Study: Vision testing rates at well-child visits low in US
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Key takeaways:
- Less than half of children and adolescents with private insurance received vision testing during a wellness visit.
- The rates were even lower rates among patients without private insurance.
Despite guidelines recommending yearly testing, the probability of receiving a vision test from a primary care physician was low in youth and varied by insurance status, a recent study found.
“As an ophthalmologist, I know how important it is to diagnose and treat pediatric eye diseases early, before they cause permanent vision loss,” Olivia J. Killeen, MD, MS, a health services researcher at the University of Michigan Kellogg Eye Center, told Healio. “Because children often are not aware that they have an eye problem, routine vision testing can help identify children with potential eye disease. That is why childhood vision testing in schools or primary care offices is so important.”
According to Killeen and colleagues, the American Academy of Pediatrics recommends that children start receiving annual vision testing during wellness visits at age 3 years. However, previous studies have indicated that testing rates in this population are low.
“The PCP vision testing rates for U.S. individuals aged 3 to 17 years and the vision testing-insurance association are unknown,” they wrote in JAMA Ophthalmology.
Therefore, the researchers evaluated 2018 to 2020 National Survey of Children’s Health data to assess the frequency of vision testing among pediatric primary care patients. For the survey, parents were asked if their child had their vision tested during the past 12 months and where the testing took place.
The analysis included 89,936 participants aged 3 to 17 years (mean age, 10 years), 51.8% of whom were boys.
The researchers found that only 30.7% of the participants received PCP vision testing.
The adjusted odds of receiving vision testing dropped by 24% (adjusted OR = 0.76; 95% CI, 0.7-0.82) for those with public insurance and 41% (aOR = 0.59; 95% CI, 0.49-0.72) for those who were uninsured compared with participants who had private insurance.
Overall, Killeen and colleagues estimated that the probability of PCP vision testing was:
- 22% (95% CI, 18.8-25.2) for those who were uninsured;
- 26.6% (95% CI, 25.3-27.9) for those publicly insured; and
- 32.3% (95% CI, 31.4-33.2) for those privately insured.
For participants aged 3 to 5 years, the estimated probability of PCP vision testing was:
- 29.7% (95% CI, 25.6-33.7) for those who were uninsured;
- 35.2% (95% CI, 33.1-37.3) for those publicly insured; and
- 41.6% (95% CI, 39.8-43.5) for those privately insured.
“[These data give] us a baseline,” Killeen said. “It tells us that we have an opportunity to improve the early detection and treatment of eye disease by improving primary care vision testing.”
She said there are several reasons why a vision test may not occur during a visit.
“First, vision testing can be difficult, especially in young children or children who have difficulty cooperating,” Killeen said. “Moreover, vision testing is just one of many things that pediatric primary care physicians are supposed to do at well-child visits. It can be challenging to fit vision testing in with all of the other important parts of a visit, including other screening tests, counseling families about nutrition or vaccines, etc.”
The researchers noted that the study was limited given that parents or caregivers may have been unaware of whether testing was performed or what the test consisted of. Killeen and colleagues also wrote that they did not analyze the implication of gaps in insurance coverage for PCP vision testing, and that the COVID-19 pandemic may have influenced the findings.
“To increase vision testing rates, it should be built into the visit so that is a routine part of well-child visits just like measuring a child’s height or weight,” Killeen said. “There are devices called photoscreeners, which are automated vision screening tests for young children; these devices can save time and make vision testing easier for doctors and their staff.”
Perspective
Back to TopDonny W. Suh, MD, FAAP, MBA, FACS & Kourosh Shahraki, MD
The recent article sheds light on a concerning issue: the low rates of vision testing conducted by PCPs among children and adolescents, with notable disparities based on insurance status. The study underscores the significance of vision testing in identifying potential vision problems that hinder learning and contribute to the risk of amblyopia.
The study reveals a striking contrast in PCP vision testing rates, which are contingent upon insurance status. Alarmingly, less than half of children with private insurance underwent the recommended yearly testing, and even fewer children without private insurance received such testing. It is evident that there exist substantial disparities in access to vision testing, which can have enduring consequences for children's visual health and academic performance.
To rectify the disparities in PCP vision testing, targeted endeavors are imperative. Firstly, health care policies should prioritize vision screenings during well-child visits, ensuring that all children receive regular eye examinations. This objective can be achieved by advocating for insurance coverage that supports vision testing.
Secondly, raising awareness among parents regarding the importance of PCP vision testing is paramount. Educating families about the benefits of early detection can empower them to prioritize screenings and seek appropriate care for their children's vision.
Thirdly, health care systems should allocate resources to PCP training and comprehensive vision screenings. This can be accomplished through medical education programs and collaborative efforts with eye specialists to ensure accurate screenings.
The study's findings underscore the urgent necessity of addressing the disparities in PCP vision testing, particularly among children aged 3 to 5 years. Enhancing access to comprehensive vision care for all children, irrespective of their insurance status, is crucial to ensure early detection and intervention for vision problems.
Through the implementation of policy changes, increased awareness and improved PCP training, we can strive toward a future in which every child receives the necessary vision screenings to optimize their visual health and educational outcomes.
Perspective
Back to Top
Coming out of the pandemic, a recent analysis estimated that by 2060, 26% of children between 3 and 5 years of age will have some form of visual impairment, owing in part to vision loss easily prevented by early detection. Combined with the assertions that fewer than one-third of all children — and a disproportionately lower number of children who are uninsured — are receiving screenings through their pediatrician or PCP, there is a clear and systemic issue and gap in care that doctors of optometry are ready to address.
According to the American Optometric Association's (AOA’s) clinical practice guidelines, infants 6 to 12 months of age should visit a doctor of optometry for an assessment and then again for an exam at age 3 and 5 years before entering kindergarten. After that, children and adults should receive yearly comprehensive eye exams, unless otherwise advised by their doctor of optometry. This review underscores that children are not getting the screenings at the PCP’s office, much less getting an in-person, comprehensive eye exam to help protect their eye health and vision.
Recognizing the significant burden already placed on America’s PCPs, this review points to the need to work with doctors of optometry to provide access to care for all children. Individually, doctors of optometry have worked with pediatricians in their communities to ensure that referral loops are closed and that children who fail vision screenings receive needed follow-up care. By working together as a referral team, we can accomplish the type of awareness that we all agree is so critical to improve sight for millions of our children, improve health outcomes increase productivity, offer children better futures and lessen multisector disparities.
The AOA is actively developing a nationwide and cross-professional strategic to develop and activate solutions that will close this important gap and look forward to further conversations with PCPS, teachers, policymakers and all stakeholders vested in protecting the eye health and vision of our next generation.
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