The NHANES Vision Examination data will be used to: 1) measure the prevalence of visual acuity impairment (visual acuity worse than 20/40) in the U.S. population; 2) measure the distribution of refractive error in the U.S. population; and 3) evaluate functional impairment related to vision.
The NHANES Vision Examination consisted of three parts:
Eye Glasses Prescription Determination – For persons 12 years of age and older, eye glass prescriptions were measured when eye glasses for viewing distant objects were available.
Distance Visual Acuity and Objective Refraction/Keratometric Evaluation – For all persons 12 years and older, distance vision was assessed regardless of whether they wore eyeglasses or contacts; the refraction test measured the person’s refractive error and corneal curvature.
Vision Near Card Test – For persons 50 years and over, visual acuity at near was assessed.
All sample persons aged 12 years and older were eligible to participate in (1) automated determination of prescription for eye glasses used to view distant objects, (2) distance visual acuity assessment and (3) automated objective refraction/keratometric evaluation. Sample persons aged 50 years and older were also eligible for the Near Card visual acuity test.
Participants were excluded from the Vision Exam if they were determined to be completely blind or unable to see in both eyes based on the following question asked in the Sample Person Household Interview: “With both eyes open, can you see light?” Participants were also excluded from the exam if they had a severe eye infection (i.e., purulent discharge with redness and inflammation) in one or both eyes. A participant wearing an eye patch would not be excluded; however, the exam would not be conducted on the affected eye.
The vision exam included measurements of: 1) eyeglass prescription for glasses used to view distant objects; 2) presenting visual acuity with current correction; 3) visual acuity incorporating objective refraction; and 4) near-vision acuity.
Health technicians completed screening questions that involved observation of the subject to determine if the medical exclusion criteria applied. The sample person was then asked additional screening questions (e.g. do they wear any distance correction) to determine which measurements in the examination protocol were relevant.
If the sample person wore eyeglasses to see distant objects, their current eyeglass prescription was determined by using the Nidek Auto Lensmeter Model LM-990A. The Nidek Auto Refractor Model ARK-760 instrument was used to assess visual acuity. Presenting visual acuity was tested with whatever distance correction the participant usually wears, if any. If the participant’s visual acuity with their usual correction was 20/30 or worse, visual acuity was further assessed using the objective refraction measurements as the “correction factor” for the participant.
For sample persons aged 50 years and older, near vision was tested with a near vision card, and usual reading distance was recorded prior to measuring their presenting distance visual acuity.
The Nidek Auto Lensmeter Model LM-990A and the Nidek Auto Refractor Model ARK-760 instruments have been used since 1999.
The Vision Examination Protocol is discussed in detail in the NHANES Vision Procedures Manual.
A variety of quality control procedures were used to ensure the accurate and reliable collection of these data. Calibrations of the lensmeter and the autorefractor were performed prior to conducting examinations at each survey location, and weekly thereafter. At regular intervals, NCHS and contractor staff observed vision examinations conducted in the MEC to evaluate whether appropriate procedures and techniques were being followed. Retraining sessions were conducted with all MEC health technicians to review data collection procedures.
The MEC health technicians conducted the vision examination. These technicians received 8 weeks of training initially, and subsequently underwent updates and remedial training as needed. Technicians referred to the Vision Procedures Manual for specific instructions for the administration of this component.
For details on the QA/QC process for this component, please refer to the NHANES Vision Procedures Manual.
Automated data collection procedures for the survey were used to collect the vision data. Eyeglass prescription data were captured electronically by the lensmeter, and the objective refraction and visual acuity data were captured by the autorefractor. Both sets of data were then transferred to the survey database system. Visual acuity data values were also captured manually by the technician and entered directly into the database.
During the editing process, all data were examined for logical inconsistencies and technician or equipment errors. Back-end edits of the data were performed when errors were detected.
Variable-Specific Editing:
VIDLVA and VIDRVA – Presenting visual acuity variables
These variables provide the participant’s presenting visual acuity, tested with the autorefractor, while wearing whatever distance correction the participant usually wears, if any. The values were automatically captured from the autorefractor and also manually recorded by the technician. In cases of disagreement between the automatic and technician-recorded values, the values recorded by the technician were used (unless they were missing, in which case the machine-captured data were used).
VIDLOVA and VIDROVA – Visual acuity with objective refraction variables (measured only for eyes with presenting visual acuity of 20/30 or worse).
