areas, the need for eye treatment was

clbserved to be greater among males than femaley in

umban communities, the need for such care was

generally somewhat greater among females than

males.

IJnder care

The proportion of the population with eye conditions being treated was observed to be greater in urban

than rural areas among males and females (table 10).

In both population density areas, females were observed to be more likely to be receiving treatment than

males.

Of all those in need of treatment for an eye

condition, regardless of whether care was being received, about half of those in need of care in rural and

urban areas were observed to be receiving it.

Ilncome

Vision decrease

There was an inverse relationship between eye

pathology causing vision decrease and annual family

income (figure 11). The age-adjusted prevalence rates

16
500

400

100

0

Some eye pathology

m Under $5,000

INN $5,000-$9,999

El $10,000 or more

I

95-percent

confidence limit for

estimated role

Vision decreasefrom Treatment needed- Under care for

eye pathology not received for eye eye pathology

pathology

Fkwre 11. Prevalence rates (age-adjusted) for eye pathology, eye conditions causing decrease in vision, eye conditions needing but not receiving

;edical treatment, and eye conditions for which care is being received among persons 1-74 years of age, by annual family income United

States, 1971-72

for such pathology were observed to decrease consistently with increasing income from 84.8 per 1,000

population among those in families with annual

income under $5,000 to 58.0 in those with income

$10,000 or more. This trend for ages 1-74 years as well

as for adults was consistent among males and females.

Treatment needs

The need for treatment of eye pathology was also

observed to decrease consistently with increase in size

of family income. The age-adjusted rates ranged from

41.3 per 1,000 population ages 1–74 years among those

in families with income less than $5,000 to 27.4 per

1,000 in the $lO,OOO-and-overbracket (table 9).

Among adults ages 18–74 years in the population

with eye pathology, the proportion needing medical

treatment was observed to decrease from 50.5 per

1,000 among those in the lowest income bracket

(under $5,000) to 30.3 per 1,000 among those with

annual income of$10,000 or more.

Under care

The proportion receiving treatment for eye pathology was observed to show a direct association with

income. The age-adjusted prevalence rates for those

under care ranged from 26.1 per 1,000 population ages

1–74 years with income under $5,000 to 40.6 per 1,000

among those in the $10,000 and over bracket (table

lo).

The age-adjusted proportion under care for eye

pathology among those determined to be in need of or

receiving such care was observed to increase from 39

percent among the population 1–74 years of age in the

lowest income level group to 60 percent among those

with annual family income of $10,000 or more.

Education

Vision decrease

Eye pathology causing

among adults 18–74 years

decrease in visual acuity

was observed to show a

17
consistent decrease in prevalence

of education. The age-adjusted

151.0 per 1,000 population with

with increasing level

rates declined- from

less than 5 years of

formal schooling to 44.5 per 1,000 population with 13

years or more, a trend consistent among men and

women (table 11).

Treatment needs

The extent of need for treatment of eye pathology

also was observed to be inversely related to the

education level of adults. The age-adjusted prevalence

rates of need for medical care of eye conditions

decreased from 71.4 per 1,000 adults 18–74 years with

less than 5 years of schooling to a minimum of 17.8 per

1,000 among those with 13 years or more education.

In relation to the extent of eye pathology for which

treatment was needed, the age-adjusted proportion was

observed to decrease from 15 percent among adults

with the least education (less than 5 years) to 5 percent

among those with some college education (13 years or

more).

Under care

The proportion of the adult population receiving

care for eye pathology was observed to be somewhat

greater among those with less than 5 years of formal

schooling than among those with more education. The

respective age-adjusted rates were 46.1 per 1,000

population compared with 30.3 and 33.7.

Among all adults receiving or needing treatment

for eye pathology, the proportion being treated was

observed to increase consistently with education from

39 percent among those with less than 5 years of

completed education to 65 percent with 13 years or

more of education.

Comparison with previous studies

National prevalence estimates for eye pathology

based on findings from the three previous National

Health Examination Surveys of 1960-62 among adults

18-79 years of age, of 1963-65 among children 6-11

years of age, and 1966-70 among youths 12–17 years

of age have been published. ‘2-14

The initial National Health Examination Survey

among adults in 1960-62 included a funduscopic

examination performed by the survey physician with

an ophthalmoscope during the physical examination.

The prevalence of eye pathology as determined for

U.S. adults 18-74 years of age in 1960-62, when

standardized with the 1971–72 U.S. population distribution, was approximately 35 percent, compared with

the prevalence rate of 48 percent among this age range

in the 1971-72 national study (NHANES). The higher

rates in the more recent study were expected because

t:he eye examination was more comprehensive.

In the 1963–65 National Health Examination

Survey among children 6-11 years of age, the examination by the survey pediatrician was limited principally

to identification of tropias, phorias, and infectious

conditions affecting the lids or conjunctival. The

r,ssultant prevalence rate for eye pathology from the

1963–65 national study among children ages 6-11

years was 9 per 100, compared with the rate of21 per

100 from the 1971-72 NHANES. In the 1966-70

National Health Examination Survey among youths

12–17 years of age, the examination by the survey

pediatrician was more comprehensive than that given

the children in 1963–65, including an inspection of the

sclerae, pupils, and irides not done in the preceding

survey. However, the prevalence of eye pathology

among U.S. youths in 1966-70” was only 8 per 100,

compared with 24 per 100 in the 1971-72 NHANES.

Again, the higher rates from the more recent national

survey would be expected because the eye examination

was more comprehensive than those in 1963-70 among

children and youths.

The prevalence of selected types of eye pathology

was determined in 1973–75 among the still-living

members of the Frarningham (Ma.) study population,

who had been under investigation for coronary disease

riisk factors since 1948 and who were in 1973-7’5 ages

52–85 years.lsJG The eye examination given by ophthalmologists included diagnostic identification of

cataracts, diabetic retinopathy, macular degeneration,

and glaucoma. Among the Framingham group, the

prevalence rates found for senile cataract were 9.6

percent, for diabetic retinopathy 1.6 percent, for senile

macular degeneration 4.0 percent, and for open-angle

glaucoma 1.4 percent. For the comparable age group

(65-74 years) the prevalence of senile cataracts among

the Framingham study population were observed to be

only about one-third the size of the national estimates

from NHANES, the rates for diabetic retinopathy and

senile macular degeneration three times as large, and

the rate for open-angle glaucoma twice as large. These

differences may reflect the more thorough eye examination given the Framingham group and the somewhat

greater diagnostic precision used there. However,

except for the cataract group, the diiTerences did not

exceed the confidence limits for the national estimates

and hence could be due to sampling variability alone.

Information from the National Health Interview

Survey in 1974 on limitation of activity due to visual

impairments among the civilian noninstitutio]~alized

population has been published. 17These data collected

by household interview, although not really comparable with NHANES data for those with vision decrease

from eye pathology, show a similar pattern of association with income but not with region or sex.

18
References

lNational Center for Health Statistics Origin, program, and

operation of the U.S. National Health Survey. Vital and Health

Statzktics. Series l-No. 1. PHS Pub. No. 1000. Public Health

Service. Washington. U.S. Government Printing Office, Aug. 1963.

ZNational Center for Health Statistic Plan and initial program of

the Health Examination Survey. Vitai and IIealth S’tatz3tics.Series

l-No. 4. PHS Pub. No. 1000. Public Health Service. Washington.

U.S. Government Printing Office,July 1965.

JNational Center for Health Statistics Cycle I of the Health

Examination Survey Sample and response, United States,

1960-62. Vital and Ileahh Watzktics. Series 1l-No. 1. PHS Pub.

No. 1000. Public Health Service. Washington. U.S. Government

Printing Office, April 1964.

oNational Center for Health Statistics: Plan, operation, and

response results of a program of children’s examinations. Vital and

Health Statistics. Series l-No. 5. PHS Pub. No. 1000. Public

Health Service. Washington. U.S. Government Printing Office,

Oct. 1967.

sNational Center for Health Statistics: Plan and operation of a

Health Examination Survey of U.S. youths 12-17 years of age.

Vital and Health Statistics. Series l-No. 8. PHS Pub. No. 1000.

Public Health Service. Washington. U.S. Government Printing

Office, Sept. 1969.

bNational Center for Health Statistics: Plan and operation of the

Health and Nutrition Examination Survey, United States, 1971-73

(extended through June 1974). Vital and Health Statistics. Series 1-

Nos. 10a and 10b. DHEW Pub. No. (HSM) 73-1310. Health

Services and Mental Health Administration. Washington. U.S.

Government Printing Office, Feb. 1973.

TNational Center for Health Statistics A study of the effect of

remuneration upon response in the Health and Nutrition Examination Survey, United States. Vital and Health Statistics. Series 2-No.

67. DHEW Pub. No. (HRA) 76-1341. Health Resources Administration. Washington. U.S. Government Printing Office, Oct. 1975.

SNational Center for Health Statisti~ Eighth Revision International Class@ation of Dikeases, Adapted for Use in the United States.

PHS Pub. No. 1693. Public Health Service. Washington. U.S.

Government Printing Office, 1967

gNational Center for Health Statistics, J. Roberts and J. Ludford:

Monocular visual acuity of persons 4-74 years, United States,

1971-1972. Vital and Health Statistics. Series 1l-No. 201. DHEW

Pub. No. (HRA) 77-1646. Health Resources Administration.

Washington. U.S. Government Printing Office, Mar. 1977.

10Nation~ center for Health s~tistics, J. Ro&fis and M.

Rowland: Refraction status and motility defects of persons 4-74

years, United States, 1971–1972. Vital and Health Statistics. Series

1l-No. 206. DHEW Pub. No. (PHS) 78-1654. Public Health

Service. Washington. U.S. Government Printing Office, Aug. 1978.

1lF.W. Newel: OphthamoIogy, Principles and Concepts, 2d ed. St.

Louis. The C.V. Mosby Co., 1969.

lzNational Center for Health Statistics, J. Roberts and J. Cohrssen:

History and examination findings related to visual acuity among adults,

United States, 1960-1962. VitaIand HealthStatistics. Series 11-No. 28.

DHEW Pub. No. (HSM) 72-1057. Public Health Service. Wash@on.

U.S. Government Printing Office, Mar. 1968.

‘‘National Center for Health Statistics, J. Roberts: Eye examination

findings among children, United States. Vital and Health Statistics.

Series 11-No. 115. PHS Pub. No. 1000. Health Services and Mental

Health Administration. Washington. U.S. Government Printing Office,

June 1972.

locational Center for Health Statistics, J. Roberts: Eye examination findings among youths aged 12-17 years, United States. Vital

and Health Statistics. Series 1l-No. 155. DHEW Pub. No. (I-IRA)

76-1637. Health Resources Administration. Washington. U.S.

Government Printing Office, Nov. 1975.

15H.A. Kahn, H.M. L.eibowitz, J.M. Ganley, and others: The

Framingham eye study. I. Outline and major prevalence findings.

Am. J. Epidem. 106 (I): 17–32, 1977.

16H.M. Leibowitz, and others: The Framingham Eye Study

Monograph. Survey of Ophthaimoiogy. 24 (Supp.) May-June 1980.

Wational Center for Health Statistics, C. Wilder. Limitation of

activity due to chronic conditions, United States, 1974. Vital and

Health Statistics. Series 1O-NO. 111. DHEW Pub. No. (HR4) 77-

1537. Health Resources Administration. Washington. U.S. Government Printing Office, June 1977.

19
List of detailed tables

1. Prevalence rates and prevalence of eye conditions, number of

eye conditions per person, and persons with one or more types

of eye conditions among the population 1-74 years by age

and sex with standard errors: United States, 1971 -72 . . . . . . .

2. Prevalence rates of eye conditions by part of the eye affected

among the population ages 1-74 years according to age and

sex with standard errors: United States, 1971 -72 . . . . . . . . . . .

3. Prevalence rate for the more prevalent types of eye conditions

by type and part of the eye affected (NEI classification) among

the population ages 1-74 years according to age and sex with

standard errors: United States, 1971 -72 . . . . . . . . . . . . . . . . . . .

4. Prevalence rates for principal types of eye conditions (lCDA–

8th revision classifications) among the population ages 1-74

years with standard errors: United States, 1971 -72 . . . . . . . . .

5. Prevalence rates for principal types of eye conditions (lCDA—

8th revision classifications) —all eye conditions, conditions

causing decrease in vision, conditions needing but not

receiving medical care and conditions under medical care

among the population ages 1-74 years with standard errors:

United States, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Prevalence rates for eye conditions causing decrease in

vision, needing (but not receiving) medical treatment and

under medical care among the population ages 1-74 years by

21 algeand sex with standard errors: United States, 1971 -72...

7. Mean intraocular pressure, standard error of the mean and

percent distribution of adults ages 20-74 years in the population by age, sex, and race United States, 1971 -72 . . . . . . . . .

22 8. Prevalence rates of eye pathology (actual and standardized)

9.

23

24 10.

11.

25

causing vision decrease among the population 1-74 years by

race, geographic region, population size, and income, with

selected standard errors United States, 1971-72 . . . . . . . . . .

Prevalence rates of eye pathology (actual and standardized]

needhg but not under medjcal treatment among the population 1-74 years by race, geographic region, population size,

and income, with selected standard errors: United States,

‘1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prevalence rates of eye pathology (actual and standardized)

under medical care among the population 1-74 years by

race, geographic region, population size, and income with

:selected standard errors United States, 1971-72 . . . . . . . . . .

Prevalence rates (actual and standardized) of eye pathology

causing decrease in vision, eye conditions needing medical

‘treatment, and those under medical care for eye conditions

among adults 18-74 years of age by education level, with

standard errors: United States, 1971 -72 . . . . . . . . . . . . . . . . . . .

26

27

28

28

29

29

20
Table 1. Prevalence rates and prevalence of eye conditions, number of eye conditions per person, and persons with one or more types of eye conditions among the population

1-74 years by age and sex with standard errors: United States, 1971-72

Number of

Age at examination

eye conditions and sex All ages, 1-5 8-11 12-17 18-24 25-34 35-44 45-54 55-84 85-74

1-74 years years years years years years years years years years

Both sexes

Persons with one or more eye conditions ......................................................................

All eye condtions .................................................................................................................

Eye conditions per person:

None ...................................................................................................................................

1 ..........................................................................................................................................

2 ..........................................................................................................................................

3 or more ..........................................................................................................................

Males

Males with one or more eye conditions .........................................................................

AH eye conditions .................................................................................................................

Eye conditions per person:

None ...................................................................................................................................

1 ..........................................................................................................................................

2 ..........................................................................................................................................

3 or more ..........................................................................................................................

Females

Females with one or more eye condtions .....................................................................

All eye conditions .................................................................................................................

Eye conditions per person

None ...................................................................................................................................

1... .......................................................................................................................................

2 ..........................................................................................................................................

3 or more ..........................................................................................................................

Persons with one or more eye conditions

Both sexes ............................................................................................................................

Males ......................................................................................................................................

Females ..................................................................................................................................

Persons with one or more eye conditions

Both sexes ............................................................................................................................

Males ......................................................................................................................................

Females ..................................................................................................................................

Rate per 1,000 population

243 292 320 386

327 393 440 578

381

677

624

215

87

74

389

679

619

227

82

72

374

675

628

204

92

76

73,448

36,331

37,117

12.1

15.3

13.3

105

129

890

93

13

4

103

125

894

91

13

2

107

134

888

95

13

4

1,778

889

889

14.5

19.9

18.2

215

257

792

169

31

8

232

255

779

189

29

3

197

259

804

149

33

14

5,345

2,927

2,418

1:::

14.0

571

1,030

647

1,430

854

2,303

763 710 688 631

178 213 218 232

41 59 71 102

18 18 23 35

427

316

144

113

351

276

157

216

141

231

232

396

261 309 360 398

334 406 481 630

744 695 648 628

203 227 254 222

42 60 79 99

11 18 19 51

590

994

640

1,544

855

2,355

411

355

123

111

358

252

150

240

149

228

220

403

225 276 283 376

321 381 404 527

555

1,063

653

1,330

853

2,263

781 723 724 633

153 200 186 242

41 58 63 104

25 19 27 21

Population estimate in thousands

6,031 6,318 8,237 9,341

3,271 3,259 4,338 4,698

2,760 3,059 3,899 4,643

Standard errors of rates

11.2 13.5 23.3 28.1

15.0 17.8 35.0 37.4

12.5 13.8 21.0 36.8

443

281

164

112

134

233

241

392

347

298

162

193

13,454

6,674

6,780

12,071

5,592

6,479

10,873

4,683

6,190

34.8

46.2

45.6

38.8

50.4

49.2

51.0

67.4

67.0
hl

N Table 2. Prevalence rates of eye conditions by part of the eye affected among the population ages 1-74 years according to age and sex with standard errors United States, 1971-72

Age 2 at examination

Site of eye condition

Sex

All ages,

and NEI1 code All ages, 1-5 6-11 12-17 18-24 25-34 35-44 45-54 55-64 65-74

1–74 years years years years

Male Female both sexes

years years years years years years

Amblyopia ....................................................

Refractive mechanism ..............................

Orbit .............................................................

Lids ..............................................................

Lacrimal apparatus ....................................

Conjunctival .................................................

Eyeball .........................................................

Cornea .........................................................

Sclera ...........................................................

Anterior chamber .......................................

Uveal tract ..................................................

Iris, pupil .....................................................

Choroid ........................................................

Lens .............................................................

Vitreous .......................................................

Retina ..........................................................

Optic newe .................................................

Neuromuscular system .............................

Site not s~ecified ......................................

25

61 5

62 3

63 71

64 ‘o

65 29

66 2

67 111

68 4

69 14

70 7

71 38

73 35

74 117

75 17

76 126

77 13

78 57

99 2

6

●_

*3

35

14

‘o

8

*1

●1

13

●5

15

●2

27

20

*2

*_

47

—

18

—

38

●4

●3

●1

27

●4

12

*3

20

11

46

Rate per 1,000 population

16 23 30 32

11 ‘4 ●2 6

‘2 *1 *3 6

37 55 50 64

—

28 26- 34 32

*o ●o 1’

36 68 88 114

*o *5 ●2 ●3

‘4 13 7 10

‘4 ●4 11 6

41 30 29 28

7 10 19 50

27 52 47 62

*1 *5 ●3 13

43 47 57 100

8 12 10 13

59 36 46 34

‘3 - ●o ‘2

41

8

‘4

99

28

9

174

‘1

27

17

39

70

171

23

223

10

76

8

27

●2

6

123

32

●5

249

10

22

10

63

77

317

41

302

28

114

*3

19 17 32

‘3 ●3 6

6 4 3

193 80 63

●3 *o ●o

55 35 22

*5 ‘4 ●o

338 128 96

12 4 4

70 11 18

15 8 7

103 43 34

118 34 36

603 110 123

102 16 18

533 126 126

29 10 16

94 46 67

●2 ●o ‘4

Standard error

2.4

0.6

0.4

4.2

●

2.6

0.3

5.2

0.6

2.2

1.2

3.7

3.4

5.4

1.6

5.9

2.0

3.3

0.3

lNEl is the National Eye Institute, National Institutes of Health, U.S. Department of Health and Human %’ViCeS.

