Vision Testing for Adolescents in the US

Abstract

ImportanceUntreated refractive error contributes to the racial, ethnic, and socioeconomic disparities in visual function of adolescent children in the US.ObjectiveTo describe patterns in vision testing as a function of age among US adolescents and identify sociodemographic factors associated with vision testing.Design, Setting, and ParticipantsThis cross-sectional study used data from the National Survey of Children’s Health (2018-2019), a nationally representative survey of the noninstitutionalized US pediatric population. A total of 24 752 adolescent children (aged 12 to <18 years) were included. Data were analyzed from March 22 to August 11, 2023.Main Outcomes and MeasuresThe primary outcome was the caregiver report of vision testing within the last 12 months. Linear regression was used to describe the patterns in reported vision testing as a function of participant age. Logistic regression was used to describe the association of sociodemographic factors with the report of vision testing in each setting.ResultsAmong 24 752 adolescents, the median (IQR) age was 14 (13-16) years; 12 918 (weighted, 51%) were male. Vision testing in any setting within the previous year was reported by caregivers of 18 621 adolescents (weighted, 74%). Vision testing was reported to have occurred at an eye clinic in 13 323 participants (weighted, 51%), at a primary care clinic in 5230 participants (weighted, 22%), at a school in 2594 participants (weighted, 11%), and at a health center in 635 participants (weighted, 4%). The percentage of adolescents reported to have vision tested decreased with age (−1.3% per year; 95% CI, −2.5% to 0% per year) due to a decrease in testing in primary care and school settings. After adjusting for age and sex, there were lower odds of vision testing reported for adolescents who were uninsured vs insured (adjusted odds ratio [AOR], 0.81; 95% CI, 0.76-0.87), had caregivers with less than vs greater than high school education (AOR, 0.89; 95% CI, 0.84-0.95), and were from a family born outside vs inside the US (AOR, 0.90; 95% CI, 0.82-0.98).Conclusions and RelevanceIn this cross-sectional study, vision testing in adolescents decreased as a function of age due to fewer reported tests performed in primary care and school-based settings. Relative to children in socioeconomically advantaged families, those from disadvantaged families were less likely to report receiving vision testing in clinical settings. Efforts to expand the role of school-based vision testing for older adolescents from disadvantaged backgrounds may enable opportunities to address disparities in untreated refractive error.

Vision Screening for Children

“…Her narrative highlights the important role of school-based vision care, 2 especially for children who may otherwise have limited access to clinical resources. 3 As a physician caring for children referred for failed vision screening, Dr Jastrzembski shared astute observations regarding inequities in the burden of false-positive screening results. Opportunity costs of lost time and productivity for caregivers are not consistently included in economic evaluations of vision screening, 4 and this burden may disproportionately affect those from socioeconomically disadvantaged backgrounds.…”

Gaps in the Vision Screening Pathway for School-Aged US Children

“…Vision screening is a fundamental component of preventive health care delivered to children worldwide . In the US, children may receive vision screening in multiple settings, including primary care clinics, schools, and community events . However, the multifaceted approach and variability in vision screening policies may result in missed care for children with preventable vision loss .…”

Vision Screening for Children

“…To the Editor In their article titled “Gaps in the Vision Screening Pathway for School-Aged US Children,” Oke et al discuss the “evidence of inequitable opportunities for access to vision screening and subsequent care experienced most often by socioeconomically vulnerable groups.” I wholeheartedly endorse this statement, and for a very personal reason: I was from one of those vulnerable groups.…”