Objective: To characterize habitual visual acuity, contrast sensitivity, spectacle use, and eye care utilization in a large sample of older adults residing in nursing homes. Methods: Of 33 nursing homes identified in Birmingham, Alabama, 17 served as sites. Eligibility criteria included age 55 years or older, English-speaking, and Mini-Mental State Examination score of 13 or higher. Habitual distance and near visual acuity and contrast sensitivity were measured for each eye and binocularly. Residents and a family member/guardian were interviewed about spectacle use and eye care utilization. Medical records provided information on demographics, chronic medical conditions, date of last eye examination, duration of residence in the nursing home, and health insurance. Results: Of 380 enrollees, 57% had distance visual acuity in the better eye worse than 20/40; 10% had visual acuity of 20/200 or worse. Near visual acuity was slightly worse on average by a line than distance acuity. Three-fourths of residents had abnormal binocular contrast sensitivity. The medical record had no record of or reference to an eye examination for 66% of enrollees despite 90% having health insurance. Conclusion: The high rate of visual impairment in nursing homes underscores the need to understand its causes and to evaluate interventions to address this public health challenge. ©2007 American Medical Association. All rights reserved.