In data from the 2018-2020 National Survey of Children’s Health, an annual, nationally representative cross-sectional study, fewer than half of children aged 3-5 with private insurance received vision testing, with rates even lower in those lacking private insurance. The findings point to unmet eye care needs, especially in young children for whom early testing to ward off vision loss is highly recommended.
The report was published online in JAMA Ophthalmology by Olivia J. Killeen MD, MS, an ophthalmologist during the study in the department of ophthalmology and visual sciences at the University of Michigan, Ann Arbor, and colleagues.
Grace Han
Dr. Olivia J. Killeen
Future work should focus on improving primary care provider vision screening rates, especially for the 3- to 5-year age group, the authors wrote.
“Because children often are not aware they have an eye problem, routine vision testing in the primary care setting can help identify those with potential eye disease,” Dr. Killeen said. “We have an opportunity to improve the early detection and treatment of eye disease by improving primary care vision testing.”
Childhood vision testing, which falls into the vital signs section of the wellness check, is critical because undiagnosed problems can cause amblyopia or “lazy eye.” The American Academy of Pediatrics recommends vision testing at well-child visits starting at age 3. Regional studies,however, have suggested low rates of PCP vision testing.
Study findings
In a sample of 89,936 participants, with a mean age of 10 years (51.1% male), an estimated 30.7% overall received vision testing in primary care. Adjusted odds of vision testing in primary care decreased by 41% (odds ratio, 0.59; 95% confidence interval [CI], 0.49-0.72) for uninsured and by 24% (OR, 0.76; 95% CI, 0.70-0.82) for publicly insured participants vs. those with private insurance.
Adjusted estimated probability of vision testing was 22% (95% CI, 18.8%-25.2%) for uninsured participants, 26.6% (95% CI, 25.3%-27.9%) for those publicly insured, and 32.3% (95% CI, 31.4%-33.%) for those privately insured.
In children aged 3-5, estimated probability was 29.7% (95% CI, 25.6%-33.7%) for those 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 – all well under 50%. The children least likely to be tested, regardless of insurance status, were adolescents aged 12-17.
Commenting on the study but not involved in it, Natalie J. Choi, MD, assistant professor of family medicine at Northwestern Medicine in Chicago, noted that the authors did not address other screening venues such as schools. She also pointed out that it is challenging for primary care physicians to address all the recommended prevention measures in addition to acute issues during an office visit.
Northwestern University
Dr. Natalie J. Choi
“Oftentimes parents are the first to notice a concern about vision, and parental concerns are routinely addressed in primary care,” she said.
According to Dr. Killeen, vision testing should always be worked into the exam flow as a routine part of well-child visits. “There are devices called photoscreeners which provide automated vision tests for young children and can save a lot of time and make vision testing less burdensome for physicians and their staff,” she said. Not all primary care offices, however, offer these testing modalities.
Dr. Choi said low vision screening rates are part of the larger problem of preventive care. “In the study, the percentage of children attending a preventive health visit within the last 12 months varied by insurance coverage and was definitely not 100%,” she said. “Investing in preventive medicine helps us identify things before they become a problem, so I would love to see the number of well-child checks increase.” Identifying this gap in vision care is one of many steps, she said.
This work was supported by the University of Michigan National Clinician Scholars Program and by an unrestricted grant to the University of Michigan Department of Ophthalmology and Visual Sciences from Research to Prevent Blindness. Study coauthor Brian C. Stagg, MD, reported a grant from the National Eye Institute during the conduct of the study. Dr. Choi disclosed no conflicts of interest relevant to her comments.