2A~e.S~eCifiC detai[ sho~n only to indicate trends with age, although most of the estimates do not meet NCHS standard for reliability and Precision.
Table 3. Prevalence rate for the more prevalent types of eye conditions by type and part of the eye affected (NEI classification) among the population ages 1-74 years according to

age and sex with standard errors United States, 1971–72

Site and type of eye condition

Age t at examination Sex

and NEI1 code All ages, 1-5 6-11 12-17 18-24 25-34

All ages,

35-44 45-54 55-64 65-74

1-74 years years years years years years

Male Female both sexes

years years years years

Lid

Blepharitis .....................................................

Angioma, fibroma .........................................

Elastosis ............................................7...........

Absent lashes, etc. .....................................

Conjunctival

Dilation, etc. .................................................

Conjunctivitis .................................................

Cornea

Disease, erosion ..........................................

Corneal guttata ............................................

Ptwygium .....................................................7

opacity, healed ............................................

Iris, pupil

Pupillary membrane .....................................

Anisocoria .....................................................

Choroid

Drusen ...........................................................

Cataract, other3 ...........................................

Opacity ..........................................................

Vitreous

Floater, opacity ............................................

Retina

Retinal vascular change .............................

6320

6353

6360

6399

6500

6520

6700

6766

6772

6789

7113

7180

7363

7460

7489

7564

7600

Macular degeneration ................................. 7670,7672

Pigment changes ......................................... 7694,7695

Neuromuscular system

Esotropia ....................................................... 7862

Exotropia, acquired ...................................... 7864

Hypeflropia .................................................... 7866

Rate per 1,000 population

24

14

6

6

6

13

14

14

16

34

8

10

30

34

57

8

84

13

12

13

21

6

13

●2

6

‘2

11

*1

‘3

8

*I

‘1

*3

9

‘4

16

●5

●2

26

6

*2

14

●5

28

8

10

‘3

●3

●1

13

6

24

8

●2—

16

8

*2

●5

20

8

16

16

6

●3

‘2

8

●4

18

‘3

10

17

27

‘5

28

6

8

*3

12

6

‘3

40

12

10

7

●3

13

●5

28

11

12

12

*3

31

8

●o

*o

7

12

15

●3

20

34

9

10

14

‘2

20

*2

28

*3

12

6

22

●4

22

21

‘o

‘4

10

12

13

16

18

33

●3

6

41

8

32

7

64

11

13

*5

20

‘3

24

25

‘3

8

6

15

24

25

31

51

7

9

63

26

92

14

161

19

13

E

6

25

27

21

15

12

6

30

37

46

45

●3

23

72

100

173

18

221

30

13

14

39

20

37

34

52

12

10

16

36

78

38

65

*4

26

99

285

286

42

364

85

28

6

36

10

29

15

8

6

8

16

13

11

25

47

7

13

27

31

49

7

82

15

12

8

19

4

20

14

4

6

3

12

15

17

8

21

10

8

32

36

64

9

88

12

11

2

6

Standard error

2.3

2.1

0.9

0.9

0.8

2.0

2.1

2.1

1.5

3.3

1.2

1.6

2.7

3.2

3.3

1.2

4.5

2.2

2.0

2.0

2.3

0.9

INEI is the National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services.

2Age.specific detail shown on[y to indicate trenda with age, although most of the estimates do not meet NCHS standard for reliability and Precision.

Sother than congenital or traumatic.
M

s Table 4. Prevalence rates for principal types of eye conditions (lCDA—8th revision classifications) among the population ages 1-74 years with standard errors

United States, 1971 J72

Age at examination Sex

Eye condition and ICDA code All ages, 1-5 6-11 12-17 18–24

All ages,

25-34 35-44 45-54 55-64 65-74

1-74 years

Male Female

years years years years

both sexes

years years years years years

190,224,227,238

270,272

285

350,358

360-369

360

361

362

363

366-369

370-379

370

371

372

373

374

375

376

377

378

379

440

692,701

744

781

802,870,921,930,997

25 *2

2 —

*o

●1

56 30

13 12

26 15

*1 ●1

2 *1

13 *1

454 65

5 *o

35 *3

16

41 23

94 *4

6

‘1 —

78 12

171 22

6

85 9

6 11

10 11

7 *2

5 *1

Rate per 1,000 population

Neoplasms ........................

Metabolic diseases ..........

Diseases of blood

(anemia) ..........................

Diseases of nerves,

peripheral ganglia ..........

Inflammatory diseases of

eye ...................................

Conjunctivitis .................

Blepharitis .....................

Hordeolum ....................

Keratitis .........................

Other, various parts

of eye ..........................

Other diseases and

conditions of eye ..........

Refractive error ............

Corneal opacity ............

Pterygium ......................

Strabismus ....................

Cataract .........................

Glaucoma ......................

Detachment retina .......

Other, retina optic

nerve ...........................

Other, other parts of

eye ...............................

Other neuromuscular

conditions and

blindness .....................

Diseases of circulatory

system

(arteriosclerosis) .............

Diseases of skin and

subcutaneous tissue .......

Congenital eye

anomalies ........................

Symptoms referable to

nervous system, sense

organs ..............................

Accidents ...........................

NOTE Age-specific detail shown only to indicete trends with age, although most of the estimates do not meet NCHS standard for reliability and precision.

9

48

14

30

*2

‘3

167

*2

26

36

6

*I

37

58

13

●2

8

*3

●3

17

‘4

—

47

20

20

*2

●1

●4

218

11

17

—

49

13

●1

—

45

79

●3

18

*2

13

*5

*3

16

●2

57

12

28

*3

‘3

11

265

*4

42

●3

27

24

8

54

102

*3

28

8

8

*3

●4

15

*1

*1

58

12

33

*o

●1

12

310

●5

34

20

34

28

*5

*1

71

112

●o

28

*o

10

8

6

38

*2

—

—

45

12

22

*o

*2

9

406

6

34

18

29

41

6

121

150

●1

64

*4

7

7

2

40

8

—

67

15

24

—

*2

26

732

8

52

31

46

122

14

*2

176

258

13

161

8

7

10

6

40

●1

‘2

64

7

28

●o

*5

24

1,058

*2

49

46

78

276

12

*4

196

374

21

221

16

11

14

‘5

64

7

*o

‘3

101

16

42

7

*4

32

1,714

“3

70

41

53

576

49

7

302

592

21

364

12

13

7

6

28

1

*o

63

16

32

*1

‘1

13

455

4

50

25

31

84

5

‘1

74

173

8

82

7

11

6

7

22

3

‘o

‘1

49

10

21

‘1

3

13

453

6

22

8

50

103

8

●1

82

169

4

88

6

8

7

3

Standard error

2.6

0.3

●

●

3.3

1.9

2.4

*

0.7

1.2

6.1

1.0

3.4

1.6

3.4

4.5

1.1

●

4.5

3.2

1.1

4.3

1.1

1.3

1.1

1.0
Table 5. Prevalence rates for principal types of eye conditions (lCDA-8th revision classifications)-all eye conditions, conditions causing decrease in

vision, conditions needing but not receiving medical care andcondtions under medical care among the population ages l-74 years with standard

errors United States, 1971-72

Eye condition and ICDA code All eye Decreasing vision Needing care Receiving care All eye

conditions conditions

Neoplasms . . . . . . . . . . . . . . . . . . . 190,224,227,238

Metabolic conditions . . . . . . . . . . . . . . . . . . 270,272

Blood condition (anemia) . . . . . . . . . . . . . . . . . . . 285

Diseases of nerves . . . . . . . . . . . . . . . . . . . . . 350,358

Inflammatory diseases . . . . . . . . . . . . . . . . . 360-367

Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360

Blepharitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361

Hordeolum . . . . . . . . . . . . . . . . . . . . . . . . . . ...362

Keratitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...363

Other, uveal tract . . . . . . . . . . . . . . . . . . . . . ...366

Other, retina . . . . . . . . . . . . . . . . . . . . . . . . . ...367

Other, lacrimal system . . . . . . . . . . . . . . . . . . . 368

Other, other part of eye . . . . . . . . . . . . . . . . . . 369

Other eye conditions . . . . . . . . . . . . . . . . . . 370-379

Refractive errors . . . . . . . . . . . . . . . . . . . . . ...370

Corneal opacities . . . . . . . . . . . . . . . . . . . . . ...371

Pterygium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

Strabismus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...374

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . ...375

Detached retina . . . . . . . . . . . . . . . . . . . . . . ...376

Other, in retina . . . . . . . . . . . . . . . . . . . . . . . ...377

Other, in other parts of

eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378

Other neuromuscular

conditions and blindness . . . . . . . . . . . . . . . 379

Diseases of circulatory system

(arteriosclerotic changes) . . . . . . . . . . . . . . ...440

Diseases of skin (eyelids) . . . . . . . . . . . . . . 692,701

Congenital eye conditions . . . . . . . . . . . . . . . . . . 744

Symptoms —exophthaloma,

nystagmus, visual field

de fects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...781

Accidents, etc. . . . . . . . . . . . . . . . 802, 870, 921, 930

Rate per 1,000 population

25 *o ●2 ●1

*2 ●o

*o

‘1 ‘o ●o

56 *2 9 *3

13 *3 ●1

26 *o ●5 *1

●1 ●o *o

*2 *o *o *o

7 ●2 ●1 ‘o

*1 ●o

*o

●4 ●o *o

454 82 25 22

5 *o ●o ●o

35 ●2 ●1 *1

16 ●1 “2 ‘1

41 ‘7 ●3 *6

94 29 ●4 ●4

6 ‘3 4 *2

*1 ●1 ●o ●1

78 36 ‘6 ●4

171 *3 ‘4 ●2

6 ●o ‘0 ●o

Standard error

2.4

0.3

*

*

3.3

2.0

2.4

*

●

1.2

*

*

1.1

6.1

1.0

3.4

1.6

3.5

4.6

1.1

*

4.6

3.2

1.1

85 ●o ‘2 *2 4.4

6 ‘o 1.1

10 *1 o 0 1.4

7 ●2 *o *1 1.1

5 ●o *o ●o 1.1

NOTE Data included to show relative magnitude of the problem, although the estimates for most do not meet NCHS standards for reliability and precision.

25
Table 6. Prevalence rates for eye conditions causing decrease in vision, needing (but not recieving) medical treatment and under medical

care among the population ages 1–74 years by age and sex with standard errors United States, 1971-72

Eye conditions

Age and sex Causing vision Needing Under Causing vision Needing Under

decrease medical care medical care decrease medical care medicai care

Rate per 1,000 population Standard errors

AH ages, 1–74 ......................................... 73 34 36 47 4.2 47

1-5 years .................................................

6–11 years ...............................................

12-17 years .............................................

18-24 years .............................................

25-34 years .............................................

35-44 years .............................................

45-54 years .............................................

55-64 years .............................................

65–74 years .............................................

’11

28

28

30

40

57

89

151

364

’21

*16

●28

22

*31

23

44

54

98

*8

30

20

18

29

24

48

62

127

3.8

5.1

8.0

4.8

7.6

10.8

12.6

25.3

29.3

9.3

6.6

8.4

4.4

8.4

6.5

9.7

11.2

11.7

2,9

7,9

6,,6

4,,6

6,,3

8.8

12.6

17.8

10.8

Males, 1–74 years .................................. 66 34 31

Females, 1-74 years .............................

. . . . . .,, .

79 35 41 . . . . . . .,, .

1Does not include conditions receiving medical care.

26
Table 7. Mean intraocular pressure, standard error of the mean and percent distribution of adults ages 20-74 years in the population by age, sex, and race United States, 1971-72

All races White Black

Tonometry group and sex 20-74 20-24 25-44 45-64 65-74 20-74 .20-24 2544 45-64 65-74 20-74 20-24 25-44 45-64 65-74

years years years years yeare years years years years years years years years years years

Both sexes

All groups ..................................

Less than 10.0 mm Hg ..........

10.0-14.9 mm Hg.....................

15.0-19.9 mm Ha,....................

20.0 mm Hg or more ..............

Mean intraocular pressure in

mm Hg .....................................

Standard error ...........................

Sample examined .....................

Population in thousands ..........

Males

All groups ..................................

Less than 10.0 mm Hg ..........

10.0-14.9 mm Hg .....................

15.0-19.9 mm Hg .....................

20.0 mm Hg or more ..............

Mean intraocular pressure in

mm Hg .....................................

Standard error...........................

Sample examined .....................

Population in thousands ..........

Females

All groups ..................................

Less than 10.0 mm Hg ..........

10.0-14.9 mm Ha.....................

15.0-19.9 mm Ha.....................

20.0 mm Hg. and over ...........

Mean intraocular pressure in

mm Ha......................................

Standard error...........................

Sample examined .....................

Pomrlation in thousands ..........

Percent distribution

100.0 100.0 100.0

3.4 4.3

60.8 54.0 4::i

33.8 39.1 44.2

1.9 2.6 6.3

Summary statistics

14.2 14.4 15.0

2.63 2.34 3.13

538 1,844 1,086

14,721 42,706 38,024

Percent distribution

100.0 100.0 100.0

2.5 4.9 6.0

57.7 54.2 43.8

36.7 38.6 43.2

3.1 2.3 7.0

Summary statistics

14.4 14.3 15.0

4.14 2.71 3.65

163 547 531

6,922 20,782 18,240

Percent distribution

100.0 100.0 100.0

4.1 3.8 4.0

63.6 53.7 45.2

31.4 39.6 45.1

0.9 2.9 5.8

Summary statistics

13.9 14.4 15.0

1.93 2.42 3.00

375 1,297 557

7,799 21,925 19,784

100.0 100.0 100.0 100.0 100.0

2.4

36.5

48.8

10.3

15.8

2.73

1,649

12,453

100.0

3.0

42.0

46.9

8.1

15.5

2.77

813

5,409

100.0

2.0

35.8

50.3

11.9

16.1

3.09

836

7,044

100.0

4.2

49.7

41.4

4.6

14.7

2.44

4,732

106,745

100.0

4::

40.9

4.6

14,7

2.76

1,852

50,837

100.0

3.6

49.7

42.0

4.7

14.8

2.40

2,880

55,909

100.0 100.0

2.3 4.1

38.4 47.1

49.5 40.1

9.8 8.7

100.0

2.1

66.3

26.6

5.0

14.1

4.85

208

2,010

100.0

71.9

28.1

13.8

7.16

49

882

100.0

4.0

61.4

25.2

9.3

14.4

5.56

159

1,127

100.0

4.6

49.0

39.3

7.1

14.7

3.56

547

5,174

100.0

3.4

46.6

43.4

6.6

14.8

3.94

129

2,164

100.0

5.3

50.6

36.6

7.5

14.7

5.03

418

2,990

100.0

4.6

35.9

46.8

10.8

15.7

5.45

324

3,891

100.0

4.0

41.9

42.9

11.2

15.5

5.30

157

1,824

100.0

5.4

28.8

55.6

10.2

15.8

7.66

167

2,067

100.0

3.4

39.1

41.1

16.3

16.5

4.64

372

1,113

100.0

1.1

33.4

47.2

18.3

17.3

5.65

192

486

100.0

5.3

43.6

36.4

14.7

15.9

6.19

180

624

4.3

49.4

41.4

5.0

3.2

61.6

32.9

2.2

4.3

53.4

39.3

3.0

5.1

43.6

44.6

6.6

14.8

2.29

6,255

119,852

14.2

2.44

755

16,873

14.4

2.17

2,428

46,389

15.0

3.07

1,423

42,137

15.8 15.1

2.88 3.05

1,262 1,451

11,294 12,188

100.0

4.6

49.4

41.1

4.8

100.0

2.2

59.4

35.7

2.7

100.0

4.7

53.3

39.4

2.6

100.0

42:

43.4

7.3

100.0 100.0

3.2 2.8

42.8 48.2

46.9 40.8

7.2 8.2

14.7

2.57

2,412

56,720

14.4

3.86

215

7,886

14.4

2.53

690

23,290

15.0

3.50

694

20,135

15.4 15.1

2.65 3.36

611 527

4,893 5,378

100.0 100.0 100.0 100.0 100.0 100.0

1.6 5.1

35.1 46.2

51.5 39.5

11.7 9.2

3.9

49.3

41.7

5.1

4.1

63.6

30.5

1.9

3.9

53.4

39.3

3.4

4.5

43.7

45.8

6.0

14.8

2.28

3,843

63,132

14.0

1.96

540

8,987

14.4

2.35

1,738

25,099

15.0

3.01

729

22,022

16.1 15.0

3.31 3.69

651 924

6,401 6,808
Table 8. Prevalence rates of eye pathology (actual and standardized) causing vision decrease among the population 1-74 years by race,

—

aeoaraDhic reaion, DomJlation size, and income, with selected standard errors United States, 1971-72

Eye pathology causing vision decrease

Characteristic Actua/ rates

—

Standardized rates All ages,

Both sexes Males Females Both sexes Males Females both sexes

Race Rate per 1,000 population Standard error

All racesl ...................................................................... 73 66 79 4.7 —

White

. . . . . .

................ ........................................................ 72 64 80 71 62 “78 4.7

Black .......................................................................... 78 85 74 95 103 88 12.0

Geographic region

Notiheast ....................................................................... 75 58 91 72 57 85 10.0

Midwest ............................... . ...... . ...... . .... .............. 71 65 76 74 66 81 14.3

South ............................................................................. 92 94 91 90 92 87 8.3

West ............................................................................... 52 45 59 54 46 61 7.5

Urban-rural

All urban places .......................................................... 75 67 83 5.9

Rural areas ...................................................................

. . . . . .

68 63 72 69 62 “’” 76 7.3

Annual family income

Under $5,000 ............................................................... 124 139 113 85 114 170 9.7

$5.000.$9.999 .............................................................. 71 56 85 76 58 93 7.3

$10,000 and over ........................................................ 47 41 54 58 47 60 5.0

‘Includesotherracialgroups.

—

Table 9. Prevalence rates of eye pathology (actual and standardized) needing but not under medics/ treatment among the population 1=

years by race, geographic region, population size, and income, with selected standard errors United States, 1971-72 —

Eye pathology needing but not under medical care

Characteristic

—

Actual rates Standardized rates All ages,

Both sexes Males Females Both sexes Males Females both sexes

—

Race Rate per 1,000 population Standard error

All racesl ...................................................................... 34 34 35 . . . 4.2 “

White ......................................................................... 32 32 32 32 32 “i; 4.3

Black .......................................................................... 52 46 58 59 53 65 8.3

Geographic region

Nodheast ....................................................................... 30 25 35 30 25 34 4.9

Midwest ......................................................................... 34 34 34 35 35 35 13.2

South ............................................................................. 33 30 35 32 31 34 7.4

West ............................................................................... 39 46 33 40 47 35 5.5

Urban-rural

All urban places .......................................................... 40 37 42 . . 5.7

Rural areas ...................................................................

. . .

