Free eye disease screenings in primary care clinics aid at-risk, underserved individuals
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Key takeaways:
- The most common reason for participants not getting an eye exam was lack of insurance.
- Underusing eye care services led participants to be underdiagnosed and undertreated.
People in underserved areas who took part in a free eye disease screening program were found to be underusing eye care services despite being at high risk, according to a study published in JAMA Ophthalmology.
“Fortunately, many causes of visual impairment can be treated,” Eric Sherman, MD, from the department of ophthalmology and visual sciences at Michigan Medicine, and colleagues wrote. “However, despite the projected increase in the prevalence of visual impairment, many who would benefit from eye examinations do not use eye care services. Inadequate access to eye care and affordability of care are barriers both for correcting refractive error by prescribing glasses and detecting and treating eye disease.”
In this cross-sectional study, Sherman and colleagues sought to determine whether the Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT) program — a CDC-funded service that provides eye disease detection to residents in two lower-income communities — was reaching those most at risk. They also aimed to understand reasons why individuals underused or did not use the program.
The researchers included 1,171 first-year MI-SIGHT participants (mean age, 55 years; 38% men), of whom 54% identified as Black or African American, 34% as white and 10% as Hispanic or Latino. Forty-three percent had no more than a high school education, and 70% reported an annual household income of less than $30,000.
Participants were recruited from a free primary care clinic and a federally qualified health clinic and received comprehensive eye disease screenings. They also completed surveys assessing health and previous eye care use.
According to results, 55% of participants reported they had not had an eye exam in at least 2 years, 5% reported never having had their eyes examined, 30% reported having their eyes examined in the past year, and 10% reported having their eyes examined 1 to 2 years ago. In addition, 44% of participants had not had their pupils dilated in more than 2 years and 12% had never had their pupils dilated.
Among those who had not had an eye exam in at least 2 years, 23% were aged 65 years or older, 33% self-reported diabetes, 25% had a family history of glaucoma, 3% had self-reported glaucoma, and 33% of Black or African American individuals were aged 50 years or older.
Further, of those who had gone more than 2 years without an eye exam, 21% screened positive for glaucoma, 20% for cataracts, 6% for diabetic retinopathy and 1% for age-related macular degeneration.
Reasons for not using eye care services ranged from not having insurance (28%) to not believing they had a reason to go (22%) and cost of examination (16%).
“Our findings underscore barriers to eye care among people living in poverty,” Sherman and colleagues wrote. “Policy change, such as implementing technology-based eye disease detection programs in [federally qualified health clinics], expanding Medicare to include coverage for glasses and eliminating cost-sharing for screening eye examinations, is needed to improve eye disease detection and treatment, especially in communities with high rates of poverty.”
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