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Best and worst states for eye health


RX Safety conducted an analysis across all 50 US states and Washington DC to determine which state has the best eye health, as well as the worst.

In the US, 12 million people over the age of 40 have vision impairment of some kind, while 4.2 million suffer from uncorrectable vision impairment. By 2050, the CDC estimates this number will more than double to nearly 9 million due to a rise in diabetes and other chronic illnesses.1

On the other side of the coin, just under 7% of children younger than 18 in the US have a diagnosed eye and vision condition. Not to mention the rising prevalence of myopia, which is estimated to affect 41.6% of the US population.2

Recently, RX Safety conducted an analysis across all 50 US states and Washington DC to determine which state has the best eye health, as well as the worst.1

The organization looked at 7 key factors to determine the ranking of each state, each with a different weight on the results:

  • Percentage of population with ≤20/32 vision – 30%
  • Number of school grades screened for vision – 10%
  • Percent of children with adequate and continuous insurance – 10%
  • Number of residents per optometrist – 10%
  • Percentage of population with vision coverage from employer or Medicaid – 20%
  • Smokers, percentage of population – 10%
  • Average cost of healthcare per capita – 10%

Results showed Hawaii was the number 1 state across the nation in eye health, while West Virginia was the worst.

In Hawaii, 81% of all children had continuous and adequate insurance coverage, the highest rate in the country. The state, while not alone, also screens for vision problems from pre-k through senior year of high school.

Hawaii also has the second-highest number of optometrists per capita, with 4966 residents to each optometrist as well as the fourth lowest percentage of smokers. Additionally, while the cost of living may be higher in Hawaii, the average cost of healthcare is just below the national average per capita of $10,191.3

West Virginia on the other hand ranked as the worst state in the nation for eye health. In West Virginia, only 1 grade is screened for vision problems. However, 72.4% of children have continuous and adequate insurance coverage, which is higher than the top 5 states in the country, excluding Hawaii.

West Virginia also has the highest percentage of smokers in the nation, with 26%, which is important since smokers are twice as likely to develop age-related macular degeneration (AMD) as non-smokers. The state is also ranked on the lower side of optometrists per capita at 11,834 and pays more than the average per capita on healthcare at $12,769.

According to RX Sight, when data on US vision acuity loss is compared to the median income by state, generally, the lowest median incomes also have the highest rate of vision acuity loss. West Virginia was at the top of this list with 3.58% of people with ≤20/32 vision and +65.1% prevalence compared to the national average. RX Sight concluded that lower incomes may mean diminished access to vision care across America.

Neighboring state Kentucky was ranked the second worst with numbers like West Virginia. The state however does not do vision screening in any grade but is on par with the national average on healthcare cost per capita.

One of the more notable trends was that most states in the bottom half of the rankings were located in the Southern US while most at the top were in the Pacific region and surrounding the Great Lakes.

RX Sight urges those who live in the lower-ranked states to take special care to visit an optometrist for a comprehensive eye exam regularly and calls on policymakers and healthcare providers to prioritize eye health and access to vision care.

  1. Best & Worst states for eye health. RX Sight. https://rx-safety.com/2024/01/best-and-worst-states-for-eye-health/
  2. Vitale S., Sperduto R.D., Ferris F.L., 3rd Increased Prevalence of Myopia in the United States between 1971–1972 and 1999–2004. Arch. Ophthalmol. 2009;127:1632–1639. doi: 10.1001/archophthalmol.2009.303.
  3. Health Care Expenditures per Capita by State of Residence. https://www.kff.org/other/state-indicator/health-spending-per-capita
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