24 28 20 24 28 20 6.2

Annual family income

Under $5,000 ............................................................... 52 62 45 41 50 37 7.2

$5.000.$9.999 .............................................................. 32 30 35 34 28 38 5.3

$10,000 and over ........................................................ 27 27 28 27 27 29 5.6 —

‘includesotherracialgroups.

28
Table 10. Prevalence rates of eye pathology, (actual and standardized) under medical care among the population 1-74 years by race,

geographic region, population size, and income with selected standard errors United States, 1971-72

Eye pathology causing vision decrease

Characteristic Actual rates Standardized rates A//ages,

Both sexes Males Females Both sexes Males Females both sexes

Race Rate per 1,000 population Standard error

All races’ ...................................................................... 36 31 41 4.7

White .........................................................................

. . . . . .

38 33 44 38 33 43 4.9

Black .......................................................................... 20 16 24 25 20 29 5.8

Geographic region

NoRheast ....................................................................... 36 29 42 35 28 40 6.4

Midwest ......................................................................... 34 34 34 35 34 36 14.4

South ............................................................................. 42 33 51 41 32 49 6.3

West ............................................................................... 33 28 38 34 29 38 6.5

Urban-rural

All urban pIaces .......................................................... 41 35 46 6.7

Rural areas ...................................................................

. . . . . .

28 23 33 28 22 33 4.3

Annual family income

Under $5,000 ............................................................... 36 29 42 26 18 29 7.2

$5.000.$9.999 .............................................................. 35 32 36 36 34 40 5.0

$10,000 and over ........................................................ 36 31 41 41 33 48 6.4

llncludes other racial groups.

Table 11. Prevalence rates (actual and standardized) of eye pathology causing decrease in vision, eye conditions needing medical treatment, and

those under medical care for eye conditions among adults 16-74 years of age by education level, with standard errors United States, 1971-72

Eye pathology causing vision decrease

Eye condition status and

years of schooling completed Actual rates Standardized rates All ages,

Both sexes Males Females Both sexes Males Females both sexes

Condition(s) causing vision decrease

Education:

Less than 5 years .......................................................

5-8 years ......................................................................

9-12 years ....................................................................

13 years or more ........................................................

Condition(s) needing medical treatment

Education:

Less than 5 years .......................................................

5-8 years ......................................................................

9-12 years ....................................................................

13 years or more ........................................................

Condition(s) under medical care

Education:

Less than 5 years .......................................................

5-8 years ......................................................................

9-12 years ....................................................................

13 years or more ........................................................

Rate per 1,000 population

306 308 304 151 155 148

179 175 183 84 86 82

81 71 89 65 55 73

58 54 63 44 45 44

152 175 124 71 93 48

56 55 57 38 40 36

37 34 39 28 24 32

26 26 25 18 19 17

72 81 61 46 37 52

55 39 71 33 32 35

39 35 42 30 25 35

44 33 59 34 26 43

Standard error

35.7

18.6

5.6

7.3

26.7

8.7

4.8

6.6

15.2

8.9

7.1

8.6

29
Appendixes

Contents

1. Statistical notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Survey design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nonresponse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Missing data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Small numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sampling and measurement error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tests of significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Examiner variability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. The ophthalmology examination and recording forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Examination prior todilatation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dilatation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Eye examination afterdilatation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmic diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Detailed ophthalmology examination recording form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Diagnosed eye conditionsbytype, site, and etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Eye pathology classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V. Demographic andsocioeconomic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofappendix figures

1. Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination

Survey, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofappendixtables

1. Percent distribution of nonresponse adjustment factors, National Health and Nutrition Examination Survey

(NHANES l). stands l.35. 1971.72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. Numberofexamineesandnumberand percentofexamineesnotgiveneye examination,byageatexamination, and

number not given eye examination by race and sex: NHANES,19-71-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Numberofexaminees and age-sex-adjusted proportionswith eyepathology, by ophthalmologistexaminer number:

NHANES, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Number ofexamineesand age-sex-adjusted proportion ofexamineeswitheye pathology, byexamination location:

NHANES, 1971-72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

31

31

32

33

33

33

34

34

37

37

37

38

38

39

48

63

68

39

33

34

35

36

30
Appendix 1. Statistical

notes

Survey design

The sampling design for the first National Health

and Nutrition Examination Survey (NHANES I),

conducted in 1971–74, was basically a three-stage

stratified, multistage probability sample of loose clusters of persons in land-based segments. The sample

was designed to be representative of the civilian

noninstitutionalized population 1–74 years of age of

the coterminous United States. Excluded from the

selection were persons residing in Alaska and Hawaii

and those within the coterminous United States who

were confined to institutions or residing on lands set

aside for use by American Indians. Successive elements

dealt with in the process of sampling were primary

sampling units (PSU’S), census enumeration districts

(ED’s), segments (clusters of households), households,

eligible persons, and finally sample persons.

The starting points in the first stage of this design

were the 1960 decennial census lists of addresses and

the nearly 1,900 PSU’S into which the entire United

States was divided. Each PSU was either a standard

metropolitan statistical area (SMSA), a single county,

or two or three contiguous counties. The PSU’S were

grouped into 357 strata as they were for use in the

1963–72 National Health Interview Surveys and subsequently collapsed into 40 superstrata for use in the

NHANES I.

Of the 40 superstrata, 15 contained single large

metropolitan areas of more than 2 million population.

Those 15 large metropolitan areas were selected for the

sample with certainty. The 25 noncertainty strata were

classified into 4 broad geographic regions of approximately equal population and cross-classified into 4

broad population density groups in each region. Then

a modified Goodman-Kish controlled selection technique was used to select 2 PSU’S from each of the 25

noncertainty superstrata with the probability of selection of a PSU proportionate to its 1960 population so

that proportionate representation of specified State

groups and rate of population change classes was

maintained in the sample. In this manner a total firststage sample of 65 PSU’S was selected. These 65

sample PSU’S, or stands, are the areas within which

samples of persons would be selected for examination

over the 3–year survey period.

To produce national estimates of the nutritional

status of the U.S. population at an earlier date, a

probability subsample of 35 of the 65 stands was

selected. This 35–stand subsample also made it possible to produce national estimates of certain other

aspects of health status in the population that were

critically needed at an earlier date and estimates of the

findings for examination components that for logistic

reasons could not be continued for the remainder of

the 65 stands. Included among the 35 stands were 10

of the 15 large “certainty” metropolitan areas and 1

stand from each of the 25 “noncertainty” superstrata.

The reduction from 15 to 10 large metropolitan areas

was accomplished by randomly selecting one stand

from multiple-stand standard metropolitan statistical

areas (SMSA’S), e.g., selecting the southern half of the

Chicago SMSA to represent the entire SMSA. (This

selection procedure was based on operational considerations, and although unbiased, is recognized as not

behg statistically optimal.) It is this subsample of 35

stands upon which the findings contained in this report

are based.

Although the 1970 census data were used as the

frame for selecting the sample within PSU’S when they

became available, the calendar of operations required

that 1960 census data be used for the 35–stand sample

of NHANES. Census enumeration districts in each

PSU were divided into segments of an expected six

housing units each. In urban EDs the segments were

clusters of six addresses from the 1960 census listing

books. For ED’s not having usable addresses, area

sampling was employed, and consequently some variation in the segment size occurred. To make the sample

representative of the then-current population of the

United States, the address or list segments were

supplemented by a sample of housing units that had

been constructed since 1960.

Within each PSU a systematic sample of segments

31
was selected. The ED’s that fell into the sample were

coded into one of two economic classes. The first class,

identified as the “poverty stratum,” was composed of

“current poverty areas” that had been identified by the

U.S. Bureau of the Census in 1970 (pre–1 970 census),

plus other ED’s in the PSU with a mean annual

income of less than $3,000 in 1959 (based on the 1960

census). The second economic class, the “nonpoverty

stratum,” included all ED’s not designated as belonging to the poverty stratum.

All sample segments classified as being in the

poverty stratum were retained in the sample. For those

sample segments in nonpoverty-stratum ED’s, the

selected segments were divided into eight random

subgroups, and one of the subgroups was chosen to

remain in the NHANES sample. This procedure

permitted a separate analysis with adequate reliability

of those classified as being below the poverty level and

those classified as being above the poverty level.

After identification of the sample segments, a list

of all current addresses within the segment boundaries

was made, and the households were interviewed to

determine the age and sex of each household member,

as well as other demographic and socioeconomic

information required for the survey.

For selection of persons in sample segments to be

examined in the National Health and Nutrition Examination Survey, all household members 1–74 years of

age in each segment were listed on a sample selection

worksheet, with each household in the segment listed

serially. The number of household members in each of

the six age-sex groups shown below was listed on the

worksheet under the appropriate age-sex group column. The sample selection worksheets then were put

in segment number order and a systematic random

sample of persons in each age-sex group was selected

to be examined using the following sample rates:

Age in years Rate

The persons selected in the 35–stand sample of the

Health and Nutrition Examination Survey comprised

a representative sample of the target population and

included 14,147 sample persons 1–74 years of age, of

whom 10,126, or 71.6 percent, were examined. When

adjustments are made for differential sampling for

high-risk groups, the response rate becomes 72.8

percent.

All data presented in this report are based on

weighted observations; that is, data recorded for each

sample person are inflated to characterize the subuniverse from which that sample person was drawn. The

weight for each examined person is a product of the

reciprocal of the probability of selecting the person, an

adjustment for nonresponse cases (i.e., persons not

examined), and a poststratified ratio adjustment that

increases precision by bringing survey results into

closer alignment with known U.S. population figures.

A more detailed description of the survey design

andl selection technique can be found in “Plan and

operation of the Health and Nutrition Examination

Survey, United States, 1971-1973,” Vital and Health

Statistics, Series 1, No. 10a.G

Ncmresponse

In any health examination survey, after the sample

is identified and the sample persons are requested to

participate in the examination, the survey meets one of

its more severe problems. Usually a sizable number of

sample persons will not participate in the examination.

Whether an individual participates is determined by

many factors, some of which are uncontrollable and

therefore may reasonably be treated as an outcome of a

random event with a particular probability of occurrence. In this situation the effect of nonparticipation

would be only to reduce the sample size, thereby

increasing the sampling errors of examination findings.

In practice, however, a potential for bias due to

nonresponse exists if participation is not random event

ancl if nonparticipants ditTer from participants. Because of the possibility of bias intensive efforts are

made in the National Health and Nutrition Examination Survey to develop and implement procedures and

inducements that would reduce the number of nonrespondents and thereby reduce the potential of bias due

to nonresponse. These procedures and inducements are

discussed in “Plan and operation of the Health and

Nutrition Examination Survey,” Series 1, No. 10a.G

Despite these intensive efforts, 27.2 percent of the

sample persons from the first 35 stands were not

examined. Consequently, the potential for a sizable

bias does exist in the estimates in this publication.

From what is known about the nonrespondents and

the nature of nonresponse, it is believed that the

likelihood of sizable bias is small. For instance, only a

small proportion of persons gave reasons for nonparticipation that would lead to the belief that they would

never agree to participate in examination surveys and

that they might have differed from examined persons

with respect to the characteristics under examination.

Only 15 percent of the nonrespondents gave as their

reasons for nonparticipation ‘Lpersonal illness,” “physically unable,” “pregnant,” “antidoctor,” or “feZLrof

finding something wrong.” Typical among the reasons

given by the other nonrespondents were “unable

because of work, school, or household duties”; “suspicious” or skeptical of the program”; “just not interestNOTE: A list of references follows the text.

32
ed in participating”; and “private medical care

sufficient” or “just visited doctor.”

An analysis of medical history data obtained for

most nonexaminees as well as examinees also supports

the belief that the likelihood of sizable bias due to

nonresponse is small. No large differences were found

between the examined group and the nonexamined

group in the statistics compared. For example, 11

percent of persons examined reported having an illness

or condition that interfered with their eating as

compared with 9 percent of persons who were not

examined but who had completed a medical history.

The proportion of persons examined who reported

ever being told by a doctor that they had arthritis was

20 percen~ the proportion for high blood pressure was

18 percent and for diabetes, 4 percent. The corresponding proportions for nonexamined persons were

17 percent for arthritis, 21 percent for high blood

pressure, and 4 percent for diabetes.

As mentioned earlier, the data in this report are

based on weighted observations, and one of the

components of the weight assigned to an examined

person was an adjustment for nonresponse. A procedure was adopted that multiplied the reciprocal of the

probability of selection of sample persons by a factor

that brought estimates based only on examined persons up to a level that would have been achieved if all

sample persons had been examined. This nonresponse

adjustment factor is the ratio of the sum of sampling

weights for all sample persons within a relatively

homogeneous class defined by age, sex, and poverty

status to the sum of sampling weights for all responding sample persons within the same homogeneous

class. To the degree that homogeneous groups that are

also homogeneous with respect to the characteristics

under study can be defined, the procedure can be

effective in reducing the potential bias from nonresponse.

For the 35-stand sample of the National Health

and Nutrition Examination Survey, persons were

grouped into 20 age-sex-poverty status groups within

each stand, yielding 700 separate cells with an average

membership of about 20 sample persons each. These

adjustment factors were distributed among examined

persons as shown in table I.

Table 1. Percent distribution of non response adjustment factors,

National Health and Nutrition Examination Survev (NHANES D.

. .

stands 1-35, 1971-72

. .

Size of factor Percenr

distribution

Total ........................................................................ 100.0

l. 00.1.24 ................................................................ 38.4

1.25-1 .49 ................................................................ 31.6

1.50-1 .74 ................................................................ 12.9

1.75-1 .99 ................................................................ 8.4

2.00.2.49 ................................................................ 6.1

2.5&2.99 ................................................................ 1.2

3.004.03 ................................................................ 1.4

Missing data

Examination surveys are subject to the loss of

information not only through the failure to examine all

sample persons but also from the failure to complete

all examination components and to record the various

items of information needed for each of those who

come to the examining units.

The extent of missing data for the eye examination

ranged from 1.9 percent for those 18–24 years and

45–54 years to 3.6 percent of those 3544 years of age

(table II).

More data are missing among males than among

females (4 percent compared with 1 percent) and more

among nonwhites than among whites (5 percent

compared with less than 2 percent). Only among

nonwhite males ages 35-44 years and 25–34 years is

the loss sufficient to make the estimates for these

groups substantially less reliable than for the others. In

those two age groups, 32 percent and 20 percent,

respectively, of the eye examinations for nonwhite

males were not completed.

No imputation was made to replace missing eye

examination data. The assumption has been made here

that the distribution by age, sex, race, and other

variables of these findings relating to eye pathology

among persons with missing data is similar to that

among those who were examined.

Small numbers

In some tables, magnitudes are shown for cells for

which the sample sizes are so small that the sampling

errors may be several times as great as the statistics

themselves. In such instances the numbers, if shown,

have been included to convey an impression of the

overall story of the table.

Sampling and measurement error

This report has referred to efforts to minimize bias

and variability of examination methods and measurement techniques. The potential of residual bias due to

the high nonresponse rate has also been discussed.

The probability design of the survey makes possible the calculation of sampling errors. Traditionally

the role of the sampling error has been the determination of how imprecise the results of a survey may be

because they come from the measurement of a sample

rather than all elements in the universe.

The estimation of sampling errors for a study of

the type of the National Health and Nutrition Examination Survey is difficult for at least three reasons: (1)

Measurement error and “pure” sampling error are

confounded in the data—it is not easy to find a

33
Table Il. Number of examinees and number and percent of examinees not given eye examination, by age at examination, and number not

given eye examination by race and sex: lNational Health and Nutrition Examination Survey, 1971-72

Examination status, sex, and race

Age at examination

Al/ages, 1-5 6-11 12-17 18-24 25-34 35-44 45-54 55-65 (55-74

1–74 years years years years years years years yeara years years

Number

All examinees ............................................... 10,126 1,489 1,061 1,045 1,015 1,259 1,170 793 630 1,653

Examinees not given eye examination . 248 38 25 25 20 31 42 15 14 38

Percent

Examinees not given eye examination .... 2.4 2.6 2.3 2.4 1.9 2.4 3.6 1.9 2.2 2.3

Number

Male ............................................................ 171 22 16 15 15 24 30 10 8 31

Female ....................................................... 77 16 9 10 5 7 12 5 6 7

White ............................................................... 115 19 14 12 9 8 12 10 7 24

Male ............................................................ 85 12 10 8 7 7 11 6 4 20

Female .......... ................................ ........... 30 7 4 4 2 1 1 4 3 4

Black ............................................................... 133 19 11 13 11 23 30 5 7

Male ............................................................

14

86 10 6 7 8 17 19 4 4 11

Female ....................................................... 47 9 5 6 3 6 11 1 3 3

procedure that will either completely include both or

treat oneorthe other separately; (2)the survey design

and estimation procedures are complex and, accordingly, require computationally involved techniques for

the calculation of variances; and (3) hundreds of

statistics are presented in the tables in this report,

many for subclasses of the population for which there

were small numbers of sample cases. Estimates of

sampling error are obtained from the sample data and

are themselves subject to sampling error, which may

be large when the number of cases in a cell is small or,

occasionally, when the number of cases is substantial.

Estimates of the standard errors for selected

statistics used in this report are presented in the

detailed tables. These estimates have been prepared by

a replication technique that yields overall variabilityy

through observation of variability among random

subsamples of the total sample. The standard error is

primarily a measure of sampling variability, that is, of

the variations that might occur by chance because only

a sample of the population has been surveyed. As

calculated for this report, the standard error also

reflects part of the variation that arises in the measurement process. It does not include estimates of any

biases that might exist in the data, The chances are

about 68 out of 100 that an estimate from the sample

would differ from a complete census by less than the

standard error. The chances are about 95 out of 100

that the difference would be less than twice the

standard error and about 99 out of 100 that it would be

less than 2 1/2 times as large.

Tests of significance

The procedure used in this report for testing the

significance of the difference between two rates or

percents consisted of dividing the difference between

the two rates by the standard error of the differenc~

that is, a z statistic was computed. An approxim~ation

of the standard error of a difference d = x — y alftwo

statistics (rates, percents or other) x and y is given by

the formula

in which S%and Sy are the sampling errors respectively, of x and y. If the two groups or measures are

positively or negatively correlated, the formula gives

an overestimate or underestimate, respectively, c~fthe

actual standard error. A 95–percent confidence limit

has been used in the text, i.e., z = d/& < 1.96.

Patterns of dtierences or consistent trends in which

the differences are not large enough to be statistically

significant are referred to as “observed.”

Examiner variability

Supervised examinations and testing with ~some

measurement replication were done by the senior

ophthalmologists from NEI at 24 of the 35 examination locations for approximately 2.5 percent of the

9,878 persons given the complete eye examination.

This close supervision of the actual examination was

done at the first two sessions at each of the 24

examination locations.

Additional training in the ophthalmology examination protocol had been given each ophthalmologist

before the survey examinations were started. In additiom, the senior ophthalmologists reviewed the methods used and the findings recorded by the 96 oph,thalmalogists employed during the survey. After completion of this part of the NHANES survey, there was a

complete review of the findings and diagnoses of eye

conditions under protocol established by Dr. Ganley

and others at NEI.

