Study: 1 in 4 US Adolescents Did Not Receive Vision Testing in Past Year

Isdin Oke, MD, MPH

Credit: Harvard Ophthalmology

A nationally representative survey of approximately 25,000 adolescents in the United States revealed close to 1 in 4 adolescents did not receive vision testing within the previous year.¹

Patterns of vision testing in adolescents were observed to decrease as a function of age, sex, or insurance status, as well as caregiver education level, country of birth, and socioeconomic status. Those from socioeconomically disadvantaged backgrounds were less likely to report receiving vision testing in a clinical setting, but similarly likely to have reported testing in a school-based setting.

“Shifts in the setting of care delivery may create barriers for those who have difficulty accessing subspecialty care,” wrote the investigative team, led by Isdin Oke, MD, MPH, Boston Children’s Hospital. “Health insurance, transportation, and language barriers may delay the establishment of care and interfere with the appropriate treatment and follow-up.”

Vision impairment during adolescence is typically due to refractive error – untreated refractive error has been linked to racial, ethnic, and socioeconomic disparities in visual function among children in the US.² Vision testing allows for the identification of ocular conditions, including untreated refractive error, but most states do not have mandates for testing in adolescence, compared with early school age.¹

Oke and colleagues noted the settings for vision evaluation, the patterns in testing as a function of age, and sociodemographic factors associated with testing have not previously been described using a nationally representative cohort of adolescents in the US. The analysis included all adolescent children from the 2018 to 2019 National Survey of Children’s Health (NSCH) survey cycles. Data were analyzed from March - August 2023.

Children were selected to participate in the NSCH using stratified random sampling. A caregiver considered most knowledge about the well-being of a child completed the survey. Caregivers were asked if a child had their vision tested within the past 12 months and asked to select the setting in which the testing occurred, including an eye clinic, primary care clinic, or school setting.

The survey included variables on age, sex, race, ethnicity, insurance type, household income, educational level of caregivers, household generation, and primary household language. For the analysis, linear regression was used to describe patterns in reported vision testing as a function of age. Logistic regression models were used to evaluate the association between reports of vision testing and sociodemographic factors, adjusting for age and sex.

A total of 24,752 adolescents were included in the analysis, with a mean age of 14 years, and consisting of 49% females (n = 11,834). Previous vision testing in any setting within the prior 12 months was reported by the caregivers of 18,621 adolescents (74%). Testing occurred at an eye clinic (51%), primary care clinic (22%), school (11%), and health center (4%).

Analyses showed the percentage of adolescents reporting vision testing in any setting decreased with age (–1.3% per year; 95% CI, –2.5% to 0% per year). The pattern was associated with a decrease in reported vision testing in the primary care setting (–2.8%; 95% CI, –4.3% to –1.4% per year) and the school-based setting (–2.4% per year; 95% CI, –3.3% to –1.5% per year).

Patterns showed the percentage of adolescents who reported receiving vision testing in an eye clinic did not differ by age (0.5% per year; 95% CI, –0.7% to 1.6% per year). In the multivariable analysis, adjusted for age and sex, there were lower odds of vision testing for adolescents who were uninsured (adjusted odds ratio [aOR], 0.81; 95% CI, 0.76 - 0.87), had caregivers with less than a high school education (aOR, 0.89; 95% CI, 0.84 - 0.95), and were from a family born outside of the US (aOR, 0.90; 95% CI, 0.82 - 0.98).

Oke and colleagues suggested both language- and education-related barriers may have contributed to differences in caregiver-reported vision testing. They noted efforts to expand the role of school-based vision testing, particularly for those from socioeconomically disadvantaged backgrounds, could help address existing disparities in untreated refractive error among adolescents.

“Limited access to vision testing may delay the identification and treatment of ocular conditions and contribute to the inequities in visual function (and related educational and employment opportunities) in the adolescent population,” investigators wrote.

References

1. Oke I, Slopen N, Hunter DG, Wu AC. Vision Testing for Adolescents in the US. JAMA Ophthalmol. Published online October 12, 2023. doi:10.1001/jamaophthalmol.2023.4475
2. Iapoce C. Visual health disparities by race, ethnicity reported in children in United States. HCP Live. September 15, 2022. Accessed October 16, 2023. https://www.hcplive.com/view/visual-health-disparities-race-ethnicity-children-united-states.