Vision screening, eye exam rates lower among children from disadvantaged backgrounds
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Key takeaways:
- Vision screening rates differed by age, race/ethnicity and insurance status.
- Targeted strategies may increase vision screening and access to eye care services among children from disadvantaged backgrounds.
Survey data suggest that social, health-related and economic factors may drive disparities in access to pediatric eye care, according to a study published in Ophthalmology.
“For decades, challenges in obtaining vision screening and eye care have persisted among children from disadvantaged backgrounds,” Bani Antonio-Aguirre, MD, MPH, postdoctoral research fellow at Wilmer Eye Institute of Johns Hopkins Medicine, and colleagues wrote.
“Results of the 2021 National Survey of Children’s Health enable a broader understanding of pediatric vision care and the role of patient and sociodemographic characteristics on access to eye care services,” they added.
In a cross-sectional study, Antonio-Aguirre and colleagues used deidentified data from the 2021 National Survey of Children’s Health on 50,892 children aged 17 years and younger in the U.S to investigate the associations between social determinants of health and pediatric eye care.
The researchers applied weighted prevalence calculations to analyze the survey data; they also performed logistic regression to explore associations between reported eye care and demographic, health and parent-related variables.
The main outcomes of the study were caregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits and prescription of corrective lenses.
Overall, 53.2% of children had a caregiver-reported vision screening at least once if the child was aged 5 years or younger or within the past 2 years if the child was aged older than 5 years.
The researchers found that screening rates differed by age (P < .001), race/ethnicity (P = .005) and insurance status (P < .001).
Specifically, screening rates were highest among children aged 6 to 12 years (66%), non-Hispanic white children (55.1%) and children with any private insurance (56.2%). Conversely, children who identified as “non-Hispanic other” (50%) and those with no insurance (36.9%) had the lowest screening rates.
Of the children who underwent vision screening, 26.9% were referred to an eye doctor, according to the researchers. Children aged 13 to 17 years were the most often referred (34.6%), whereas those aged younger than 3 years were the least referred (12%; P < .001).
Referral rates were higher among children living in non-English speaking households (39.6% vs. 24.9%; P < .001); however, the researchers noted that “despite this higher referral rate, a lower rate of eye examinations was reported among households where English was not the primary language, suggesting that language may be a barrier to accessing an eye examination.”
Higher referral rates were also linked to parents with a high school education or less (34% vs. 24.4%; P < .001) and those with household income below 200% of the federal poverty level (P < .001).
Additionally, 38.6% had an eye doctor visit, leading to the prescription of corrective lenses for uncorrected refractive error in 55.4% of cases. The highest rates of receiving corrective lenses were among uninsured children (59.7%).
According to the researchers, “the survey data suggest several avenues to improve access to care,” such as “promoting health literacy among parents and caregivers, which emphasizes the significance of follow-up care after abnormal vision screenings, is paramount.”
Additionally, they noted that efforts to address barriers to pediatric eye care “should be focused on increasing awareness of the significance of vision and eye health in a child’s development, building more robust systems for data collection, and leveraging the expertise of pediatric eye care providers, primary care and community partners to increase access to eye care services among underserved populations.”
The researchers acknowledged several study limitations, including that they were restricted to a cross-sectional analysis of 2021 responses due to this being the first National Survey of Children’s Health to incorporate expanded vision screening and eye examination questions.
“In the future, it is possible that a trend analysis may be performed to measure changes over time,” the researchers added.
Perspective
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This study explores the impact of social determinants of health in acquisition of vision screenings and eye exams for children, while also highlighting the marked lack of eye care services in the overall pediatric population. The authors call on all eye care providers, pediatricians and community partners to prioritize the expansion of eye care services, with emphasis given to underserved populations.
These findings demonstrate the dire need for systemic change in improving health literacy and access when it comes to vision and eye care for children. Recent progress has been made with the introduction of the bipartisan Early Detection of Vision Impairments in Children Act, a call for pediatric and eye health mobilization by the American Optometric Association, and the formation of a Children’s Vision Strike Force by Ohio Gov. Mike DeWine and the Ohio Department of Health.
It is important to note that 2021 was the first time the National Survey of Children’s Health included questions about the outcomes of vision screenings and eye examinations. Analyzing this data in future surveys will be helpful in measuring the success of various public health campaigns promoting the importance of children’s vision care.
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