34
The number of examinees per ophthalmologist

examiner ranged from 3 to 50, with 30 percent

examining fewer than 50 persons, 29 percent 50-99

persons, 31 percent 100-199 persons, and 8 percent

200 persons or more. Variation would be expected

among examiners in the proportion of their examinees

found to have significant eye pathology because of

differences in age-sex distribution among the groups

examined, area differences, hereditary differences, the

extent and type of environmental exposure that may

affect the eyes, and other factors. So the extent of

examiner variability and the effect that it may have

had on the findings from this ophthalmology examination may be assessed, the effect of age-sex d~erences in

the groups examined by each ophthalmologist has been

controlled through a direct adjustment method. In this

method the age-sex specific rates for each examiner

have been applied against the number of persons in

that age-sex group for the total population and the agesex adiusted rate recomputed.

Among

proportions

persons e;amined, the age-sex adjusted

found to have significant eye pathology

range from 6.6 to 83.5 percent per examiner, with onefourth of the ophthalmologists finding 27.4 percent or

fewer of the examinees to have such pathology, onehalf finding between 27.4 and 48.0 percent and the

remaining one-fourth finding 48.0 percent or more

with significant eye pathology (table III).

A further assessment of examination location

differences that may affect the prevalence of eye

pathology as determined in this study shows that the

number of examinees given the eye component ranged

from 112 to 539 per stand. The age-sex adjusted

prevalence rates for significant eye pathology ranged

from 18.8 percent to 63.0 percent among the 35

examination locations. In one-fourth of the locations,

32.1 percent or fewer of the examinees were found to

have significant eye pathology, one-half showed between 32.1 and 43.6 percent, and the remaining onefourth 43.6 percent or more (table IV).

These tables show very large variations in eye

pathology rates by examiner and examination location,

reflecting both variation in the occurrence of such

conditions in the population and examiner variability

that cannot be separated in the data available.

Table IIl. Number of examinees and age-sex-adjusted proportions with eye pathology, by ophthalmologist examiner number

NHANES, 1971-72

Examiner number Eye pathology rate Number Examiner number Eye pathology rate Number of

per 1,000 persons examinees par 1,000 persons examinees

All examiners .............................

1 ................................................

2 ................................................

3 ................................................

4 ................................................

5 ................................................

6 ................................................

7 ................................................

8 ................................................

9 ................................................

10 ................................................

11 ................................................

12 ................................................

13 ................................................

14 ................................................

15 ................................................

16 ................................................

17 ................................................

18 ................................................

19 ................................................

20 ................................................

21 ................................................

22 ................................................

24 ................................................

25 ................................................

27 ................................................

28 ................................................

29 ................................................

31 ................................................

32 ................................................

33 ................................................

34 ................................................

35 ................................................

381.1

401.6

512.6

275.4

572.7

341.2

388.0

114.6

297.6

240.0

449.1

273.8

414.5

263.2

173.2

361.7

353.0

316.3

267.8

324.9

235.4

169.2

571.9

278.5

254.2

114.2

284.6

187.6

722.3

290.2

351.8

109.4

112.1

485.8

617.9

566.4

9,879

272

36

62

39

32

154

79

75

85

88

12

29

30

24

98

22

44

52

37

36

50

34

41

26

42

31

174

42

77

81

11

15

137

19

127

36 ................................................

37 ................................................

38 ................................................

39 ................................................

40 ................................................

41 ................................................

42 ................................................

43 ................................................

44 ................................................

45 ................................................

46 ................................................

47 ................................................

48 ................................................

49., ..............................................

50 ................................................

51 ................................................

52 ................................................

53 ................................................

54 ................................................

55 ................................................

56 ................................................

57 ................................................

58 ................................................

59 ................................................

60 ................................................

61 ................................................

62 ................................................

63 ................................................

64 ................................................

65 ................................................

66 ................................................

67 ................................................

68 ................................................

69 ................................................

70 ................................................

71 ................................................

72 ................................................

293.9

419.7

284.0

208.0

271.1

290.5

323.6

238.6

448.2

620.1

492.5

661.7

474.0

451.2

509.4

285.5

427.8

369.9

574.1

312.8

588.4

367.0

461.3

800.6

537.0

338.0

475.2

491.6

316.7

286.4

649.9

324.7

376.0

304.8

66.3

365.7

320.0

221

85

98

131

147

90

115

48

200

95

69

38

74

78

107

140

152

124

118

106

128

157

188

194 .

147

163

119

101

129

507

324

193

150

42

5

134

138

35
Table Ill. Number of examinees and age-sex-adjusted proportions with eye pathology, by ophthalmologist examiner numbec

NHANES, 1971-72-Con.

Examiner number Eye pathology rate Number

per 1,000 persons examinees Examiner number Eye pathology rate Number of

per 1,000 persons examinees

73 ................................................

79 ................................................

80 ................................................

415.7

345.9

222.6

380.1

452.0

509.7

301.2

265.8

835.2

320.2

630.0

217.1

76

103

35

407

98

67

78

134

96

112

78

80

548.5

233.0

550.1

325.0

802.8

252.2

300.8

346.8

204.9

455.7

477.7

326.2

279

23

66

38

43

59

35

52

3

63

160

431

Table IV. Number of examinees and age-sex-adjusted proportion of

examinees with eye pathalogy, by examination location: NHANES,

1971-72

Examination location number Eye pathology Number of

rate per 1,000 examinees

381.1

413.6

387.8

263.0

301.5

390.8

280.9

351.2

187.6

386.1

315.3

490.3

293.9

319.5

306.3

267.1

447.6

533.1

515.4

414.9

476.5

354.4

472.5

395.6

435.7

342.2

649.9

315.7

380.7

424.0

254.2

384.9

404.2

346.8

548.5

474.7

9,879

270

179

165

218

303

395

243

174

316

241

112

221

187

216

368

199

352

264

415

476

249

539

230

429

363

324

259

218

245

247

406

272

275

279

230

36
Appendix IL The

ophthalmology examination

and recording forms

Examination prior to dilatation

Ocular history.—The ophthalmologist examiner

asked each exarninee whether the examinee had ever

had problems (excluding refraction) or diseases of the

for which he or she had seen a physician, and eye

specialist, or an optometrist and, if so, what the

problem was (figure I).

Pupils.—The presence of anisocoria was recorded,

along with the measurement in millimeters of the

diameter of the pupils in both eyes if their diameters

differed by more than 1 mm.

The absence of direct light reflex was determined

in a normally lighted room by the examiner directing

the beam of a Finoff ocular transilluminator directly

into the examinee’s eyes from a distance of approximately 3 inches and observing pupillary contraction

while the examinee was fixating at distance. The

examiner determined the absence of consensual light

reflex by observing the pupillary response in the

unstimulated eye.

Lids.—The examination of the lids was done by

gross examination, using a Finoff hand illuminator in a

fully illuminated room, followed by slit lamp evaluation of the lid margins under low magnification.

Globe.—For suspected conditions of exophthalmos, the actual Hertel measurements and the base

used were recorded for later review. For suspected

conditions of microthalmus, the horizontal corneal

diameter from external limbus to external limbus was

measured for later review.

Conjunctiva.—The conjunctival were examined by

gross inspection under the low magnification of the slit

lamp.

Cornea.—The cornea was screened under the low

magnification of the slit lamp; abnormalities found

were then examined under higher power.

Anterior chamber.—The anterior chamber was

examined for flare with the small dot of light from the

slit lamp directed toward the pupil at about a 60°

angle.

Iris.—The iris was examined under the lower

power of the Zeiss microscope. The examiner evaluated evidence of atrophy of the iris by directing the

light beam through the pupil into the posterior

chamber and looking for transmission of light through

the iris tissue. Gonioscopy was used to confirm

conditions of peripheral anterior synechiae when

suspected.

Tonometry.-Applanation tonometry was performed on all individuals ages 2CP74 years. When it

was necessary to hold the lids open for tonometry

because of lid-squeezing reflex or when the upper lid

rested on the tonometer with any degree of pressure

during the measurement, the test was recorded as

unsatisfactory because either may artificially elevate

intraocular pressure to give a falsely high reading.

The Goldman applanation tonometer used for this

procedure was mounted on a Zeiss slit lamp. Intraocular pressure measurements were made soon after the

installation of 0.1 percent fluorescingin the eyes. Three

readings, obtained under magnification of 8-1 OX, were

taken in each eye consecutively starting with the right.

The tonometer was repositioned for each reading after

the measuring scale had been turned to 10 mm Hg.

The slit illuminating aperture was opened fully and

positioned at about a 60° angle to the slit lamp with

the prism in contact with the cornea. The position was

corrected so that the two semicircles were of equal si~e

and in the middle of the field of view. The measuring

drum in the tonometer then was turned until the inner

borders of the two fluorescingrings just touched each

other (the midpoint of each pulsation of the eye); the

pressure from the drum was recorded to the nearest

mm Hg.

Dilatation

Before dilatation the examinee was asked about

symptoms compatible with attacks of acute narrowangle glaucoma including transient blurring of vision

associated with ocular pain or frontal headaches.

37
The examinee checked the depth of the anterior

chamber before dilatation by directing the slit beam of

the illuminator at about 60° toward the anterior

chamber just inside the lumbus. If the separation was

slitlike, or less than one-fourth the corneal width,

gonioscopy was used to rule out the possibility of angle

closure or symptoms suggestive of angle closure. The

angle at the narrowest area in each eye was recorded

for further review.

Dilatation was not done if the angle of closure was

found to be 10° or narrower in any area. Dilatation for

all other examinees was done with a solution of 1

percent mydriacyl unless the person was 50 years of

age or younger, was hyperopic without corrective

lenses and would be driving immediately after the

examination. For this latter group a solution of 10

percent phenylephrine was used.

Twenty to 70 minutes after dilatation, the examinee was returned to the ophthalmologist for the remainder of the eye examination. The examiner then

recorded whether the dilatation at that point was

adequate for the fundus evaluation.

Eye examination after dilatation

Lens.—The crystalline lens was evaluated with the

slit lamp and then with a direct ophthalmoscope (+10

lens). Only opacities observed by both instruments

were recorded unless there was evidence of nuclear

sclerosis (decreased lucency of the nucleus recorded as

nuclear opacity) on the slit lamp evaluation.

Retina. —Goldman or Hruby lenses were used in

the examination of the fundus only if pathology was

suspected. The indirect ophthalmoscope was not used

for routine examination of the examinee because

dilatation was not uniformly adequate for evaluation

of the periphal retina and because the examiners were

not equally proficient in the use of the instrument.

Ophthalmic diagnosis

The ophthalmologists recorded their diagnostic

findings as abnormal if any physiologic or pathologic

changes were found during the course of the eye

examination. Not classified as abnormal were findings

limited to refractive error, phoria, arcus senilis, benign

melanosis, concretions, pingueculum, inclusions. or

follicles. If a refractive error was associated with

other ocular pathology, such as myopia, Fuchs’ spot,

or peripheral retinal degeneration, the finding was

classed as abnormal.

Diagnostic entities were recorded under this section rather than under the checklist of findings on

which the diagnosis was based as shown in the detail of

the eye examination. If the physiologic or pathologic

changes found in the eye were not part of a more

general diagnosis, they were listed in the diagnostic

section. If the lens, cornea, extraocular muscles,, etc.,

had become involved in the diabetic process, in

addition to the diagnosis of diabetic retinopathy, those

related conditions would also be listed separately as

cataract secondary to diabetes mellitus, iris neovascularization secondary to diabetes mellitus, etc. Refractive error associated with other ocular pathology, such

as myopia and Fuchs’ spots or peripheral retinal

degeneration would have been shown as the appropriate diagnostic entity of degenerative, pathologic, progressive, or malignant myopia. Etiology identification

was included on the diagnoses wherever possible.

Amblyopia was diagnosed if vision could not be

corrected to 20/30 or better and resulted from a

strabismic or anisometropic condition (the difference

in refractive error between the two eyes) but not if the

loss of vision was due to other causes.

Up to 11 diagnoses were recorded for each

examinee with abnormal eye pathology. The most

serious conditions—those that needed treatment and

those that caused decrease in visual acuity–-were

listed first.

For each diagnostic entity the examiner indicated

whether the condition contributed to transient or

permanent decrease in distance vision (any vision

worse than 20/20 in the involved eye). The examiner

also indicated for each diagnosis whether treatment

was needed but not being received, treatment was

needed and was being received, or treatment was not

needed.

Conditions were considered as needing treatment if

the examiner concluded during the examination that

treatment should be provided. For example, an examinee with narrow angles would not be considered to

require treatment, while one with occluded angles

would. An adult with divergent strabismus would not

be considered to require treatment even though cosmetic surgery might be beneficial. An examinee with

cataracts and 20/40 vision would not be deemed in

need of surgery, whereas one with cataracts and

201\200 vision would likely be evaluated as needing

treatment.

38
Detailed ophthalmology examination

recording form

1~$1~ IPAcE11 Form Approved

!Cv. 5/71 O.M.B. No. 62-R 1184

DEPARTMENT OF HEALTH, EDuCATION, ANO WELFARE

PUSLIC HEALTH SERVICE ASSURANCE OF CONFIDENTIALITY

HCALTH SERVICES AND MCNTAL HCALTH AoMINISTRATloN

NATIONAL CENTER FOR HEALTH STATISTICS

All info”intstierrwhich would permit

HEALTH AND NUTRITION EXAMINATION SURVEY

identification of theindividual will

be held strictly ccmfidential, will be

used only by persons engazed in

and for the purposes of the survey,

●nd will not be disclosed or relessed

OPHTHALMOLOGY - DETAILED EXAM to others for any other purposes

(22 FR 1687).

z. Deck No. b. Sample No. c. Sex d. Age ●. Examiner No. f. Name of examiner

162 __. ––

t ❑ Male

2 ❑ Female —— ——

I

A. SIGNIFICANT OCULAR HISTORY ~ @ lUYes

I 20N0

1. Surgery - ❑ Strabismus ❑ Cataract i @ ------

2. Other - ❑ Iniury ❑ Infection i@------

3. Other - Specify w------

I

I

I

I

B. VISUAL ACUITY I

l. Optotype used, . . . . . . . . . . . . . . . . . 1. ~ @ I ❑ Snellen

I

I

2D Ill. E

I

2. Acuity cc OD 2. ~ (@- —

0s ,0~m7 *__

sc OD : @*--

0s ~ @iil*--

3. If not 20/20, pinhole (Acuity) . . . . . . . . 3. /

OD ! @l*--

KTo be. entered by coder

0s ~ @iiJ*__

I

I

C. MOTILITY

l. Tropia . . . . . . . . . . . . . .. . . . . . . . . .

:

1. I @ IDESO 2 ❑ Exo 3 ❑ Neither

: @ I ❑ Hyper

i

2 ❑ Not hyper

~,_o014 I ❑ Comitant 2 ❑ Incomitant

-----------------------------------------

2. Phoria . . . . . . . . . . . . . . . . . . . . . . . 2.1 @ IOESO 2 ❑ Exo 3 ❑ Neither

~ @ t ~ Hyper 2 ❑ Not hyper

------------------------------------------

3. Nystegmus . . . . . . . . . . . . . . . . . . . . 3. \ @ I ❑ Pendular 4 n Jerk-rotq

I

2 ❑ Jerk-horiz. 5 ❑ No nystagmus

/.

I

3 ❑ Jerk-vert.

Figure 1. Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971-72

39
1-

1

I

I

I

b

I

D. PUPILS I C)D 0s Ou

I

1. Anisocoria - location. . . . . . . . . , . . . 1. ~@ 1[3 20 3U

a. -(mm) . . . . . . . . . . . . . . . . . . a.! ——

2. Absent Ii ght reflex

I

a. Direct . . . . . . . . . . . . . . . . . . . 2a. l@ 1[~ 2= 3D

b. Consensual . . . . . . . . . . . . . . . . b.@ 1[~ zl_J 30

I

3. Other – Specify I

3. I@ 1[3 20 30

4. No abnormal icy . . . . . . . . . . . . . . ...4. / 1 [3 20 30

I

E. TONOMETRY - Three readings

—

Applanation

I

OD 0s

a.m. I

Time of test p.m. ~ @ _,_ o024 _ _

❑ Unsatisfactory test

(Code 99 in space 023) @-- 0026 _ _

‘o/027 _. _ o028 _ _

—

I

Anterior segment check prior to dilatation.

-

~ @ 1 ~ NOt dilated:

—

F. DILATATION

(I gtt. 10% Phenylephrine OU)

a Suspicious anterior chamber

❑ History of angle closure

❑ Unable to instill gtts.

I

I 2 ❑ Mydriasis inadequate for fund us copy

I

3 n Di Iatation adequate I

H. MAXILLARY SINUS TRANSILLUMINATION !

l. Right . . . . . . . . . . . . . . . . . . . . . . 1. ~ @ l13Normal 2~Dull 3 ❑ Opaque

2. Left . . . . . . . . . . . . . . . . . . . . . . . 2. ~ @ I ❑ Normal 20 DuII 3 ❑ Opaque

I

NOTES

Figure L Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971-72-Con.

40
. REFRACTION Eye Sphere Cylinder Axis VA PH

@ cwJ O& OXIJ (IWJ

1. Present glasses OD 10+ 10+

2D - ——.—— D 2u - __, __EI ___”

040J 041J C@ 043J 044J

0s 10+ 10+

2a- __. __D 2n - __. ——D ———

0

O&J C14t5J 047J 048J 049J 050J 051J

2. If acuity less than OD 10+ 10+

20/40, retinoscopy 2!7J - __. _— D 2u - __. __D _——” c*—— c.*__

I152J 053J 054J 055J 05ifJ 057J Ox?J

0s 10+ 10+ — .

*To be entered by coder

o

2n - __. __D 2a- __. ——D ——— c*—— c*__

1. LIDS 0s Ou

l. Blepharitis . . . . . . . . . . . . . . . . . . . . . . . . 1. :@l: Zn 3U

a. Angular . . . . . . . . . . . . . . . . . . . . . . . . a.~@ll_J ZU SU

2. Chalazion . . . . . . . . . . . . . . . . . . . . . . . . . 2.~@ln 20 30

3. Concretions . . . . . . . . . . . . . . . . . . . . . . . 3. @ln 20 SD

4. Ectropion . . . . . . . . . . . . . . . . . . . . . . ...4. ~@ln 21-J ,~

5. Entropion . . . . . . . . . . . . . . . . . . . . . . . . . 5./@l~ 20 30

6. Hordeolum . . . . . . . . . . . . . . . . . . . . . . . . 6.@l D 20 30

7. Ptosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.~@la 20 30

I

8. Other – Specity I

/

8.@lD 2D 30

9. No abnormal icy . . . . . . . . . . . . . . . . . . . . . 9.@ln 20 30

(. GLOBE I

OD 0s Ou

I

l. Enucleation . . . . . . . . . . . . . . . . . . . . . . . l.~@l c-J 2CI 3D

2. Exophthalmos . . . . . . . . . . . . . . . . . . . . . . 2.: @l-J 20 3CI

I

a. Measurement . . . . . . . . . . . . . . . . . . .

a. I

I

b. Base . . . . . . . . . . . . . . . . . . . . . . . . b. :

I

3. Microphthalmos . . . . . . . . . . . . . . . . . . . . . 3.~@ln 2 !-J Sm

I

a. Measurement (mm) . . . . . . . . . . . . . . .

a, I

4. Other–Specify

4.:@l D 2 L:] 30 I

5. No abnormality . . . . . . . . . . . . . . . . . . . . . 5.~@lD 20 3n

I

Figure 1. Detailed ophthalmology examination coding sheet National Health and Nutrition Examination Survey, 1971-72-Con.