These variables provide the participant’s visual acuity, measured after incorporating information from the objective refraction measurements. The values were automatically captured from the autorefractor and also manually recorded by the technician. In cases of disagreement between the automatic and technician-recorded values, the values recorded by the technician were used (unless they were missing, in which case the machine-captured data were used).
Users are encouraged to note carefully the English instructions describing the various variables in the codebook documentation.
This dataset only contains data for the vision examination conducted in the MEC. There is another dataset containing household interview responses to the vision section (VIQ) of the Sample Person Questionnaire. Data from the two datasets can be combined and analyzed using the guidelines provided by NCHS. Note that not all of the same persons appear in the household interview and MEC examination datasets.
Exam sample weights should be used for analyses. Please refer to the Analytic Guidelines for further details on the use of sample weights and other analytic issues. The Analytic Guidelines are available on the NHANES website.
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 5 | 5 | |
2 | No | 6543 | 6548 | VIQ130 |
. | Missing | 369 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Right | 1 | 1 | End of Section |
2 | Left | 3 | 4 | End of Section |
3 | Both | 1 | 5 | End of Section |
. | Missing | 6912 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 0 | 0 | |
2 | No | 6543 | 6543 | VIQ150 |
. | Missing | 374 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Right | 0 | 0 | |
2 | Left | 0 | 0 | |
3 | Both | 0 | 0 | |
. | Missing | 6917 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 2387 | 2387 | |
2 | No | 398 | 2785 | VIXNC1 |
9 | Don't know | 3 | 2788 | |
. | Missing | 4129 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 2048 | 2048 | |
2 | No | 339 | 2387 | VIXNC1 |
. | Missing | 4530 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Glasses | 2011 | 2011 | |
2 | Contacts | 31 | 2042 | |
3 | Both glasses and contact lenses | 6 | 2048 | |
. | Missing | 4869 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 5 | Range of Values | 2775 | 2775 | |
8 | Could not obtain | 13 | 2788 | |
. | Missing | 4129 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
4 to 31 | Range of Values | 2775 | 2775 | |
88 | Could not obtain | 13 | 2788 | |
. | Missing | 4129 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 98 | 98 | |
2 | No | 6409 | 6507 | VIQ200 |
9 | Don't know | 20 | 6527 | VIQ200 |
. | Missing | 390 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Right | 8 | 8 | |
2 | Left | 8 | 16 | |
3 | Both | 80 | 96 | |
9 | Don't know | 2 | 98 | |
. | Missing | 6819 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 534 | 534 | |
2 | No | 5982 | 6516 | VIQ220 |
9 | Don't know | 11 | 6527 | VIQ220 |
. | Missing | 390 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Right | 75 | 75 | |
2 | Left | 71 | 146 | |
3 | Both | 384 | 530 | |
9 | Don't know | 4 | 534 | |
. | Missing | 6383 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 2976 | 2976 | |
2 | No | 3548 | 6524 | VIXOCMT |
9 | Don't know | 3 | 6527 | |
. | Missing | 390 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 2582 | 2582 | |
2 | No | 394 | 2976 | |
. | Missing | 3941 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Glasses | 2214 | 2214 | |
2 | Contacts | 351 | 2565 | VIXOCMT |
3 | Both glasses and contact lenses | 17 | 2582 | |
. | Missing | 4335 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Yes | 2220 | 2220 | |
2 | No | 11 | 2231 | |
. | Missing | 4686 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
-15 to 9.25 | Range of Values | 2154 | 2154 | |
88 | Could not obtain | 70 | 2224 | |
. | Missing | 4693 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
-1.75 to 6.25 | Range of Values | 2154 | 2154 | |
88 | Could not obtain | 70 | 2224 | |
. | Missing | 4693 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 180 | Range of Values | 2154 | 2154 | |
888 | Could not obtain | 70 | 2224 | |
. | Missing | 4693 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
-14.25 to 9.25 | Range of Values | 2155 | 2155 | |
88 | Could not obtain | 69 | 2224 | |
. | Missing | 4693 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
-0.25 to 6 | Range of Values | 2155 | 2155 | |
88 | Could not obtain | 69 | 2224 | |
. | Missing | 4693 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 180 | Range of Values | 2155 | 2155 | |
888 | Could not obtain | 69 | 2224 | |
