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Health insurance status associated with frequency of eye care visits

Individuals with no or inconsistent health care coverage appear less likely to regularly seek eye care, even if they are visually impaired, according to a report in the March issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Eye disorders have an estimated economic impact of more than $51 billion annually in the United States, according to background information in the article. "Recommendations for periodic eye examinations vary across ocular and medical organizations, but most recommend one- to two-year screening intervals depending on age and ocular risk factors," the authors write.

David J. Lee, Ph.D., of University of Miami Miller School of Medicine, and colleagues analyzed data from almost 290,000 individuals who participated in the National Health Interview Survey from 1997 through 2005. These adults age 18 and older reported whether they were visually impaired and whether they had seen an eye care professional in the previous year, along with sociodemographic information such as age, sex, education level, family income and insurance status.

In an analysis pooling all the years of data, 58.3 percent of individuals who were severely visually impaired, 49.6 percent of those with some visual impairment and 33.7 percent of those with no visual impairment reporting seeking eye care in the previous year. Rates of eye care use for individuals without health insurance were 35.9 percent among severely visually impaired, 23.8 percent among those with some visual impairment and 14.3 percent for those without visual impairment.

Low rates of eye care utilization were associated with no visual impairment, lack of health insurance, male sex and low education. The lowest rates were reported among individuals who were without health insurance for 12 months or longer: in this group, 11.3 percent of those with no visual impairment, 20.5 percent of those with some visual impairment and 33.5 percent of those with severe visual impairment accessed eye care.

"Interventions designed to increase eye care utilization rates in select sociodemographic subgroups are needed," the authors conclude. "Overall utilization rates may also be enhanced if progress is made toward dramatically increasing the number of Americans with health insurance."

(Arch Ophthalmol. 2009;127[3]:303-310. Available pre-embargo to the media at

Editor's Note: This study was supported by a grant from the National Eye Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Alternate Solutions to Universal Coverage Also Must Be Considered

The authors of the paper "assert that providing universal vision care coverage would insure that financial resources are no longer a barrier for those seeking access to a vision care provider," write Steven M. Kymes, Ph.D., M.H.A., and Kevin D. Frick, Ph.D., of Washington University School of Medicine, St. Louis, in an accompanying editorial.

"However, we must also consider whether this would indeed be the most effective method to achieve the social goal of increased use of vision care services," they continue.

"Lee and his colleagues have made an important contribution to this growing literature by examining barriers to vision care. However, the principles of scientific inquiry should not be shortchanged simply because we are debating a policy question rather than a biochemical one. The vision care community has an obligation to fully consider alternative solutions and their consequences in seeking way to remove barriers to vision care."


Contact: Kyla Gordon
JAMA and Archives Journals

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