Primary Care Vision Testing Rates Associated with Health Insurance Status

An analysis of 2018-2020 National Child Health Survey (NSCH) studies showed low rates of primary care vision screening for children, with marked differences by insurance status.¹

Recommendations list the need for annual vision screenings for children ages 3 to 5. However, analyzes report that fewer than half of children with private insurance have their eyes tested, and even less among children without private insurance. .

A research team led by Olivia J. Killeen, M.D., of the University of Michigan, said: “Vision screening by primary care physicians is critical to identifying vision problems that interfere with learning and risk factors for amblyopia before vision loss.” Says. “The findings of this analysis are based on studies reporting associations between insurance status and unmet eye care needs.”

Undiagnosed vision problems are associated with amblyopia or lazy eye, a loss of vision in one eye caused by abnormal visual development early in life.² The American Academy of Pediatrics recommends vision screening during wellness visits from age 3, but local studies have found screening rates to be low.³ Testing rates for individuals aged 3 to 17 years in the United States and the relationship between vision testing and insurance are unknown.

For the current analysis, researchers pooled data from nationally representative cross-sectional 2018-2020 NSCH studies.¹ Parents or caregivers were asked, “During the past 12 months, has this child been tested for visual acuity with pictures, graphics, letters, etc.?” The place where the test was performed (e.g. ophthalmologist, pediatrician, other general practice, doctor’s office, health center, school, etc.).

Investigators obtained insurance eligibility (public only, private only, private and public, or no insurance) from a parent or caregiver. After classifying private and public insurance into private-only categories, the analysis left him with three insurance categories: uninsured, public insurance, and private insurance. Study covariates included survey year, age (3–5 years, 6–11 years, or 12–17 years), sex, race and ethnicity, preventive health visits in the previous year, and special medical needs. It is included.

Multivariate logistic regression adjusted for covariates to assess the probability of vision screening for primary care physicians by insurance status. The study sample included 89,936 participants, of whom 48.1% were female, with a mean age of 10.1 years. Upon analysis, the researchers estimated that 30.7% of the study sample had an eye exam by a primary care physician.

The analysis showed a 41% reduction in adjusted odds for visual acuity testing (odds ratio [OR]0.59; 95% CI for uninsured participants, 0.49–0.72) and 24% for public and privately insured participants (OR, 0.76; 95% CI, 0.70–0.82).

The researchers found that the adjusted probability of a primary care physician’s vision screening was 22.0% (95% CI, 18.8%–25.2%) for uninsured persons and 26.6% (95% CI, 25.3%–25.2%) for those with public insurance. 27.9%) and 32.3%. For private policyholders (95% CI, 31.4% to 33.2%).

The estimated probability of vision screening at ages 3–5 years was 29.7% (95% CI, 25.6%–33.7%) for uninsured persons and 35.2% (95% CI, 33.1%–37.3%) for those with public insurance, It was 41.6%. % (95% CI, 39.8% to 43.5%) for children with private insurance.

Investigators noted that parents and guardians may not know the details of vision screening, which may have led to under- or over-reporting of the Health Vision Screening Association, and that parents and guardians should not be informed about vision screening. He pointed out that the availability of information is limited. However, the team did not analyze the impact of gaps in insurance coverage for primary care physician vision screenings.

“The results may also have been influenced by the COVID-19 pandemic, which has reduced the use of preventive services and continued Medicaid eligibility,” the researchers wrote.

References

1. Killeen OJ, Choi H, Kannan NS, Asare AO, Stagg BC, Ehrlich JR. Association between health insurance and primary care vision screening in children and adolescents. JAMA Ophthalmology. Published online on August 17, 2023. doi:10.1001/jamaophysicalmol.2023.3644
2. Boyd K. Amblyopia: What is the Lazy Eye? American Academy of Ophthalmology. April 6, 2023. Accessed 21 August 2023. https://www.aao.org/eye-health/diseases/amblyopia-lazy-eye.
3. Hagan JF Jr., Shaw JS, Duncan PM, eds. Bright Future Guidelines for Infant, Child and Adolescent Health Care. American Academy of Pediatrics, 4th Edition. 2017