. | Missing | 4693 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Monovision glasses/contacts worn for visual acuity | 9 | 9 | |
2 | Cataract contact lenses worn for objective refraction | 3 | 12 | |
3 | Contacts worn for objective refraction | 12 | 24 | |
4 | Artificial eye | 5 | 29 | |
5 | Monovision contacts worn for objective refraction | 3 | 32 | |
6 | Contact in right eye only for presenting visual acuity | 2 | 34 | |
7 | Contact in left eye only for presenting visual acuity | 3 | 37 | |
. | Missing | 6880 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
-18 to 12 | Range of Values | 6239 | 6239 | |
88 | Could not obtain | 267 | 6506 | |
. | Missing | 411 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 7.75 | Range of Values | 6238 | 6238 | |
88 | Could not obtain | 267 | 6505 | |
. | Missing | 412 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 180 | Range of Values | 6239 | 6239 | |
888 | Could not obtain | 267 | 6506 | |
. | Missing | 411 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
5 to 9 | Range of Values | 6291 | 6291 | |
. | Missing | 626 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
-22 to 9.5 | Range of Values | 6169 | 6169 | |
88 | Could not obtain | 337 | 6506 | |
. | Missing | 411 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 7.75 | Range of Values | 6168 | 6168 | |
88 | Could not obtain | 337 | 6505 | |
. | Missing | 412 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 180 | Range of Values | 6169 | 6169 | |
888 | Could not obtain | 337 | 6506 | |
. | Missing | 411 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
5 to 9 | Range of Values | 6295 | 6295 | |
. | Missing | 622 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
6.79 to 9.95 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
34 to 49.75 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 180 | Range of Values | 6432 | 6432 | |
888 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
4.91 to 9.25 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
36.5 to 68.75 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 179 | Range of Values | 6432 | 6432 | |
888 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
6.04 to 9.46 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
35.75 to 56 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 24.75 | Range of Values | 6432 | 6432 | |
88 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 179 | Range of Values | 6432 | 6432 | |
888 | Could not obtain | 72 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
6.43 to 9.56 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
35.25 to 52.5 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 180 | Range of Values | 6441 | 6441 | |
888 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
4.95 to 9.22 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
36.5 to 68.25 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 179 | Range of Values | 6441 | 6441 | |
888 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
6.22 to 9.37 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
36 to 54.25 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 25.25 | Range of Values | 6441 | 6441 | |
88 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 179 | Range of Values | 6441 | 6441 | |
888 | Could not obtain | 63 | 6504 | |
. | Missing | 413 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
20 | 20/20 | 2583 | 2583 | |
25 | 20/25 | 1730 | 4313 | |
30 | 20/30 | 656 | 4969 | |
40 | 20/40 | 319 | 5288 | |
50 | 20/50 | 704 | 5992 | |
60 | 20/60 | 89 | 6081 | |
80 | 20/80 | 115 | 6196 | |
200 | 20/200 | 188 | 6384 | |
666 | 20/200+ | 57 | 6441 | |
. | Missing | 476 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
20 | 20/20 | 2549 | 2549 | |
25 | 20/25 | 1718 | 4267 | |
30 | 20/30 | 704 | 4971 | |
40 | 20/40 | 308 | 5279 | |
50 | 20/50 | 705 | 5984 | |
60 | 20/60 | 117 | 6101 | |
80 | 20/80 | 121 | 6222 | |
200 | 20/200 | 168 | 6390 | |
666 | 20/200+ | 62 | 6452 | |
. | Missing | 465 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
25 | 20/25 | 1396 | 1396 | |
30 | 20/30 | 154 | 1550 | |
40 | 20/40 | 103 | 1653 | |
50 | 20/50 | 226 | 1879 | |
60 | 20/60 | 21 | 1900 | |
80 | 20/80 | 31 | 1931 | |
200 | 20/200 | 59 | 1990 | |
666 | 20/200+ | 21 | 2011 | |
. | Missing | 4906 | 6917 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
25 | 20/25 | 1430 | 1430 | |
30 | 20/30 | 142 | 1572 | |
40 | 20/40 | 95 | 1667 | |
50 | 20/50 | 253 | 1920 | |
60 | 20/60 | 17 | 1937 | |
80 | 20/80 | 31 | 1968 | |
200 | 20/200 | 59 | 2027 | |
666 | 20/200+ | 24 | 2051 | |
. | Missing | 4866 | 6917 |