Best & Worst States for Eye Health

With Visual Impairment Surging, Lifestyle and Access to Medical Care Plays a Huge Role


Most of us are guilty of taking eyesight for granted. A luxury that 12 million people in the United States with vision impairment do not have.  Of those cases, one million people are blind and by 2050 that number is projected to double to two million.  

In America, and around the world, incidents of vision impairment and blindness are expected to rise significantly in years to come due to overpopulation and people aging. However, we need not be resigned to living in a world with increasingly poor vision. In fact, while genetics obviously play a huge role, it is only half the story.

According to the World Health Organization (WHO), of the 2.2 billion people with vision impairment globally, at least 1 billion – almost half of the cases – could have been prevented or has yet to be addressed. Additionally, the prevalence of vision impairment in low-and middle-income regions is four times higher than in high-income regions.

These trends show that  lifestyle choices, financial stability, access to vision coverage and medical attention also plays a huge role in eye health and varies in states across America. 

To determine where Americans have the best eye health, RX Safety analyzed seven factors in all 50 states and D.C. such as vision impairment per capita, public school vision screenings, access to vision insurance, optometrists per capita, prevalence of smokers and the cost of medical care.

Key Findings

Hawaii Nº 1 Best State:
81% of Hawaiian children have insurance coverage – most in the nation. Hawaii is also first for vision screenings in public schools, and has the 4th highest percentage of adults with vision coverage.

West Virginia Nº 1 Worst State:
West Virginia has the highest percentage of people with vision less than 20/32 at 3.58%. The state is also surprisingly expensive for those needing vision care, with the 6th highest cost of healthcare in the U.S.

7 of 10 Best States Out West, 9 of 10 Worst Down South:
The regional disparity can be attributed to genetic lineage as well as lifestyle differences and access to vision coverage and medical attention. 

States With the Most Eye Doctors:
North Dakota, Hawaii, and California have the highest number of Optometrists per capita in the U.S. 

What Are the Main Causes of Vision Impairment in the U.S.?

The main cause for imperfect vision is refractive error, a condition that occurs when the shape of the eyeball prevents light from focusing directly on the back of the eye. While refractive error can be brought on by environmental conditions, it is often genetic.

However, while refractive error is currently the main cause of imperfect vision, there are a variety of widespread eye diseases and conditions that also contribute significantly to vision impairment in the U.S. In fact, these conditions are the main causes of blindness (categorized as <20/200 vision) in the U.S.

Graphic-RX-Safety-Blog_Number One Cause of Blindness in the US by Age

In many cases, these conditions are preventable or treatable. They are often caused by environmental factors and a lack of access to vision care, not genetics. For example, exposure to tobacco smoke and air pollution can increase the risk of both cataracts and age-related macular degeneration.

According to the U.S. Centers for Disease Control and Prevention, 90% of blindness caused by diabetes is preventable. Likewise, 90% of people who receive cataract surgery will experience improved vision.  The earlier an eye condition is diagnosed and treated, the more likely the patient is to avoid vision impairment.

This means that there are concrete steps that state and federal governments can take to help prevent blindness and vision impairment in their populations. Our ranking is meant to give an overall view of eye health in a state by focusing on vision impairment statistics, how states address causes of vision impairment, and the local availability of vision care.

Best States For Eye Health

Because states were ranked based on 7 different factors, our top states either have good grades all around or stand out in key categories.

Graphic-RX-Safety-Blog_Best and Worst States for Eye Health

1st Place — Hawaii

Hawaii, our number one state, has high scores in several categories. 81% of Hawaiian children have continuous and adequate insurance coverage, the highest rate in the country. The state is also tied for first in the number of school grades screened for vision problems.

Hawaii has the  4th highest score in the percentage of adults with vision coverage from their employer or Medicaid. While the overall cost of living is high in Hawaii, the cost of medical care is actually just below the national average.

Hawaii also has the second-highest number of optometrists per capita in the U.S., and the fourth-lowest percentage of smokers.

2nd Place — California

California, our runner-up, is an all-rounder. It has good scores in most categories, and the highest score in the percentage of adults with access to vision coverage from their employer or Medicaid, at 69.8%. It also has the second lowest percentage of smokers in the U.S., at 11.3%.

It also stands out in access and cost of healthcare. Despite above average cost of living, medical costs per capita in California are below the national average. The state also has the third-highest number of optometrists per capita in the U.S.

3rd Place — Oregon

Oregon has good scores in most categories. It has a below-average cost of medical care, a below-average number of residents with vision less than or equal to 20/32, and an above-average number of optometrists per capita. The area where it stands out most is in the percentage of adults with access to vision coverage from their employer or Medicaid, with the second highest score of 66.3%.