41
1 —

I

-- CONJUNCTIVA OD 0s Ou

I

l. Bitot’s spot . . . . . . . . . . . . . . . . . . . l.l@ln 20 30

2. Conjunctivitis

I

a. Allergic . . . . . . . . . . . . . . . . . ~a.~@ln 20 30

b. Follicular . . . . . . . . . . . . . . . . bj @10 ZU 30

c. in factious . . . . . . . . . . . . . . . . .

.o~@ln 20 30

(1) Bacterial – SpecifyF

I

I

I

I

(l)! @ la

I

(2) Viral – Specify7 I

I

(2)1 @ In 2U 3n

I

3. Follicles (no inflammation). . , . . . . . . . 3’. ~@l c-J 20 30

4. inclusions . . . . . . . . . . . . . . . . . ...4. !@IO ZU 3D

5. Pingueculum . . . . . . . . . . . . . . . . . . . 5’. @ln 20 30

6. Xerosis . . . . . . . . . . . . . . . . . . . ...6. @lD z~ 3~

7. Other – Specify

I

I

7.!@ln 2D 3D

8. No abnormal icy . . . . . . . . . . . . . . . . . a.@ln 20 30

d. SCLERA

—

OD 0s Ou

l. Ectasia . . . . . . . . . . . . . . . . . . . . . . l.i@ln 20 3D

2. Episcleriti s . . . . . . . . . . . . . . . . . . . 2.~@l(g 20 3D

I

3. Scleritis . . . . . . . . . . . . . . . . . . . . . 3.~@ln 20 30

4. Other – Specify

I

I

4.~@lD zn 30

5. No abnormal icy . . . . . . . . . . . . . . . . . 5.~@lD Zu 30

I

JOTES

-—

—

Figure L Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971 -72—Con.

i32
4. CORNEA I OD 0s Ou

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Arcussenilis . . . . . . . . . . . . . . . . . . l.po 2U

Band keratopathy . . . . . . . . . . . . . . . 2.~@la 2D

Degenerate on - Specify

I

3.! @ID z=

Dystrophy – Specify_

I

I

Edema

4.~@llg

—

a. Epithelial . . . . . . . . . . . . . . . . 5a.~ @l 1 ❑

b. Stromal, . . . . . . . . . . . . . . . . b.@~~

Endothelial KP’s . . . . . . . . . . . . . . . 6.@lD

Guttata . . . . . . . . . . . . . . . . . . . . . . 7. @lo

Keratitis - Specify 1

8.:@) ll_J

I

Keratomalacia . . . . . . . . . . . . . . . . . 9.; (@la

I

Krukenberg spindle . . . . . . . . . . . . . . lo.~@la

I

Opacity - Specify I

11. ~@lm 20

0. Superficial stromal . . . . . , . . . . . . ..~@l~ 2~

Pterygium . . . . . . . . . . . . . . . . . . . . 12. @lcl 20

I

Vessels – Specify i

1

13. @ln 20

Other - Specify

I

I

14. @Jln 20

No abnormal icy . . . . . . . . . . . . . . . . . 15. \@la

~ (@ 1 ❑ Location s;o~

30

30

30

30

30

30

3D

3C

30

30

30

30

3U

3n

3CI

3D

3@

i ‘Do‘so Diagram location of abnormalities . . . . 16. ~

O. ANTERIOR CHAMBER

I

I 0“ 0s Ou

1. Cells . . . . . . . . . . . . . . . . . . . . . . . L~@ln Zn 30

2. Flare . . . . . . . . . . . . . . . . . . . . . . . 2.@l~ 20 3n

3. Other – Specify

[

I

3.~ijl~ 2C 3@

4. Noabnori,!ality . . . . . . . . . . . . . . . . . 4.l@ln 21-J 3EI

Figure 1. Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971-72-Con.

43
I

P. IRIS I OD 0s Ou

1. Synechiae

a. Anterior . . . . . . . . . . . . . . . . . . la.~@lD 2!7 30

I

b. Posterior . . . . . . . . . . . . . . . . . b.~@la 20 3U

2. Atrophy . . . . . . . . . . . . . . . . . . . ...2. i@lcl 2~ ,~

3. Coloboma . . . . . . . . . . . . . . . . . . ...3. ~@trJ 2~ ,~

4. lritis . . . . . . . . . . . . . . . . . . . . . ...4. [ @ II-J 21’--J ,~

5. Neovascularization . . . . . . . . . . . . . . . 5. \ @ II-J ,~ ,~

6. Other-Specify I

& ~ @ In 2Q 30

7. No abnormality . . . . . . . . . . . . . . . . . 7. I @ In 20 30

~

Q. LENS

1. Aphakia . . . . . . . . . . . . . . . . . . . . . +2)1: 2: 3:

2. Cataract

a. immature . . . . . . . . . . . . . . . . 2a. \@ln 2U 3CI

b.lntumescent . . . . . . . . . . . . . . b.;@lU 20 3U

c. Mature . . . . . . . . . . . . . . . . . . ..\@ 10 20 30

d. Hypermature . . . . . . . . . . . . . . d.~@ln 20 30

e. Morgagnian . . . . . . . . . . . . . . . e.! @lD 21_J 3~

3. Opacity

a. Anterior polar . . . . . . . . . . . . . 3a.~@l~ 2D 30

b. Cortical . . . . . . . . . . . . . . . . b.@la 2D 30

c. Nuclear . . . . . . . . . . . . . . . . . ..~@ln ,~ ,~

d. Post subcapsular. . . . . . . . . . . d.@)ln 2D 31--J

I

4. Pigment on surface . . . . . . . . . . . . . . 4.;@l= 2U 30

I

5. Other - Specify I

5.\@l E3 20 3U

6. No abnormality . . . . . . . . . . . . . . . . . 6./@IU 20 30

1

R. VITREOUS I 0s Ou

l. Detachment . . . . . . . . . . . . . . . . . . . 1. & 2D 3D

2. Hemorrhage . . . . . . . . . . . . . . . . . . 2.@J1n 20 30

I

3. Opacity - Specify

I

3.~@lD 20 30

4. Other - Specify

I

I

4.~@lD 20 30

5. No abnormal icy . . . . . . . . . . . . . . . . . 5.~@ln 2U 30

I

Figure 1. Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971-72-Con.

44
00

la. @lo

@ IQ

(iiiJIQ

Drusen . . . . . . . . . . . . . . . . .

Glaucomatous cup . . . . . . . . .

Neovascularization . . . . . . . . .

Optic atrophy

(l) Primary . . . . . . . . . . .

(2) Secondary . . . . . . . . . .

Papilledema . . . . . . . . . . . . .

Papillitis. . . . . . . . . . . . . . .

Other – Specify

b.

e.

d(l)

(2)

e.

f.

(@In

(i@n

o144

0145

e.

f.

9*

•1

c1

9*

2. Macula

a.

b.

c.

d.

e.

f.

Degeneration

(l) Senile . . . . . . . . . . . .

(2) Disciform . . . . . . . . . .

(3) Circinate . . . . .

. . . . .

Diabetic involvement . . . . . . .

Edema . . . . . . . . . . . . . . . . .

Hypertensive involve . . . . . . .

Pigment epith. detach . . . . . . .

Other - Specify

2a(1)

(2)

(3)

b.

c.

d.

e.

f.

.3. Vessels

a. Arteries

(1)

(2)

(3)

(4)

b. Veins

(1)

(2)

(3)

(4)

(5)

(6)

Branch occlusion , . . . . 3a(1)

. . . . (2)

. . . . (3)

. . . . (4)

. . . . b(1)

. . . . (2)

Central occlusion .

Gen. narrow ( 14).

Sclerosis ( 1-4) . .

Branch occlusion .

Cerltral ucclusion .

Dilatation . . . . . . . . . . (3) mu

o162

0163

0)64

o165

Sausaging . . . . . . . . .

(4)

Sheathing . . . . . . . . . .

(5)

Tortuosi~ . . . . . . . . . (6)

•1

❑

•1

•1

c. Capillaries

(1) Microaneurysms . . . . . . c(1)

(2) Neovascularization. , . .

(2) (@n

d. Other - Specify

d.

Figure L Detailed ophthalmologyexamination coding sheet, National Health and Nutrition ExaminationSurvey, 1971-72-Con.

45
I

S. RETINA - Continued I

4. Exudates

o. Cotton wood . . . . . . . . . . . . . 4a. !@l:

b. Hard, . . . . . . . . . . . . . . . . . b. l@lcl

c. Waxy . . . . . . . . . . . . . . . . ..ea ~@L5

d. Other - Specify I

!5. Hemorrhages

~. pu

o. Choroidal . . . . . . . . . . . . ...5.. i@ln

b.preretinal . . . . . . . . . . . . . . b,, !@ ’In

c. Retina l. . . . . . . . . . . . . . . . .

(l) Deep . . . . . . . . . . . . . c(1) ~ @ ‘1❑

(2) Superficial . . . . . . . . . (2)\@’in

d. Other - Specify I

d. !@m

6. Pigment changes

a. Choroidal . . . . . . . . . . . . . . . 6a. f@l~

b. Epithelial

(l) Atrophy . . . . . . . . . . . . b(l) @jl U

(2) Hyperplasia . . . . . . . . . (2)~@lD

I

c. Other - Specify

I

7. Angioid streaks . . . . . . . . . . . . . . . 7. @l~

8. Detachment . . . . . . . . . . . . . . . . . . 8m @l~

9. Drusen . . . . . . . . . . . . . . . . . . ...9., @ln

10. Inflammation

a. Chorioretinitis - Specify 1

1

10!3. @i-jlm

(l) Active . . . . . . . . . . . . . . . . . (l)l@ln

(2)lnactive . . . . . . . . . . . . . . . .

(2)@lcl

11. Retrolental fibroplasia . . . . . . . . ...11. @lrJ

12. Other – Specify

I

12. @J1~

13. No abnormality . . . . . . . . . . . . . ...13. M@n

14. Not visual iced . . . . . . . . . . . . . ...14. @K2

Continue with item /5, Diagram location of

retinal abnormalities, on page 9. I

0s

2U

20

20

20

30

30

30

30

an

EID

SD

30

30

30

30

30

30

30

30

Figure L Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971-72-Con.

46
I

S. RETINA - Continued/

15. Diagram

Iocati on of

I @ 1 ❑ Location shown

retinal

I

abnormalities \

I OD 0s

I

1,

I

I

1

T. OPHTHALMIC I

DIAGNOSIS ~ (@ f ❑ Incomplete examination

2 ❑ No abnormality I

3 ❑ Abnormality I

Mark column applicable, leave blank if unknown

Code Condition Treatment Eye affected

decreases

Needed Uc::r Not

vision needed OD 0s Ou

g WJ lMJ 196

1. Amblyopia . . . . . . .

I ❑ Present

1 ❑ Yes

2DN0 In 2U 3@ 2H 1~ _ 3 (-’-J

2. @ W&J 199 200

1 l_J Yes

——— .—. 2DN0 lU 2D 30 10 Zn 3D

3. 201 202 2@3 204

1 m Yes

——— ——— 2DN0 In 2U 3U m 2r--J3CI

L

2(MJ 206J q g

1 ❑ Yes

——— ——. 2DN0 10 2G 3D 17 2C 3~

;. g 210J 211 212

1 n Yes

2DN0 ——— ——— ~u 2D 3n In 2C 3P

i. 213 214 y 216

I m Yes

——— ——— 2~No lU Zn 3D la 2B 3D

JOTES

Figure L Detailed ophthalmology examination coding sheet, National Health and Nutrition Examination Survey, 1971-72-Con,

47
Appendix Ill. Diagnosed

eye conditions by type,

site, and etiology

These prevalence data from the complete 6-digit N El medical care within broader groupings shown in the

Ophthalmic Disease Code adapted for N HAN ES 1 are findings and detailed tables of the report. They include

included solely to give some better idea of the extent to conditions identified in at least 10persons and all conditions

which the individual eye conditions were found and their causing vision decrease. needing (but not under) medical

severity as evidenced by vision decrease and need for cm-e and those under medical care.

Ophthalmic disease code

Number

of Total Causing Needing Under

examinees minor . .

with medical medical

o~~r d;~~;se

eye

care care

conditions

61 61 00

626000

626058

626200

630000

Rates per 1,000 population

Amblyopia (no code) 257 25.0 19.1 2.7 6.1

61. REFRACTIVE ERROR

Changes, myopic (central) (macular);

Conus, disc, myopic (atrophic) (choroidal) (chorioretinal) (peripapillary);

Myopia NOS

Myopia, simple;

Myopic changes (atrophic) (peripapillary) (temporal);

Myopic conus (atrophic (peripapillary) (temporal);

Myopic crescent (atrophic) (peripapillary) (temporal);

Myopic cup

Myopic disc (atrophic) (peripapillary) (temporal);

Myopic pigment atrophy, (choroid) (epitheliums);

Myopic thinning, pigment epitheliums;

Pigment crest (myopic)

62. ORBIT

Exophthalmos NOS

Exophthalmos, endocrin~

Exophthalmos, dysthyroid

Enophthalmos (senile)

63. EYELIDS

Blinking, infrequent

Disease, eyelid NOS;

Hypereievation, eyelid;

Keloid, eyelid (scar);

Mass, eyelid (soft) (subcutaneous);

Nodule, eyelid;

Papule, eyelid;

Pigment, eyelid (area) (lesion);

Scar, eyelid NOS

Swelling, eyelid NOS

42 4.6 0.2 0.3

17 1.4 0.3 0.0

2 0.1 0.1

6 0.9 0.2

23 2.5 0.3 0.0

48

..
Number

of Total Causing examinees minor . .

