Expanded School-Based Vision Testing May Help Address Disparities, Study Says

The decrease in vision testing as a function of age in primary care and school-based settings led to an overall decrease in vision testing in adolescents, according to a study published in JAMA Ophthalmology. Children from socioeconomically disadvantaged families were less likely to report vision testing done in a clinical setting.

Visual impairment in adolescence is primarily caused by refractive error, and racial, ethnic, and socioeconomic disparities in visual function can be traced to untreated refractive error. Ocular conditions can be identified through vision testing, but mandates for vision testing are only mandated in a few states for adolescents compared with early school–aged children.

This study aimed to describe the settings of vision evaluations, patterns of vision testing, and sociodemographic factors associated with vision testing while using a nationally representative cohort of adolescents living in the United States.

Little boy undergoing eye test in clinic | Image credit: Pixel-Shot - stock.adobe.com

The researchers used a cross-sectional design for the study and used data from the National Survey of Children’s Health (NSCH), which is a nationally representative survey of the pediatric population in the United States. All adolescent children aged 12 to 18 years who took part in the 2018 and 2019 NCSH survey cycles were included. Data was evaluated from March 22 to August 11, 2023. All caregivers were asked if their child had been given a vision test within the previous 12 months and where the vision test occurred.

Age, sex, race, ethnicity, insurance, household income, education level of caregivers, primary household language, and household generation were all collected data for this study. Linear regression was used to describe patterns in vision testing and age.

There were 24,752 adolescents who were included in this study, of which 51% were male and the median (IQR) age of the entire cohort was 14 (13-16) years. A total of 74% reported vision testing in any setting within the previous 12 months, with 51% getting a vision test at an eye clinic, 22% getting one at a primary care clinic, 11% getting one at school, and 4% getting one at a health center.

Percentage of adolescents who reported having a vision test decreased with age (­–1.3% per year; 95% CI, –2.5% to 0%). There was a decrease of adolescents who reported having a vision test in a primary care setting (–2.8% per year; 95% CI, –4.3% to –1.4%) and a school setting (–2.4% per year; 95% CI, –3.3% to –1.5%), which was associated with the pattern of decreasing vision tests overall. Adolescents reporting receiving a vision test at an eye clinic did not differ by age (0.5% per year; 95% CI, –0.7% to 1.6%).

Adolescents who were male, uninsured, had caregivers with lower education levels, were born outside of the United States, and did not speak English as their primary language were found to be more likely to have not reported a vision test. Vision testing was less likely in adolescents who were uninsured vs insured (adjusted odds ratio [aOR], 0.81; 95% CI, 0.76-0.87), had care givers with less than high school education vs more than (aOR, 0.89; 95% CI, 0.84-0.95), and were a family born outside the United States vs in the country (aOR, 0.90; 95% CI, 0.82-0.98).

There were some limitations to this study. The study was reliant on the recall of the caregivers and sociodemographic factors could have affected that ability to recall, as it could affect the degree of involvement in a child’s health care.

The researchers concluded that children who would benefit most from vision tests need to be identified to properly treat impaired vision. Children from socioeconomically disadvantaged backgrounds appear to be the least likely to have vision tests in clinic-based settings, and expanding school-based vision testing may help address disparities in this area, the authors concluded.

Reference

Oke I, Slopen N, Hunter DG, Wu AC, et al. Vision testing for adolescents in the US. JAMA Ophthalmol. Published online October 12, 2023. doi:10.1001/jamaophthalmol.2023.4475