States With Highest Vision Acuity Loss

The Centers for Disease Control and Prevention track vision loss statistics by state. It can be difficult to attribute causes based on prevalence data due to the variety of genetic, lifestyle, and environmental factors that contribute to vision impairment. However, certain states have significantly higher statistics of vision acuity loss than others. West Virginia, the worst-performing state, has over 167% more cases of vision acuity loss than Maine, the best-performing state.

When you view the data on U.S. vision acuity loss mapped and compare it to data on median incomes by state, a pattern seems to emerge. Generally, the states with the lowest median incomes also have the highest rates of vision acuity loss. 

While there may be a variety of other factors that contribute to vision loss statistics, lower incomes may mean diminished access to vision care for many Americans. For example, when the CDC surveyed Ohio residents, 32.6% responded that they had not gone to an eye doctor visit because of the cost. As the median age of the U.S. population increases, states with higher incomes, a lower percentage of uninsured residents, and more accessible vision care may be better prepared to handle the ensuing increase in eye conditions and vision impairment.

What States Have the Highest Rates of Vision Coverage?

The U.S. Department of Labor collects data in each U.S. Census division about employee benefits for both private industry and state and government workers. Combining the two gives data on healthcare benefits, including vision coverage, for all U.S. civilian workers. The Pacific states — Alaska, California, Hawaii, Oregon, and Washington — have the highest percentage of employees with vision coverage from their employer, at 43%. New England states — Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont — have the lowest, at only 15%.

Graphic-RX-Safety-Blog-percentage-of-civilian-workers-with-vision- coverage

While Medicaid does not always cover glasses or contacts, it usually does cover eye exams and medically necessary vision treatment, such as cataract surgery. Each state government is responsible for determining eligibility requirements for Medicaid in that state. This, along with different average incomes in each state, means that the percentage of residents eligible for Medicaid varies from state to state.

Graphic-RX-Safety-Blog-States-with-the-Highest-and-Lowest- Medicaid-Coverage

States With The Highest Number of Smokers

Smokers are twice as likely to develop age-related macular degeneration as non-smokers, and two to three times more likely to develop cataracts. Not only can smoking damage the eyesight of the smoker, but it can also affect the eyesight of those around them. 

A study from the University of Hong Kong found that children exposed to secondhand smoke experience thinning in the choroid, a network of blood vessels that supplies nutrients and oxygen to the retina. Choroid thinning is linked to various eye conditions, including age-related macular degeneration.

According to data from the University of Washington, 24.6% of Americans have had exposure to secondhand smoke. In 2019, 25.4% of U.S. middle and high schoolers self-reported exposure to secondhand smoke in the home.

The prevalence of smoking in the U.S. is on a general decline, but some states have a higher percentage of smokers than others. West Virginia has the highest percentage of smokers in the U.S., with 26% of residents being smokers. Utah has the least, with only 8.9%.

Graphic-RX-Safety-Blog_States With the Highest And Lowest Number of Smokers
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What You Should Do To Keep Your Eyes Healthy

While the state you live in may have an effect on your eye health, you can improve your odds significantly through annual vision check-ups and lifestyle changes. Here are a few tips to remember:

  • If you haven’t had a comprehensive eye exam recently, do so. Many eye conditions have no warning symptoms in the early stages, and can only be detected through a dilated eye exam.
  • Many eye conditions are hereditary – check whether any of your relatives have been diagnosed with an eye disease or condition.
  • If you are currently a smoker, quit. Smoking is one of the main risk factors for a variety of eye conditions and diseases.
  • When outside in bright sunlight, wear sunglasses that block UV light. Look for glasses that block 99-100% of UV-A and UV-B radiation
  • Always wear appropriate eye protection. Your employer must provide safety eyewear if your job requires it, but you still need to remember to wear it. When playing sports make sure you have the right eye protection. If you already have prescription glasses, you can get a pair of prescription safety glasses for sports or work to keep your eyes as safe as possible.


As the median U.S. age continues to rise, the number of Americans with vision impairment is expected to increase. States with better access to vision care and lower rates of tobacco smoke exposure may handle this trend better than others.

Residents of low performing states should take special care to regularly visit an optometrist for a comprehensive eye exam. Policymakers and healthcare providers need to prioritize eye health and access to vision care, especially in states lagging behind. 

Addressing these challenges will be crucial in mitigating the impending increase in vision impairment across the nation.

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To create our state ranking we compared data for 7 key statistics for vision impairment and access to vision care. These datasets were standardized through Z-score distributions and all outliers were capped at 2. The data was then combined through a weighted average function.

Here are our 7 parameters and the weights assigned to them in our formula:


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