Needing Under

Ophthalmic disease code

w-th medical medical

eye

~~~r d~%;se care care

conditions

631900

632000

632019

632030

632057

6321 00

6321 19

632900

632968

633000

6331 00

633300

635000

635300

635600

636000

6361 00

636200

636400

636500

636700

Anomaly, congenital, eyelid, type specified NEQ

Distichiasi%

Epicanthus, in Mongolism (fold);

Epicanthus, absence of (fold);

Fold, epicanthal, in Mongolism;

Notch, eyelid, congenital

Blepharitis NOS (acute) (chronic) (subacute);

Granulated eyelid

Blepharitis, bacterial, organism specified NEC (acute) (chronic) (subacute);

Blepharitis, staphylococcal (acute) (chronic) (subacute)

Blepharitis, infective, organism not specified (acute) (chronic) (subacute)

Blepharitis, angular (acute) (chronic) (subacute)

Blepharitis, seborrheic (acute) (chronic) (marginal) (simple) (squamous)

(subacute)

Blepharitis, seborrheic, staphylococcal (acute) (chronic) (squamous)

(subacute)

Blephantis, sebaceous (acute) (chronic) (subacute);

Blepharitis, other specified type NEC

Acne rosacea blepharitiq

Blepharitis, acne rosacea

Hordeolum;

Stye

Chalezion

Meibomianitis

Growth, eyelid;

Tumor, eyelid NOS

Angioma, eyelid (benign);

Fibroma, eyelid (cutaneous

Hemangioma, eyelid (benign) (strawberry);

Mole, eyelid (benign) (epidermal) (pedunculated) (pigmented);

Nevus, eyelid (benign) (compound) (dermal) (intraderrnal) (margin)

(pigmented) (strawbeny);

Papilloma, eyelid (epidermal) (pigmented) (squamous);

Syringoma, eyelid (benign);

Tumor, eyelid, benign

Carcinoma, eyelid (basal cell) (squamous cellk

Tumor, eyelid, malignant

Blepharochalasis (senile);

Derrnochalasi~

DermatochalasiS

Elastosis, eyelid

Entropion NOS

Ectropion (senile)

Xanthelasma (eyelid)

Trichiasis NOS

~:n~did NOS (epidermal) (epithelial) (inclusion) (sebaceous) (Zeiss

Milia, Milium, eyelid

Rates per 1,000 population

2

204

2

1

16

20

1

2

1

12

38

3

4

151

8

97

5

20

25

12

51

0.1

22.2

0.0

0.3

1.5

2.0

0.0

0.1

0.0

1.2

3.8

0.1

0.5

14.2

0.6

5.9

0.3

1.0

1.9

1.1

3.8

0.1

0.0

0.1

.

.

0.0

4.2

0.0

0.3

0.2

0.6

0.0

0.1

0.0

0.3

0.7

0.0

0.5

0.5

0.3

0.1

0.2

0.1

0.6

0.0

0.7

0.0

0.1

0.5

0.5

0.0

0.0

0.1

0.0

0.0

49
Ophthalmic disease code

of ToM Causing examinees minor . .

Needing Under

with medioel medical

~t~~r d;;;;se

eye

care care

con-ditions

Rates per 1,000 population

639900

639970

640000

650000

650040

650044

652000

6520 10

Absent eyelashes (area) (complete) (partial) (self-induced);

Angioma, spider, eyelid;

Cilia, aberrant

Cafe au Iait spot (area), eyelid;

~sease, eyelid, type specified NEC;

Epicanthus (fold);

Fold, epicanthal;

Horn, cutaneous, eyelid;

Hypopigmentation, eyelid=

Keratosis, eyelid (sebaceous) (seborrheic) (senile);

Lagophthalmos (eyelid);

Moiluscum, eyelid (contagiosum) (pseudocarcinomatosum) (sebaceum);

Notch, eyelid;

Nevus, eyelid, spidec

Poliosis, eyelashes;

Retraction, eyelid;

Skin tag, eyelid;

Verruca, eyelid (plana) (vulgaris);

Wart, eyelid

Parkinsonism, eyelid manifestation of

64.

Dk3ease, lacrimal apparatus

Epiphor%

Tearing (excessive)

Disease, conjunctival NOS

LACRIMAL APPARATUS

NOS (nasolacrimal);

65. CONJUNCTIVAL

Dilation, Dilatation, conjunctival, vessel;

Dilation, Dilatation, conjunctival, capillaty (with venous stasis);

Gray conjunctiv~

Hyperemia, conjunctii~

Hyperplasia, conjunctival

Hemosiderin, conjunctival (pigmentation);

Hypertrophy, conjunctival, papilla~

Injection, conjunctival (due to upper respirator infection);

Mascara, follicles, conjunctival (embedded) (particles);

Micropools, conjunctiv~

Microaneutysm, conjunctive%

Pale, Pallor, conjunotiv%

Papillae, conjunctiv~

Tortuosity, conjunctival vessels

Vascularity, increased, conjunctive

Vessels, conjunctival (blood);

Vasodilation, conjunctival (red eyes);

Vascularization, conjunctival

Bleb, conjunctival, traumatic (filtering);

Trauma, conjunctival NEC or NOS

Adrenochrome granules, conjuncthq

Injection, conjunctival, pharmacologic

Conjunctivitis NOS (acute) (angular) (chronic) (follicular) (purulent)

(subacute);

Inflammation, conjunctival NOS (acute) (chronic) (subacute) --See also

Conjunctivitis

Conjunctivitis, bacterial, organism not specified (foilicular) (infection)

(infective) (acute) (chronic) (purulent) (subacute);

Infection, conjunctival, bacterial, organism not specified (acute) (chronic)

(purulent) (subacute);

Pink eye

73

1

5.5

0.0

0.0

46 5.0

1 0.4

2 0.3

61 5.4

8 0.8

0.1 0.2

0.0

0.0

0.2

0.1

0.7 0.2

0.6 0.0

50
Ophthalmic disease code

Number

of Total

examinees minor Causing Needing Under

with vision medical medical

o~~r decrease

eye

care care

conditions

Rates per 1,000 population

6520 19

652020

652030

652052

655300

656500

657200

658000

658098

6581 00

660000

6601 98

664498

666200

670000

Conjunctivitis, staphlococcal (acute) (chronic) (purulent) (subacute);

Conjunctivitis, bacterial, organism specified NEC (acute) (chronic) (purulent)

(subacute); infection, conjunctival, bacterial, organism specified NEC (acute)

(chronic) (purulent) (subacute)

Conjunctivitis, rickettsial, organism not specified (acute) (chronic) (infection)

(infective) (subacute);

Conjunctivitis, viral, type not specified (acute) (chronic) (follicular) (infection)

(infective) (subacute);

Infection, conjunctival, rickettsial, organism not specified (acute) (chronic)

(subacute);

Infection, conjunctival, viral, organism not specified (acute) (chronic)

(subacute)

Conjunctivitis, infective, organism not specified (follicular) (acute) (chronic)

(purulent) (subacute);

Infection, conjunctival, organism not specified (acute) (chronic) (purulent)

(subacute)

Allergy, conjunctival NOS

Allergy, conjunctival, other than that due to medicinal drops or ointment

(acute) (chronic) (follicular) (subacute) (vernal]

Catarrh, Iimbal vernal;

Conjunctivitis, due to hay fevev

Conjunctivitis, allergic, other than that due to medicinal drops or ointment

(acute) (chronic) (follicuiar) (subacute) (vernal);

Injection, conjunctiya, allergiq

Injection, conjunctival, due to hay fever

Hemangioma, conjunctival (benign);

Lipoma, conjunctival

Nevus, conjunctival (benign) (caruncie) (cystic) (junctional) (with melanosis)

(nonpigmented) (pigmented);

Tumor, conjunctival, Benign

Hemorrhage, subconjunctival

Pterygium (conjunctival)

Cyst, conjunctival (epithelial)

(mucous)

Cyst, postoperative

Scar, conjunctival

(fluid filled) (inclusion) (lymphatic) (Iymphoid)

66. EYEBALL

Asymmetry, one higher than other (facial);

Eye higher than other ey~

“Other” checked, not described, globe

Anophthalmos, surgical;

Absent eye, postoperative

Enucleatiom

Evisceration (eye)

Anophthalmos, surgical, following inju~

Absent eye, postoperative, following inju~

Evisceration (eye) follow”ng trauma

Enucleation following trauma

Phthisis (bulbi) NOS

67. CORNEA

Bullous area, cornea, endothelial;

Oisease, cornea NOS;

5

6

9

70

25

10

7

47

1

3

0.3

0.4

0.5

5.1

1.7

1.0

0.3

4.5

0.0

0.4

0.3

0.0

0.1

0.9

0.2

0.1

0.0

0.3

1.1

0.2

0.0

2 0.3 - 0.0

10 1.1 0.4 0.1

7 0.7 0.7

4 1.0 0.1 0.0

51
Number

of Total

examinees minor Causing Needing Under

Ophthalmic disease code with vision medical medical

~t~~r decrease

eye

care care

conditions

Rates per 1,000 population

670000

670001

670008

671900

672000

672019

673000

674045

674240

674249

674549

675000

676000

6761 00

676300

676500

676800

676800

6771 00

677200

677296

Descemet’s membrane, thickened;

Erosion, cornea (epithelial) (superficial);

Fold, Descemet’s membrane, cornea (linear);

Irregular surface, cornea

Membrane, retrocorneal;

Melanosis, cornea;

Pigment, cornea (area) (deposit) (Descemet’s) (dust) (endothelial) (epithelial)

(granules) (Iimbus) (posterior) (scattered). If recorded under Opacity, code

as Opaci@

Stain, Staining, cornea (punctate) (superficial);

Wrinkle, Descemet’s membrane

Defect, cornea, due to trichiasis (epithelial)

“Other” checked, not described, cornea

Anomaly, congenital, cornea, type specified NEQ

Embryotoxon, posterior, cornea (prominent Schwalbe’s line);

Megalocornea

Macrocorne@

Myelinated nerve fibers, cornea

Schwalbe’s line, prominent

Keratitis (acute) (chronic) (inactive) (interstitial) (punctate) (stromal)

(subacute) (superficial)

Infection, cornea, bacterial, organism specified NEC (acute) (chronic)

(subacute);

Keratitis, due to leprosy (interstitial);

Keratitis, bacterial, organism specified NEC (acute) (chronic) (punctate)

(subacute)

Ulcer, cornea NOS

Abrasion, cornea, due to contact lens (epithelia);

Edema, cornea, due to contact lens (epithelial);

Keratitis, punctate, due to contact lens

Foreign body, cornea NOS (intracorneal) (metallic)

Stain, Staining, cornea, due to foreign body

(stain, staining);

Foreign body, cornea, retained

Blood staining, cornea NOS

Tumor, cornea NOS

Dystrophy, cornea NOS

Keratopathy, band NOS

(intracorneal) (metallic)

Dystrophy, Fuch’s (cornea) (endothelial) (epithelial) (senile)

Dystrophy, cornea, stromal, (posterior);

Dystrophy, cornea, macular

Dystrophy, cornea, marginal

Cornea guttata (endothelial)

Degeneration, cornea, marginal (senile)

Degeneration, cornea, peripheral (senile)

Degeneration, cornea, Iimbal (Iipoidal)

Pterygium, cornea

Opacity, cornea, surgical, due to removal of pterygium;

Postoperative state, pterygium, cornea

140

1

13

17

29

1

1

3

5

11

1

1

2

13

3

3

2

214

26

214

6

12.5

0.0

1.3

1.1

1.8

0.0

0.1

0.5

0.4

1.2

0.0

0.0

0.1

1.9

0.1

0.2

0.3

14.0

2.5

15.4

0.6

0.5

0.0

0.3

0.0

0.1

0.2

0.1

0.2

0.1

0.0

0.4

0.6

0.0

0.2

0.0

0.2

0.0

0.1

0.1

0.0

0.0

0.3

0.2

0.1

0.1

0.3

0.0

0.0

0.2

0.4

0.2

1.3

52
Number

of ‘eta’ Causing Needing Under

Ophthalmic disease code examinees minor . .

with

medical medical

o~~r d~%.’.’e

eye

care care

conditions

677500

678000

6781 00

6781 40

678740

678843

678900

678901

678912

678940

678945

679900

679943

679945

682500

684240

6861 00

686200

Dry eye syndrome (dellen);

Degeneration, cornea, due to drying (dellen);

Degeneration, cornea, due to deficient tears (dellen)

Keratitis sicca NOS (punctate)

Krukenberg spindle

Pannu%

Vessels, cornea (blood) (deep) (Iimbal arcade) (superficial);

Vascularization, cornea

Pannus, traumatic

Opacity, cornea, due to foreign body (endothelial) (epithelial) (pigment)

(stromal) (superficial}

Opacity, cornea, metallic (like}

Rust lesion, pigmentation, ring, scar, or stain, cornea (stroma) (superficial)

Opacity, cornea, due to bum, acid (chemical) (endothelial) (epitheiial)

(pigment) (stromal) (superficial)

Opacity, cornea NOS (disciform) (endothelial) (epithelial) (Iimbus) (linear)

(microcysts, epithelial) (pigment) (stromal) (superficial);

Opaque cornea

Opacity, cornea, due to keratitis (exposure) (marginal) (stromal)

Opacity, cornea, due to old or healed ulcer

Opacity, cornea, due to syphillis (ghost vessels)

Opacity, cornea, due to trauma NEC or NOS (endothelial) (epithelial)

(lacerating) (Iimbus) (pigment) (stromal) (superficial)

Opacity, cornea, due to contact lens (epithelial) (punctate)

Bulls, cornea (epithelialk

Disease, cornea, type specified NEG

Ectasia, come%

Edema, cornea, (epithelial) (stromal~

Girdle, fimbal (cornea) (white);

Gkdle of Vogt (cornea) (Iimbusk

Hodson-Stahli line (pigmentation)

KP’s (endothelial) (pigment -cd);

Keratitis, bullous

Keratopathy, bullous

Opacity, Iimbal girdle (cornea) (white]

Precipitates, keratic (pigment -cd);

Precipitates, endothelial (pigment -cd);

Wait-Beetham lines

Edema, cornea, due to bum, acid (chemical)

Edema, cornea, due to vitreous touch following surgery (epithelial)

Episcleritis (acute) (chronic) (subacute)

Foreign body, sclera NOS (metallic)

Ectasia, scleral NOS (acquired);

Sclerectasia NOS (acquired);

Staphyloma, sclera NOS (acquired)

Blue spots, sclera (coloration);

Melanosis, sclera (benign) (oculi~

Melanotic lesion, sclerq

Pigmentation,sclera

Rates per 1,000 population

7

51

22

1

24

1

357

5

1

15

1

0.3

4.6

1.8

0.1

1.5

0.1

31.7

0.4

0.0

1.0

0.1

0.0

0.1

1.2

0.2

0.0

0.2

0.1

0.1

0.5

0.1

0,1

0.2

0.1

0.7

0.3

165 12.4 0.1 0.1 0.1

1 0.1 0.1

1 0.0 0.0

7 1.2 - 0.1

1 0.0 - 0.0

9 0.8 0.0 0.0

10 0.4 - 0.0

53
Number

Ophthalmic diseasa code

of Total Causing Needing Under examinees minor . .

with medical medical

eye

o~~r d;~;;se care care

conditions

689900

690040

69 11 00

6961 00

8961 01

697000

697098

697200

697298

697300

697398

697400

697440

697445

697498

697800

6981 00

698200

698800

698900

Rates per 1,000 population

Disease, sclera, type specified NE~

Icterus (conjunctival) (sclera);

Jaundice (conjunctival) (sclera)

Plaque, sclera, calcified (lateral rectus insertion);

Plaque, sclera, (hygiene) (senile)

Thinning, sclera (localized);

Translucent areas, scler~

Yellow (tint), conjunctival or sclera

69. ANTERIOR CHAMBER AND INTRAOCULAR PFIESSURE

Recession, angle, anterior chamber (traumatic);

Trauma, anterior chamber NEC or NOS

Glaucoma, congenital NOS

Flat anterior chamber NOS (with cornea/iris apposition or touch);

Narrow anterior chamber NOS

Shallow anterior NOS (with cornea/iris apposition or touch)

Shallow anterior chamber, due to cataract

Glaucoma NOS

Surgery, glaucoma (post op)

Glaucoma, open angle (chronic) (primary);

Glaucoma, wide angle (chronic) (primary);

Glaucoma, simple or simplex (chronic) (primary)

Glaucoma, simple (surgery)

Glaucoma, narrow angle (primary);

Glaucoma, angle closure (primary);

Glaucoma, closed angle (primary)

Glaucoma, narrow or closed angle (surgery)

Glaucoma, closed angle, secondary

Glaucoma, wide angle, secondaty

Glaucoma, narrow angle, seconda~

Glaucoma, secondary NE~

Glaucoma, open angle, secondary

Glaucoma, secondary NOS

Glaucoma, angle recess

Glaucoma, traumatic (secondary)

Glaucoma, aphakic (secondary). Excludes Glaucoma, malignant, 697945

Glaucoma, secondary (surgery)

Glaucoma, rubeoti~

Glaucoma, hemorrhagic

Glaucoma, absolute

Glaucoma, juvenile

Glaucoma suspect, narrow anglq

Glaucoma suspect, angle closure;

Narrow angle, grade O, 1, or 11,or occludable;

Shallow angle, grade O, 1, or II

Elevation, intraocular tension--Code only in histo~

Glaucoma suspect NOS

Increase, intraocular tension-Code only in histoty

Tension, intraocular, elevated or increased--Code only in history

11

3

1

35

2

62

3

12

2

9

1

2

3

1

1

1

3

1

0.6

0.1

0.0

2.6

0.1

4.2

0.1

0.8

0.2

0.4

0.0

0.2

0.0

0.0

0.0

0.0

0.1

0.0

0.1

0.0

2.0

0.0

0.5

0.1

0.0

0.0

0.1

0.1

0.9

0.1

2.0

0.2

0.0

0.1

0.0

0.1

1.1

0.0

0.6

0.0

0.4

0.0

0.0

0.0

0.0

0.0

0.1

0.0

14 1.0 0.1

33 1.3 0.1 0.1

54
Number

Ophthalmic disease code

of Total Causing examinees minor . .

Needing Under

with medical medioal

~t~~r dt%~;se

eye

care care

conditions

699900

700000

700300

7051 00

7051 40

705400

705500

706000

706030

706032

706040

7061 00

706200

706212

706232

706531

71 1200

71 1900

71 4540

71 4545

71 5300

71 6000

71 61 00

Cells, anterior chamber (pigment~

Disease, anterior chamber, type specified NEQ

Flare, anterior chamber

70. UVEAL TRACT INFLAMMATION

Inflammation, uveal NOS

Inflammation, uveal, granulomatous

Inflammation, uveal, antenor, active

Inflammation, uveal, anterior, traumatic, active

Inflammation, uveal, anterior, active, granulomatous

Inflammation, uveal, anterior, inactive, granulomatous

Inflammation, uveal, posterior

Inflammation, posterior, infection

Inflammation, uveal, posterior, due to histoplasmoais

Inflammation, posterior, active, granulomatous

Inflammation, uveal, posterior, actiie

inflammation, uveal, posterior, inactive

Inflammation, uveal, posterior, due to syphilis, inactive

Inflammation, uveal, posterior, due to histoplasmosis, inactive

Inflammation, uveal, posterior, due to toxoplasmosis, inactive

(granulomatous);

Scar, chorioretinal, due to toxoplasmosis

71. IRIS AND PUPIL

Pupillary membrane, persistent (congenital);

Pupillary membrane remnant (congenital);

Remnant, pupillaty membrane (congenital);

Remnant, iris, embryologic

Anomaly, congenital, ins and pupil, type specified NEQ

Brushfield spots;

Marcus-Gunn pupil;

Tunics vasculosa Ientis, iris

Incarceration, iris, traumati~

Prolapse, iris, traumatic

Incarceration, ins, following operation. Exclude Incarceration done as

treatment for glaucoma

Iris, adherent to or drawn to wound, following operatio~

Prolapse, iris, following surgery. Used instead of NOS if person has

aphakia, history of cataract surgery and NO history of trauma

Ephelis, iri.q

Freckle, iriq

Melanoma, iris, benig~

Nevus, iris (benign);

Tumor, iris, benign. Excludes Neurofibroma

Heterochromia (iridis)

Atrophy, ins NOS (marginal) (partial) (segmental) (sphincter) (stromal)

Rates per 1,000 population

28

5

2

4

1

1

1

5

1

2

1

1

34

1

11

9

2.3

0.2

0.2

0.3

0.1

0.0

0.0

0.8

0.2

0.1

0.1

0.0

3.3

0.0

1.4

0.3

-

0.2

0.2

0.1

0.0

0.2

0.2

0.0

0.1

0.0

0.5

0.0

0.0

0.0

0.1

0.1

0.0

0.0

0.1

0.0

0.0

0.0

0.0

.

.

0.0

.

0.1

0.1

0.4

.

92 8.4 -

12 1.3 0.0

2 0.4 0.3 0.3

5 0.4 0.3

47 4.7 - 0.1 0.1

11 1.6 - 0.1

48 3.1 0.1 . 0.5

55
Number

Ophthalmic disease code

of ‘eta’ Causing

examinees minor . .

Needing Under

with

medical medical

~t~~r d;~~;se

eye

care care

conditions

71 6640

71 7200

71 7300

71 8000

71 9900

735300

736300

736400

739900

740000

7411 00

741398

741800

744740

744745

744798

746000

746045

746056

56

Rates per 1,000 population

Coloboma, iris, traumatic 1 0.1 0.1

PAS 24 1.4 0.1 0.4

Synechia, posterior 32 1.6 0.1 0.3 0.0

Anisocoria NOS (surgical);

Dilation, dilatation, pupil, unilateral 116 9.6 0.3

Cyst, iriq

Corectopi*

Disease, pupil, lype specified NE~

Disease, iris, tvDe specified NEC;

Ectropion uveae (with pigment layer protrusion into pupil);

Entropion uveaq

lridoschisi~

Nodule, iriq

Pupillary membrane

73. CHOROID

Nevus, choroid, (benign);

Tumor, choroid, benign

Drusen, choroid;

Drusen, retinq

Drusen, maculd

Hyaloid excrescence, macula

Sclerosis, choroidal (central areolar) (peripapillary)

Disease, choroid, type specified NEC

pigment pigmentsry changes, choroidal (irregularity) (peripapillary)

74. CRYSTALLINE LENS

Aberration, Ienticuiac

Disease, lens (crystalline) NOS

Cataract, congenital (anterior) (cortical) (hypermature) (immature)

(intumescent) (mature) (nuclear) (polar) (posterior) (subcspsular)

Cataract, congenital, incompletely or partly absorbed following surgery

Mittendorf dot or spot (congenital) (lens);

Opacity, lens, congenital (anterior) (coronary) (cortical) (crystalline)

(embryonal nucleus) (fetal nucleus); (nuclear) (polar) (post. or posterior)

(punctste) (scattered) (sclerosis) (subcapsukw) (suture);

Opacity, lens, Y suture (anterior);

Opacity, lens, sutural

Cataractj traumatic NOS (anterior) (cortical) (foreign body) (hypermature)

(immature) (intumescent) (mature) (nuclear) (polar) (posterior) (subcapsular)

Cataract, secondary or remains following surgery

Aphakia, traumatic

Cataract NOS (anterior) (cortical) (hypermature) (immature) (intumescent)

(mature) (nuclear) (polar) (posterior) (snowflake) (stellate) (subcapsular)

Cataract. associated with svstemic disease NOS (anterior) (cortical)

19 1.5 0.1 0.1 0.2

22 2.4

355 29.6 1.0

22 0.9 0.2

22 1.4

1 0.0 0.0

3 0.4 0.4

1 0.1 0.1

26

8

2

2

552

(hyperrnature) (immature) ~ntumescent) (mature)’ (nuclear) ‘(polar) “(posterior)

(subcapsular) 6

Cataract, diabetic (snowflake) 1

2.5

0.4

0.2

0.0

28.0

0.4

0.1

0.4

0.2

0.0

25.9

0.1

0.1

0.1

1.2

0.0

0.1

0.2 0.0

0.1

3.8 4.9

0.1 0.1
Number

of ‘eta’ Causing examinees minor Needing Under

Ophthalmic disease code with vision

and decrease

medical medical

eye other

care care

conditions

Rates per 1,000 population

746068

746082

746098

746300

746401

747000

748900

749900

749940

750000

754445

756000

756200

7563 00

756400

760000

Cataract, senile (anterior) (cortical) (hypermature) (immature) (intumescent)

(mature) (nuclear) (polar) (posterior) (subcapsular)

Cataractj due to myotonic dystrophy

Aphakia NOS

Cataract, secondafy

Cataracta complicate (anterior) (cortical) (hypermature) (immature)

(intumescent) (mature) (nuclear) (polar) (posterior) (subcapsular);

Cataract, secondary to other eye disease (anterior) (cortical) (hypermature)

(immature) (irttumescent) (mature) (nuclear) (polar) (posterior) (subcapsular]

Cataract, complicated

Dislocation, lens (crystalline) NOS (anterior) (posterior)

Opacity, lens (adult nucleus) (anterior) (cortical) (crystalline) (embryonal

nucleus) (fetal nucleus) (nuclear) (polar) (post. or posterior) (punctate)

(scattered) (sclerosis) (snowflake) (subcapsular);

Spoking, lens (anterior);

Sclerosisj nuclear

Disease, lens (crystalline), type specified NE~

Pigment, lens surface (capsule) (epitheliums) (dust) (granules) (iris) (spicules)

Pigment, lens surface, traumatic (capsule) (granules) (iris)

75. VITREOUS

Disease, vitreous NOS

Granular vitreous

Liquefaction, Liquid vitreouq

Pigment, vitreous (granules);

Syneresis (vitreous)

Prolapse, vitreous, following surgery. Used instead of NOS if patient has

aphakia, history of cataract surgery, and NO history of trauma

Vitreous in anterior chamber or pupil, due to surgery (band) (degenerated).

Used instead of NOS if person has aphakia, history of cataract surgery,

and NO history of trauma

Vitreous adherent to or against cornea, due to surgery (band). Used instead

of NOS if person has aphakia, history of cataract surgery, and NO history

of trauma

Hyalitis, asteroid;

Opacity, asteroid, vitreous

Detachment, vitreous (base) (posterior)

Blood, vitreous (old);

Hemorrhage, vitreous

Floater (vitreous);

Muscae volitantes;

Opacity, vitreous (glass-like) (hemorrhage, due to) (myopic) (retrolental)

(vitreous degeneration, due to)

76. RETINA

Arterial sclerosis, retina (grade 1, 2, 3, or 4) (vessel);

Arteriosclerotic vascular disease, retina

Arteriosclerotic retinopathy (grade 1, 2, 3, or 4);

Arteriosclerotic changes, retina (grade 1, 2, 3, or 4) (vessel);

Arteriosclerosis, retina (grade 1, 2, 3, or 4) (vessel}

Arterioiosclerotic retinopathy (grade 1, 2, 3, or 4);

Arteriolosclerotic changes, retina (grade 1, 2, 3, or 4) (vessel);

18

1

69

1

1

4

833

206

1

20

20

25

99

4

118

0.7

0.0

4.3

0.1

0.1

0.3

56.4

22.1

0.1

1.2

1.0

0.7

4.5

0.4

8.2

0.6

0.0

1.4

0.1

0.1

0.3

0.1

0.1

0.1

0.1

0.0

0.1

0.1

0.2

0.1

1.8

0.1

1.0

0.1

0.0

0.1

0.1

0.1

0.2 0.0

0.0

0.1

0.1

0.2

5.7
Number

of ToW Causing Needing Under

Ophthalmic disease code

examinees minor . .

with medical medical

eye

