All 225 tenants (181 female and 44 male patients) of a nursing home in New York City underwent eye examinations at least once within a 1-year period to determine the prevalence of senile cataract, age-related macular degeneration (AMD), open-angle glaucoma, and diabetic retinopathy. The average age was 85.4 years (range, 60-108 years). With aphakia and pseudophakia included in the diagnosis of "cataract," the respective prevalences were found to be 81, 37, 11, and 2.1%. There was a statistically significant increase in the prevalence of cataracts and AMD in those patients 85 years of age or older when compared with the younger patients in the nursing home (P less than 0.05). Of those patients without organic brain syndrome, 44% (66/151) had a visual acuity of 20/40 or better in at least one eye. Thirty percent (45/151) had a visual acuity of 20/200 or worse in both eyes. Although this study has no control population of patients outside nursing homes, a review of the literature suggests that geriatric nursing home patients may have a higher prevalence of eye disease than their chronologic peers outside nursing homes. Further study is necessary to determine whether residents of geriatric nursing homes are receiving adequate ophthalmic care.