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 All of the nearly 900,000 children in the study were covered by a
national health insurer, but still, there were disparities in their
access to eye care, researchers report in Health Affairs.
Experts advise that all children under age 5 be screened for two eye
diseases, strabismus and amblyopia. In strabismus, the eyes are not
aligned with each other, causing double vision. To get rid of the
double vision, the brain will ignore sight from one of the eyes,
which can lead to the development of amblyopia, or so-called “lazy
eye,” in which vision from that eye is permanently reduced.
“The earlier in life strabismus is detected and properly treated,
the less likely the eye will become ‘lazy’ and the more likely any
vision loss that may have occurred can be reversed,” said lead
author Dr. Joshua Stein of the University of Michigan.
People need to know the importance of testing for these
sight-threatening diseases in children, Stein added by email.
To determine the effect of wealth on eye care visits and diagnoses
of these two conditions, Stein and his colleagues used healthcare
data on 890,090 U.S. children between 2001 and 2014. The children
were from families of varying wealth levels, but all had the same
type of health insurance.
The researchers found that children in the lowest wealth category
had 16 percent fewer visits to any eye care professional than those
at the middle wealth level, while children at the highest wealth
level had 19 percent more visits than middle-income kids.
A similar trend was seen for visits to ophthalmologists, medical
doctors who treat eye diseases like strabismus and amblyopia.
For visits to optometrists, who are more likely to conduct
screenings and provide glasses, the middle wealth category had the
highest number of visits.
Children from less wealthy families were also older at their first
visit to the eye doctor.
Compared to those in the middle wealth category, lower income
children were 15 percent less likely to have their first eye doctor
visit during the study period, while higher net worth children were
19 percent more likely to have a first visit.
Wealthier children were 64 percent more likely to be diagnosed with
strabismus by age 10 than the lowest income group and 55 percent
more likely to be diagnosed with amblyopia.
Assuming the wealthiest kids were not being misdiagnosed, the
authors calculate that the differences mean a lot of cases of eye
disease are being missed in less-wealthy children.
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Specifically, they estimate there were nearly 13,000 missed
strabismus diagnoses and 5,000 missed amblyopia diagnoses over a
10-year period just in their sample group.
Even for families with health insurance, having a lower income can
cause logistical issues in seeking eye care, said Cathy Williams, a
senior researcher at the National Institute for Health Research.
Williams, who was not involved in the study, said eye care providers
might be located far from low-income housing sites and that lower
income families may not understand the need for this type of vision
screening.
“It may be more difficult for parents to take time off from work to
take their children to an eye care professional, compared with more
affluent families,” Stein said, adding that copayments and
deductibles might also be an issue for lower-wealth families.
Williams said vision screenings are important to catch other types
of sight problems as well. “If having blurred vision in both eyes
reduces a child’s ability to learn and engage with their education,
as it may, this could lead to lasting reductions in their life
chances - all for the want of glasses,” she said by email.
Stein noted that vision screenings sometimes take place at schools
or health fairs. “If one’s child has a failed vision screening, it
is essential to promptly take him or her to an eye care professional
so they can further evaluate the child to check for these serious
eye diseases,” he said.
SOURCE: bit.ly/2b9j6kN Health Affairs, August 2016.
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