Top barriers to eye care among Americans include cost, accessibility, health care literacy
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Key takeaways:
- Low socioeconomic status and racial inequalities affect several barriers to eye care.
- One solution is telemedicine, which may address eye care service accessibility.
Cost, insurance, transport and accessibility, eye health literacy and communication were identified as major barriers to eye care among U.S. adults, with telemedicine cited as a possible solution, according to a systematic review in Cureus.
“Extensive research has identified numerous barriers that put many Americans at a disadvantage when trying to seek high-quality eye care services,” Nicholas Green, OD, FAAO, from Nova Southeastern University College of Optometry, and colleagues wrote. “Not only do the barriers to eye care services create problems for eye health, but also create a poor quality of life.”
Green and colleagues conducted a literature review using Google Scholar and PubMed and included 19 articles related to barriers to eye care. Based on their results, they identified four significant obstacles to eye care: cost and insurance, transportation and accessibility, eye health literacy and communication.
One cross-sectional survey found that 78% of participants cited high medical costs or lack of insurance as an issue. While many patients had insurance or financial insistence, high out-of-pocket costs including copays, co-insurance and deductibles made access to eye care cost-prohibitive. Furthermore, the costs of materials like spectacle lenses, contact lenses and medications had a negative impact on compliance. A survey conducted in Oregon found that fear of surprise costs was a concern for 31% of patients surveyed.
Patients of lower socioeconomic status or those using state or federal health insurance were more likely to have difficulties scheduling appointments.
A study in Alabama found that accessibility and transportation were the biggest perceived barrier to eye care for both patients and providers, citing the need for family members to take time off work to provide transportation and inconvenient locations of eye clinics. Even people in urban communities had difficulties with transportation, despite more transportation options, with 14% of individuals surveyed in Philadelphia citing inability to get transportation and 3.5% citing cost of transportation as barriers to follow-up care.
Inability to understand and interpret health information was also a major barrier, with many patients perceiving vision changes as normal. Some studies indicated that while gaps in knowledge played a significant role in people not seeking proper eye care, a need to prioritize more practical considerations may be a more significant issue.
For example, one study found that although most patients knew diabetes could affect their vision, many did not receive care. Another survey indicated that because the diabetes disease burden is significant, patients are likely to prioritize systemic management over ocular management.
Furthermore, knowledge gaps also were present among eye care providers, with many unaware of the criteria to refer patients for specialty low-vision services.
One survey found that patients cited difficulty understanding their condition as an issue, with many expressing that their doctors spent inadequate time discussing their diagnosis. One study of ophthalmologists, who were filmed educating patients on drop compliance and glaucoma, found that the ophthalmologists talked for 70% of the discussion and only detected 27% of noncompliance with eye-drop usage.
While solutions to these barriers have traditionally focused on increased patient education, these attempts have not always improved follow-up care. However, telemedicine has shown promise in helping eliminate barriers. One study found that 78% of patients reported having a regular relationship with an eye care professional after receiving recommendations based on imaging performed at an emergency room visit for other conditions.
“Many of these factors are influenced by low socioeconomic status and racial and ethnic inequalities within the United States,” Green and colleagues wrote. “However, emphasis should be placed on addressing the practical issues surrounding eye care service access to have the most impact.”
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