~~~r d;%a:e care care

conditions

760000

760008

761200

763556

763564

764540

766000

766500

766700

766800

766900

767000

767040

767082

58

Rates per 1,000 population

Arteriolosclerosis, retina (grade 1, 2, 3, or 4) (vessel);

Arteriolar sclerosis, retina (grade 1, 2, 3, or 4) vessel);

Cholesterol plaque, retinal vessel%

Changes, retinal vessels (grade 1, 2, 3, or 4);

Changes, paramacula~

Dilation, Dilatation, retinal veins

Dilation, Dilatation, retinal capillary

Disease, retina NOS

Edema, retina;

Exudates, retina (cotton wool) (drusen-like) (hard) (waxy);

Generalized narrowing, retinal arteries;

Hemorrhage, retina (blot) (deep) (flame-shaped) (preretinal) (superficial);

Lesion, paramacula~

Microaneu~sms, retina NOS (macula);

Narrowing, arterial, arterioiar, retina (general);

Neovascularization, retina NOS

Paramacular changes, lesion;

Retina, disease N05

Retinopathy, arteriosclerotic (grade 1, 2, 3, or 4);

Retinopathy, arteriolosclerotic (grade 1, 2, 3, or 4);

Sclerosis, retinal vessel=

Sausaging, veins, retina

Sclerosis, retinal arterie$

Tortuosity, retinal vessels (arteries) (veins);

Vitreoreti_nal interface chang~

Venous engorgement, retina

“Other” checked, not described,

“Other” checked, not described,

“Other” checked, not described,

“Other” checked, not described,

“Other” checked, not described,

Medullated nerve fiberq

Myelinated nerve fibers

Diabetic involvement, maculq

Retinopathy, diabetic

exudates, retina

vessels, retina;

retinz

macul~

hemorrhage, retina

Arteriolar sclerosis, hypertensive;

Changes, hypertensive (retina);

Involvement, hypertensive, macul~

Nicking, arteriovenous, retina, hypertensive

Retinopathy, hypertensive

Hole, macula, traumatic (retina)

Atrophy, retina (peripapillery)

Degeneration, retina, peripheral,

Degeneration, retina, peripheral,

Degeneration, retina, myopiq

Myopia, degenerative

Myopia, pathologic

Myopia, malignant

Myopia, progressive

lattice

other specified (senile)

Degeneration, retina NOS (peripapillary)

Cyst, macula

Degeneration, macular (retina) (circinate) (disciform) (pigmentary);

Hole, macula NOS (retina)

Degeneration, macular (retina) traumatic (pigmentary)

Degeneration, macular, heredita~ (retina)

1,117 77.8 0.4

70 6.9 -

16 1.4 -

37 1.9 0.5

76 3.1 0.4

3 0.1 0.1

11 0.8 0.1

4 0.4

3 0.1 0.0

7 0.5 0.1

4 0.3 0.0

1.6 4.7

0.2 0.6

0.8 0.8

0.4 0.0

0.1

28 2.6 2.5 0.1

2 0.0 0.0

1 0.0 0.0

0.0

0.0

0.3

0.0
Ophthalmic disease code

of Total ~u~ing Needing Under examinees minor

with vision medical medical

~t~~r decrease

eye

care care

conditions

767200

767400

767500

767900

768000

768200

768240

768300

768500

768600

769000

769098

769400

769500

769540

769600

769700

769900

770000

Degeneration, macular (retina) senile (choroidal) (circinate) (disciform)

(pigmentary)

Hemorrhage, macula NOS

Retinitis pigmentosa NOS

Hole, retina

Occlusion, retinal vessel NOS

Occlusion, retinal artery, central

Occlusion, retinal artery, central, traumatic

Occlusion, retinal artery, branch

Occlusion, retinal vein, central

Occlusion, retinal vein, branch

Detachment, retina NOS

Detachment, retina NOS (Post. Op.)

Atrophy, pigment epithelial (retina~

Freckle, retina

Hyperplasia, pigment epithelial (retina);

Hypopigmentation, retina

pigment, Pigmentation, adjacent to disc (areas);

Rates per 1,000 population

182

1

7

1

1

6

1

4

3

5

11

8

Pijment, pi~mentary changes, retina (atrophy) ‘(clumping) (depigmentation)

(epithelial) (focal) (freckle) (hyperplasia) (hypopigmentation) (lesion) (mottling)

(peripapillary) (spot);

Salt and pepper fundus 88

Atrophy, pigment epithelial, macul~

Depigmentetion, maculan

Granularity, macula, mottled;

Hypopigmentation, macula;

Pigment, Pigmentary changes, macula (accumulation) (atrophy) (clumping)

(clumps) (depigmentation) (derangement) (cfkpersion) (disturbance)

(epithelial) (fine) (hyperpigmentation) (irregularity) (mottling) (scattered)

(stippiing~

Stippling, macular (pigment) (pigmentaty) 48

Atrophy, pigment epithelial, macula, traumatiq

Pigment, Pigmentary changes, macula, traumatic (accumulation) (atrophy) 2

(clumping) (clumps) (derangement) (disturbance) (fine) (irregularity) (mottling)

(scattered) (stippling)

Inflammatory lesion, macular, old;

Scar, macula

Scar, chorioretinal or choroid (inactive) (pigment -ary, -cd);

Scar, retina (inactive) (peripapillary) (pigment-ary, -cd)

Beaten silver appearance, macul~

Disease, macula NEC or NOS

Disease, retina, type specified NEG

Edema, macular NOS;

Hollenhorst plaque, retinx

Refractive body or lesion, macula

77. OPTIC NERVE

Blurred disc margin%

Cup, Cupping, disc or nerve head (asymmetric) (one eye more than other)

(saucerization);

10.5

0.0

0.2

0.2

0.0

0.4

0.0

0.0

0.0

0.6

0.8

0.5

7.7

3.7

0.1

7.3

0.0

0.0

0.0

0.3

0.0

0.0

0.3

0.6

0.2

0.1

0.4

0.1

0.8

0.0

0.1

0.2

0.0

0.0

0.0

0.1

0.2

0.1

1.2

0.0

0.0

0.1

0.3

0.4

0.1

0.6

0.0

5 0.8 0.7

12 0.9 0.1 0.2

9 0.3 0.2 0.2

59
Ophthalmic disease code

of Total Causing examinees minor . .

Needing Under

with medical medical

~t~~r d;%’i;se

eve

care care

con-ditions

770000

77 1000

77 1900

772200

776000

7761 00

776200

776240

776272

776300

776340

776700

779900

780000

Depigmentation, disc margin;

Deterioration, optic nerve

Dieease, optic nerve NOS

Elevation, optic disc or nerve head

Fibrosis, edge of disc (optic);

Irregular dis~

Peeudopapilledem~

pigment disc (granules) (inferior) (irregularities) (nasal) (spot) (superior)

(temporal);

Pallor, disc (temporal~

Scar, disc

Anomaly, congenital, optic disc or nerve NOS

Anomaly, congenital, optic cfao or nerve, vascular or vessel;,

Anomaly, congenital, optic disc or nerve, type specified NEIQ

Bergmeister’s papilla

Coloboma, disc (congenital) (optic);

Cup, Cupping, disc or nerve head, congenita~

Elliptical disc, congenita~

Glial membrane, in front of disG

Hyaloid vessel, disc (remnant);

Hyalod attery, persistence of, disq

Loop, vascular, disc (congenital) (inferior temporal artery) (c~ptic);

Loop, venous, disc, congenital;

Membrane, epipapillary

Oblique insertion, dis~

Pit, disc (congenital) (optic);

Papilla, Bergmeister’s

Remnant hyaloid, disc (fibrotic) (vessel) (system);

Situs inversus, optis nervfa

Vertically elongated shaped disc (congenital)

Neuritis, retrobulbar NOS

Atrophy, optic (nerve) NOS (temporal)

Atrophy, optic (newe), primaty NOS

Atrophy, optic (nerve), traumatic, primary

Atrophy, optic (nerve), associated with multiple sclerosis (primary);

Atrophy, optic (nerve), associated with demyelinating disease (primary)

Atrophy, optic (nerve), secondary NOS (ischemic)

Atrophy, optic (newe), traumatic, secondary

Colloid bodies, dieq

Drusen, disc (oolloid bodies) (hyalin bodies);

Drusen, optic nerve (colloid bodies) (hyalin bodies);

Hyalin bodies, disc

Cresent, disc NOS--Refec

Oiseeee, optic nerve, type specified NEC

Neovascularization, disc (optic);

Pigment clump, disc (nasal)

78. NEUROMUSCULAR

Decreased or diminished light refle%

Disease, neuromuscular NOS;

Muscles, weak

Orthoptic~

Sluggish light reflex

Rates per 1,000 population

33 2.5 0.1 0.1 0.0

3 0.2 0.0

34

1

4

1

13

1

1

11

2

31

3.1 0.1

0.1 0.1

0.4

0.1 0.1

1.0 0.7

0.4 0.4

0.3

0.6 0.3

0.2 0.2

2.1

0.0

0.1

0.1

0.1

0.0

7 0.7 0.0 0.0

7 0.5 0.0

0.0

0.0

0.4

0.3

0.0

0.2

60
Ophthalmic disease code

of Total Causing examinees minor . .

Needing Under

wi?h medioal madioal

eye

~t~~r J%Le cam care

conditions

7811 00

781200

781400

781900

786000

7861 96

786200

786298

786400

786445

786600

786658

786674

786800

786845

786874

786900

788200

789000

789900

789998

990000

Nystsgmus, congenital (horizontal)(jerk) (pendular) (rotary) (vertical)

Marcus-Gunn phenomenon with ptosi~

Marcus-Gunn ptosi~

Ptosis, due to cranial nerve paralysis, congenite~

Ptosis in Mercus-Gunn phenomeno~

Ptosis, congenital

Exotropia, congenital (comitant) (incomitent) (intermittent)(alternating) (with

overaction or underactionof oblique)

Anomaly, congenital, neuromuscular,type specified NEQ

Duanes’s syndrome

Nyategmus, NOS (fixational) (gaze) (horizontal)(jerk) (pendular) (rotary)

(vertical)

Postoperative state, strabismus NOS

Esotropia (accommodative) (acquired) (alternating) (comitent) (hyperopic)

(incomitent)(intermittent)(with overaction or underaotionof oblique}

Turning in of eyes

Postoperativestate, esotropia

Exotropia (acquired) (alternating) (comitent) (fever, due to) (incomitent)

(intermittent)(with overaction or undersctionof oblique);

Turning out of eyes

Exotropia, secondary to surgery

Hypertropia (alternating) (comitent) (incomitent) (intermittent)(in left or right

lateral gaze) (vertical)

Hypertropia,due to thyroid disease (in left or right lateral gaze) (vertical)

Hypertropia,due to cranial nerve paralysis,due to aneuiyarn

Bell’s palsy, causing ptosi~

Ptosis, due to Bell’s palsy (acquired);

Ptosis, eenilq

Ptosis, due to cranial nerve paralysis

Ptosis, acquired

Ptosis, due to cerebrovascularaccident (stroke)

Ptosis, secondary to surgery

Ptosis, due to cranial nerve paralysis,due to aneurysm

Ptosis NOS

Homer’s syndromq

Syndrome, Homer’s

Bell’s palsy

Paralysis, Paresis, cranial nerve (abduoens) (facial) (ooulomotor)(trochlear)

(third) (fourth) (sixth) (seventh)

Absent light reflex (consensual) (direct~

Disease, neuromuscular,type specified NEC

Postoperativestate, tic douloureu~

Postoperative state, trigeminal neuralgia

99. SITE NOT SPECIFIED

Amaurosiq

Amblyopia NOS

Blindnese NOa

Rates per 1,000 population

1

10

3

1

32

1

124

1

269

2

60

1

1

12

1

1

49

3

5

52

1

0.0

0.9

0.6

0.1

3.8

0.4

12.8

0.1

21.1

0.2

5.4

0.1

0.2

1.0

0.0

0.2

3.9

0.2

0.4

4.2

0.2

0.0

0.1

1.2

3.0

0.1

2.4

1.0

.

0.2

0.4

.

.

.

0.2

.

1.4

1.2

0.1

0.1

.

.

.

.

0.3

0.0

.

0.0

.

.

0.1

0.6

0.4

3.2

,2.3

1.1

0.1

0.2

0.0

0.0

0.2

0.5

0.1

0.5

0.2

61
Number

of “?tai Causing examinees mmor . .

Needing Under

Ophthalmic disease code with medical medical

~t~~r d;;~a;e

eye

care care

conditions

Rates per 1,000 population

13 1.0 0.6 0.1 0.1

990070

997000

997076

999900

999974

Cyst, site and type not specified (excreto~) (obstructed);

Circulation, impaired, poor, site not specified;

Dtscharge from eyes. Coded only if causative condition is unknown;

Diplopia. Coded only if causative condition is unknown;

Dry eye;

Disease, eye, site and type not specified;

Film, eye (AM) (in) (morning) (on) (over);

Foreign body sensation;

Itching, eyq

Irritation;

Light, sensitivity tc!

NLP (no light perception). Coded only if cause of vision loss is unknoww

Photophobi-q

Pain, eye, site not specified;

Redness, eye (with tearing);

Skin over eyq

Swelling, eyq

Veil, eye (transient);

Vision blurred, cloudy, decreased, impaired, nil or poor (associated with

heart attack or pregnancy). Coded only if cause of imparied vision is

unknown;

Weak eye

Amblyopia, due to fever (from infection);

Dyslexia

Pseudotumor cerebri;

Scotoma, due to migraine headache (scintillating);

Water tumor, brain 1 0.4 0.4

Defect, field (visual);

Hemianopia, Hemianopsia 1 0.0 0.0

Defect, field, due to meningioma, sphenoid ridge (visual) 1 0.3 0.3 0.2

Disease, eye, site not specified, type specified NEC

Drusen, site not specified 1 0.0 0.0

Ischemic episodes, transient, affecting vision 1 0.0 0.0 0.2

62
Appendix IV. Eye pathology

classifications

To assure uniform application of diagnostic criteria throughout the study, diagnoses were added during

medical review at the National Eye Institute in which

the detail of the eye pathology as recorded by the

examining ophthahnologist was consistent with criteria for the more severe or readily identifiable eye

conditions as given in Newell’s report. ” For such

added diagnoses only, the anatomical site and the type

of disease or injury-the first four digits of the NEI

code-were used. No attempt was made to identify the

etiology of such conditions or to make judgments as to

whether the condition caused decrease in vision or

needed medical treatment.

Of the 8,789 eye conditions diagnosed in the

survey, 3,308-38 percent-were added during the

NEI review. These additional diagnoses tended to be

incomplete etiology was identified for only 760, or

fewer than 14 percent, of the 5,481 eye conditions

diagnosed by the field ophthalmologists. Because of

this, diagnostic data in the detailed tables and text of

this report, including the conversion to the more

widely used and understood Eighth Revision, International Classtication of Diseases, Adapted for Use in

the Um”tedStates (ICDA-8) system, is limited to the

first four digits of the NEI codes.

The following listing shows the 4-digit NEI codes

that have been included in each of the 3-digit ICDA-8

codes for classification of these groups of eye conditions.

