Objective:To determine the prevale nce and causes of low vision in a large sample of nursing home residents.Meth-ods:Twenty eight nursing homes on th e Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration /rehabilitation on nursing home residents.Visual acui ty was measured using both recognition charts and prefere ntial looking techniques.An ophthalmologist examined all residents with visual acuity worse than 20/40in the better-seeing eye and de-termined the primary cause for decre ased vision.Results are reported for the better-seeing e ye.Results:Of 2544eligible residents,1591(63%)participated,but 286residents were unable to respond to v isual acuity testing.Of the remaining 1307residents,496(37%)had best-corrected visual acuity worse than 20/40in the bet-ter-seeing eye.Causes were ascribed for 412subjects.Rates of low vision were similar betw een African American subjects and white subjects(39%and 38%,respectively;age-adjusted P=.18).Cataract was the leading cause of low vision,responsible for 37%of lo w vision among white subjects and 54%of low vision among African American subjects.Macular degeneration was responsible for 29%of low vision among white subjects but o nly 7%among African American subjects.Glaucom a caused low vision in4%of white subjects and 10%of Africa n American sub-jects.Refractive error was not a fre quent cause of low vi-sion in nursing home residents.Conclusions:Low vision is highly prevalent among nursing home residents,with 37%having visual acuity worse than 20/40in the better-seeing eye.Differences in causes of low vis ion between African American subjects and white subjects were noted,with African American subjects more likely to have vision loss on the basis of cataract,a readily tr eated condition.Ap-propriate interventions for nursin g home residents,who face significant obstacles in accessing eye care services,have the potential to improve the quality of life of this at-risk older population. Objective: To determine the prevailing nce and causes of low vision in a large sample of nursing home residents. Meth-ods: Twenty eight nursing homes on th e Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration / rehabilitation on nursing home residents. Visual acui ty was measured using both recognition charts and prefere ntial looking techniques. An ophthalmologist examined all residents with visual acuity worse than 20 / 40in the better-seeing eye and de-termined the primary cause for decre ased vision.Results are reported for the better-seeing e ye.Results: Of 2544eligible residents, 1591 (63%) participated, but 286residents were unable to respond to v isual acuity testing.Of the remaining 1307residents, 496 (37%) had best-corrected visual acuity worse than 20 / 40in the bet-ter-seeing eye. Caps were ascribed for 412 subjects. Rates of low vision were similar betw een African American subjects and white subjects (39% and 38%, respectively; age-a djusted P = .18). Cataract was the leading cause of low vision, responsible for 37% of lo w vision among white subjects and 54% of low vision among African American subjects. Macular degeneration was responsible for 29% of low vision among white subjects but o nly 7% among African American subjects .Glaucom a caused low vision in4% of white subjects and 10% of Africa n American sub-jects.Refractive error was not a fre quent cause of low vi-sion in nursing home residents. Conclusions: Low vision is highly prevalent among nursing home residents, with 37% having visual acuity worse than 20 / 40in the better-seeing eye. Differences in causes of low visions between African American subjects and white subjects were noted, with African American subjects more likely to have vision loss on the basis of cataract, a readily tr eated condition. Ap-propriate interventions for nursin g home residents, who face significant obstacles in accessing eye care services, have the potential to improve the quality of life of this at at-risk older population.