Sociodemographic Factors Continue to Influence US Pediatric Eye Care Access

A cross-sectional study investigated the associations between sociodemographic and health characteristics and receipt of eye care among children and adolescents in the United States.

Study Design

Data were extracted from the 2021 National Survey of Children’s Health (NSCH), a population-based survey of randomly sampled households. About 51,000 completed surveys were received from parents and caregivers.

Outcomes

Fifty-three percent of children had received at least one vision screening (within the past year for children aged ≤5 years and within the past 2 years for children aged >5 years). Twenty-seven percent of children screened were referred to an eye doctor. Younger age, fewer health care visits, no insurance coverage, lower parental education levels, and lower household income were factors associated with decreased odds of vision screening. Referrals to an eye doctor after screening were more likely in children who were of Hispanic, non-Hispanic Black, or non-Hispanic Other race/ethnicity and those from households where the primary language was not English.

Limitations

Reported rates of vision screening and eye examinations must be interpreted with caution, as the study’s results were based only on responses of survey respondents, which may not be representative of the general population. Another potential limitation of the study is reporting errors; for example, some survey respondents might not have known the difference between a vision screening test and a full eye examination.

Clinical Significance

Because the 2021 version of the NSCH introduced questions to determine the prevalence of vision screening as well as subsequent referrals and visits to an eye doctor, the survey results provide some insights into pediatric vision care in the United States and the impact of patient and sociodemographic characteristics on access to eye care services. The authors found that children coming from disadvantaged backgrounds are less likely to receive vision screening and eye care. Based on these findings, they suggest the following targeted strategies to improve this access: 1) promoting health literacy among parents and caregivers, emphasizing the importance of follow-up after abnormal vision screening results through the use of low-literacy–targeted, culturally sensitive, multilingual educational resources; 2) educating primary health care providers and school nurses to facilitate proactive engagement with families facing barriers to eye care; and 3) exploring collaborative partnerships with vision providers who offer community- or school-based vision programs.

Financial Disclosures: Dr. Phoebe Lenhart discloses no financial relationships.