ICDA condition group ICDA code NEI inclusion and code

Malignant neoplasm

Benign neoplasm

Hemangioma, Iymphanioma

Unspecified neoplasm

Congenital metabolic disorders

Amino acid

Lipid

Anemias, other NOS

Facial paralysis

Diseases of peripheral nerves

Conjunctivitis, ophthalmic

Blepharitis

190

224

227

238

270

272

285

350

358

360

361

Carcinoma, tumor-eyelid (6356)

Angioma, fibroma, hemangloma, mole, nevus, papilloma, synngoma benign, tumor-eyelid

(6353)

Hemangiorm, Iipoma, nevus, turnor (benign), cyst, dermoid, dermolipoma-conjunctiva

(6553)

Tumor, dermoid-cornea (6753)

Ephelis, freckle, melanoma (benign), nevus, tumor (benign) iris (7153)

Neurofibroma-iris (7154)

Nevus, tumor (benign)-choroid (7353)

Tuberous sclerosis, tumor (benign) - retina (7653)

Growth-eyelid (6350)

Growth, Iimbus, tumor-eyelid (6750)

Tumor-choroid (7350)

Melanocytoma, tumor-optic nerve, disc (7753)

Albinism-retina (7613)

Xanthelasma-eyelid (6364)

Pale, anemic, other manifestations-conjunctiva (6564)

Bell’s palsy, paralysis of cranial nerve (7890)

Homer’s syndrome (7882)

Conjunctivitis, infection, pink eye, injection-conjunctiva (6520)

Foreign body-conjunctiva (6542)

Blepharitis, granulated, allergy - eyelid (6320)

Biepharitis, seborrheic-eyelid (6321)

Blepharitis, sebaceouq herpes zostec acne rosacea-eyelid (6329)

63
ICDA condition 9r’oup ICDA code NE/ inclusion and code

Hordeolum 362

Keratitis 363

Iritis 364

Other inflammation of uveal tract 366

Inflammation of optic nerve, retina 367

Inflammation of lacrimal glands, ducts 366

Other inflammatory diseases of eye 369

Refractive errors

Corneal opacity

Pterygium

Strabismus

Cataract

Glaucoma

Detached retina

Other diseases of

370

371

372

373

374

375

376

retina, optic nerve 377

Hordeolum, stye (6330)

Keratitis, infection, allergy-cornea (6720)

Ulcer due to herpes simplex or other infection-cornea (6730)

Cogan’s plaques-sclera (6663)

Neovascularization, rukleosis-iris (7174)

Inflammation NOS -uveal tract (7000)

Inflammation-traumatic, granulomatous-uveal tract (7003)

Inflammation-uveal tract, anterior (7050)

Inflammation, active-uveal tract, anterior (7051)

Inflammation, inactive-uveal tract, anterior (7052)

Inflammation, active, granulomatous-uveal tract anterior (7054)

Inflammation, inactive, granulomatous-uveal tract anterior (7055)

Inflammation-uveal tract, posterior (7060)

Inflammation, active-uveal tract, posterior (7061)

Inflammation, inactive-weal tract, posterior (7062)

Inflammation, inactive or scar, due to toxoplasmosis (7065)

Retinitis, sheathing of retinal vessels-optic nerve (7620)

Papillitis-optic nerve (7721)

Neuritis, retrobulbar (7722)

Obstruction, puncture, stenosis--lacrimal process (6460)

Scleritis (6820)

Episclertis (6825)

Cells, flare, disease (6999)

Hyalitis, opacity (7560)

Myopic changes, atrophy, thinning (6161)

Myopic degeneration, malignant myopia, degeneration of retina (7668)

Opacity due to foreign body, metallic, rust lesion-cornea (6787)

Opacity due to burn-cornea (6788)

Opacity due to infection, old healed ulcer, etc.-cornea (6789)

Pterygium-conjunctiva (6572)

Pterygium, opacity due to removal of pterygium-cornea (6772)

Esophoria, congenital (7813)

Exotropia, congenital (7814)

Crossed eye, strabismus, squint (7861 )

Esotropia, (7862)

Exotropia, acquired (7864)

Hypertropia (7866)

Cataract, congenital-lens (741 1)

Cataract, congenital, partly absorbed-lens (741 3)

Mittendorf spot, congenital or sutural opacity (7418)

Cataract or aphakia, traumatic (7447)

Cataract, metabolic, diabetic, senile (7460)

Cataract, secondary 1[7463)

Cataract, secondary to other eye disease (7464)

Sclerosis, spoking, diabetic opacity (7489)

Glaucoma,

Glaucoma,

Glaucoma

Glaucoma

Glaucoma

Glaucoma

Glaucoma,

Glaucoma,

Glaucoma,

Glaucoma,

congenital (691 1)

due to systemic disease or NOS (6970)

simple open or wide angle (6972)

narrow angle, closed angle-primary (6973)

secondary, drug-induced (6974)

rubeotic, hemorrhagic (6978)

absolute (6981 )

juvenile (6982)

pigmentaly (6983)

suspect-narrow angle (6987)

suspect-angle closure (6988)

suspect-elevated intraocular tension (6989)

Detachment, retina (7690)

Degeneration, conjunctival (6570)

Microphthalmos (6612)

Atrophy of iris, traumatic (7144)

64
ICDA condition group ICDA code NEI inclusionand code

Other diseases of retina, optic nerve 377 Drusen-choroid, retina, macula (7363)

Medullated nerve fibers (7612)

Vascuiitis, retina (7623)

Retinopathy (7635)

Hole-macula, traumatic (7645)

Atrophy-retina (7660)

Degeneration, cystic-retina (7663)

Degeneration, lattice-retina (7665)

Degeneration, paving stone-retina (7666)

Degeneration, senile or other peripheral (7667)

Degeneration, retina NOS (7669)

Cyst, degeneration, hole-macula (7670)

Degeneration, senile-macula (7672)

Hemorrhage-macula (7674)

Atrophy-disc (7678)

Hole-retina (7679)

Occlusion retinal vessel NOS (7680)

Occlusion, retinal artery, central (7682)

Occlusion, retinal artery, branch (7683)

Occlusion, retinal vein, central (7685)

Occlusion, retinal vein, branch (7686)

Atrophy, freckle, hyperplasia-retina (7694)

Atrophy, depigmentation-macula (7695)

Scar, macula (7696)

Scar-choroid, retina (7697)

Disease, edema-macula (7699)

Disease, depigmentation, deterioration-optic nerve (7700)

Papilledema (7760)

Amblyopia (no code)

Atrophy, traumatic or NOS-optic nerve (7761)

Atrophy, primay-optic nerve (7762)

Atrophy, secondaty-optic nerve (7763)

Colloid bodies, drusen-disc (7767)

Conus, disc (7770)

Crescent, neovascularization, pigment clump-disc (7799)

Blindness NOS, cyst, impaired circulation, etc.-site not specified (9900)

Drusen, disease, ischemic episodes affecting vision-site not specified (9999)

Other diseases of eye 378 Miscellaneous conditions of eyelid-keloid, nodule, papule, pigment, etc. (6300)

Postoperative state, chalazion (6331)

Meibomianitis (6333)

Blepharochalasis, dermochalasis, elastosis-eyelids (6360)

Entropion-NOS (6361)

Ectotropion, senile, traumatic (6362)

Symblepharon (6363)

Trichiasis (6365)

Cyst, milia-eyelid (6367)

Cyst, disease-lacrimal process (6499)

Disease, trauma, vascularization-conjunctiva (6500)

Contact lens overwear-conjunctiva (6544)

Hematoma, hemorrhage-subconjunctiva (6565)

Hemorrhage-conjunctiva (6566)

Cyst-conjunctiva (6580)

Opacity due to foreign body, rust Iesion-conjunctiva (6587)

Scar-conjunctiva (6589)

Bitot’s spot, xerosis, disease NOS-conjunctiva (6599)

Phthisis (6662)

Melanosis, pigment, disease-cornea (6700)

Dystrophy-cornea (6760)

Keratopathy (6761)

Dystrophy Fuch’s-cornea (6763)

Dystrophy, lattice degeneration-cornea (6765)

Dystrophy marginal-cornea (6766)

Dystrophy, posterior, endothelial (6767)

Cornea guttata (6768)

Dystrophy, nodular or granular-cornea (6769)

Cornea tarinata, degeneration NOS (6770)

Dystrophy, senile-cornea (6771)

Keratitis sicca, drying-cornea (6775)

Dry spot, tears deficient-cornea (6776)

Degeneration and othelial-cornea (6777)

Krukenberg spindle (6780)

Pannus, vascularization-cornea (6781)

Vascular lesions-cornea (6782)

Edema, bullous keratitis (6799)

65
ICDA condition cvourr ICDA code NEI inclusion and code

Other diseases of eye

Blindness

Arteriosclerosis

Eczema, dermatitis

Hypertrophic, atrophic, diseases of

skin

Congenital anomalities of eyes

Symptoms—nervous system,

sense organs

378

379

440

692

701

744

781

Scar, disease, trauma NOS-sclera (6800)

Congenital anomaly, thinning-sclera (6819)

Scleromalacia in rheumatoid arthritis or NOS (6830)

Foreign body-sclera (6842)

Ectasia, staphyloma, etc., acquired or secondary to disease-sclera (6861)

Melanosis, blue spots-sclera (6862)

Icterus, jaundice, plaque, thinning-sclera (6899)

Disease, trauma NOS - anterior chamber (6900)

Schwalbe’s line, congenital anomaly-anterior chamber (6919)

Cyst, down growth - anterior chamber (6944)

Shallow, flat, narrow - anterior chamber (6961)

Bulge, dilation, disease, trauma-iris (71 00)

Papillary membrane, remnant-congenital (71 13)

Incarceration, prolapse-ids (7145)

Tumor, pigmentation N(3S - iris (7150)

Heterochromia - iris (71160)

Atrophy NOS - iris (7161)

Synechia NOS (7171)

Synechia, anterioc PAS (7172)

Synechia, posterioc seclusion-pupil (7173)

Anisocoria, dilation, traumatic mydriasis-pupil (7180)

Iridiplegia (7185)

Miosis, constriction-pupil (71 88)

Cyst, disease NOS - pupil: ectropion, entropion-uvea etc. (7199)

Sclerosis-choroid (7364)

Atrophy-choroid (7369)

Hemorrhage-choroid (7370)

Aberration, disease, surgery NOS - lens (7400)

Disiocaticm-lens (74?’0)

Pseudoexfoliation-lens (7477)

Disease, surface pigment-lens (7499)

Granular, pigment, disease NOS - vitreous (7500)

Detachment-vitreous (7562)

Hemorrhage-vitreous (7563)

Floater, opacity-vitreous (7564)

Disease, membrane-vitreous (7599)

Absent light reflex, etc. (7699)

Anophthalmos, surgical (6601, 6644)

Arteriosclerotic changee-retina (7600)

Rash, pustule, dermatitis-eyelid (6332)

Eczema-eyelid (6335)

Angioma, cafe-au-lait spot, disease, etc. - eyelid (6399)

Congenital anomaly-ortjit (6219)

Asymmetry, disease, herniation of fat-orbit (6299)

Entropion, congenital (6311)

Congenital anomaly-lid (631 9)

Asymmetry-eyeball (6600)

Cyclitic membrane-eyeball (6621)

Megalocornea, macrocornea (6719)

Embryotoxon-iris (71 14)

Congenital anomaly-iris, pupil (71 19)

Coloboma (7168)

Congenital anomaly-vitreous (751 9)

Congenital anomaly-retina (761 9)

Retinitis pigmentosa (7675)

Congenital anomaly NU%fisc, optic nerve (771 O)

Congenital anomaly, vascular or other specified type-optic nerve (7719)

Nystagmus, congenital (7811)

Marcus-Gunn, other ptosis (7812)

Duane’s syndrome, other congenital anomaly (7819)

Congenital amblyopia, blindness since birth (9910)

Exophthalmos-orbit (62!60)

Enophthalmos, senile-orbit (6262)

Nystagmus-congenital (781 1)

Nystagrnus-postoperative (7860)

Visual field defect (9970)

66
ICDA condition group ICDA code NEI inclusion and code

Fracture, skull 802 Fracture, implant-orbit (6244)

Open wound—eye, orbit 870 Prolapse, traumatic-vitreous (7544)

Vitreous attached to cataract incision or wound (7545)

Contusion – eye orbit 921 Abrasion, contusion, erosion-eyelid (6340)

Trauma, excessive tearing, dieease - Lacrimal (6400)

Abrasion, edema, keratitis - cornea (6740)

Bloodstaining - cornea (6745)

Disease, trauma-choroid (7300)

Foreign body—eye 930 Foreign body-eyelid (6342)

Foreign body-cornea (6742)

Foreign body-iris (7142)

997 Stripping, Descemet’s membrane—cornea (postsurgery) (6746)

67
Appendix V. Demographic

and socioeconomic terms

Age.—The age recorded for each examinee was the

age at last birthday at the time of examination. The age

criterion for inclusion in the sample used in this survey

was defined as age at time of census interview. In this

sample there were a few examinees who were 74 years

of age at the time of interview but 75 years of age at

examination. In the adjustment and weighting procedures used to produce national estimates, these persons

were included in the 74-years group.

Race.—Race was recorded as “white,” “black,” or

“other.” “Other” included Japanese, Chinese, American Indian, Korean, Eskimo, and all races other than

white and black. Mexicans were recorded as white

unless definitely known to be American Indian or of

other nonwhite race. Blacks and persons of mixed

black and other parentage were recorded as black.

When persons of mixed racial background were

uncertain about their race, the father’s race was

recorded.

Geographic region.—The 48 contiguous States and

the District of Columbia (excluding Alaska and

Hawaii) were stratified into 4 broad geographic regions

of about equal population. With a few exceptions, the

compositions of the regions were as follows:

Region States included

Northeast . . . . . .. . . . Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island,

New York, New Jersey, Pennsylvania

Midwest . .. . . .. . . .. . Ohio, Michigan, Indiana, Illinois, Wisconsin, Minnesota, Iowa, Missouri

South . .. . . .. . . .. . .. . Delaware, Maryland, Virginia, West Virginia, Kentucky, Arkansas, Tennessee,

North Carolina, South Carolina, Georgia,

Florida, Alabama, Mississippi, Louisiana,

District of Columbia

West . . . .. . .. . . .. . . . Washington, Oregon, Idaho, Montana,

Wyoming, Colorado, Utah, Nevada, California, Arizona, New Mexico, Texas, Oklahoma, Kansas, Nebraska, South Dakota,

North Dakota

In a few instances the actual boundaries of the

regions do not follow State lines. Some strata in the

Midwest and South include PSU’S actually located in

the West. Similarly, some strata in the West contain

PSU’S located in the Midwest and South.

Urban-rural.—The classification of urban-rural

areas is that used in the 1960 census. According to the

1960 definition, those areas considered urban are: (1)

places of 2,500 inhabitants or more incorporated as

cities, boroughs, villages, and towns (except towns in

New England, New York, and Wisconsin); (2) the

densely settled urban fringe, whether incorporated or

unincorporated, of urbanized areas; (3) towns in New

England and townships in New Jersey and Pennsylvania that contain no incorporated municipalities as

subdivisions and have either 2,500 inhabitants or

more, or a population of 2,500 to 25,000 and a density

of 1,500 persons per square mile; (4) counties in States

other than the New England States, New Jersey, and

Pennsylvania that have no incorporated municipalities

within their boundaries and have a density of 1,500

persons or more per square mikq and (5) unincorporated places of 2,500 inhabitants or more that are not

included in any urban fringe. The remaining population is classified as rural.

By means of the first digit of the identification code

on the household questionnaire, the urban and rural

population is divided into the following categories

according to population: (1) urban, 3,000,000 or mor%

(2) urban, 1,000,000-2,999,999; (3) urban,

250,000-999,999; (4) urban, under 250,00Q (5) urban

not in urbanized areas, 25,000 or more; (6) urban not

in urbanized area, 10,000-24,999; (7) urban not in

urbanized area, 2,500-9,999; and (8) rural.

Family income.—The income recorded is the total

income received during the 12 months prior to the

interview by the head of the household and all other

household members related to the head. This income is

the gross cash income (excluding pay in kind) except

in the case of a family with its own farm or business. In

that instance net income is recorded. Also included is

the income of a member of the Armed Forces living at

home with his family (even though he is not consid68
ered a household member). If he is not living at home,

allotments and other money received by ;he family

from him are included in the family income figure.

Education. —The only grades counted are those

that have been attended in a “regular” school where

persons are given formal education-either graded

public or private schools, day or night, full-time or

part-time attendance. A regular school is one that

advances a person toward an elementary certificate or

high school diploma or a college, university, or

professional school degree. Education received in

vocational, trade, or business schools outside the

regular school system is not counted in determining

the highest grade of school completed. If a person

attended school in a foreign country, at an upgraded

school, under a tutor, or under other special circumstances, the nearest equivalent of his highest grade

attended is assigned.

69

* U. S. GOVERNMENT PRINTING OFFICE : 1983 ~~,. ,6,, IOD
Vital and Health Statistics series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 10.

SERIES II.

SERIES 12.

SERIES 13.

Programs and Collection Procedures. -Reports describing

the general programs of the National Center for Health

Statistics and its offices and divisions and the data collection methods used. They also include definitions and

other material necessary forunderstanding the data.

Data Evaluation and Methods Research. -Studies of new

statistical methodology including experimental tests of

new survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to statistical theory.

Analytical and Epidemiological Studies. -Reports presenting analytical or interpretive studies based on vital

and health statistics, cerrying the analysis further than the

expository types of reports inthe other series.

Documents and Committee Reports. -Final reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

Data from the National Health Interview Survey. -Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other

health-related topics, all based on data collected in the

continuing national household interview survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Srrrvey.–

Data from direct examination, testing, and measurement

of national samples of the civilian noninstitutionalized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population with

respect to physical, physiological, and psychological

characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit

finite universe of persons.

Data From the Institutionalized Population Surveys. -Discontinued in 1975. Reports from these surveys are includad in Series 13.

Data on Health Resources Utilization. -Statistics on the

utilization of health manpower and facilities providing

SERIES 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

long-term care, ambulatory care, hospital care, and family

planning services.

Data on Health Resources: Manpower and Facilitias.-

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys. -Statistics on health and

health-related topics collected in special surveys that are

not a part of the continuing data systems of the National

Center for Health Statistics.

Data on Mortality .–Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; and

statistics on characteristics of deaths not available from

the vital records based ensample surveys of those records.

Data on Natality, Marriage, and Divorce.–Various statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

series analyses; studies of fertility; and statistics on

characteristics of births not available from the vital

records based ensample surveys of those records.

Data From the National Mortality and Natality Surveys.–

Discontinued in 1975. Reports from these sample suweys

based on vitaI records are included in Series 20 and 21,

respectively.

Data From the National Suwey of Family Growth.–

Statistics on fertility, family formation and dissolution,

family planning, and related maternal and infant health

topics derived from a periodic survey of a nationwide

probability sample of ever-married women 1544 years of

age.

For a list of titles of reports published in these series, write to:

Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. “20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Center for Health Statstics

3700 East-West Highway

Hyattsvllle, Maryland 20782

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