Ophthalmologists know the stakes of missing childhood eye disease. Amblyopia, strabismus, and uncorrected refractive error can all have lifelong consequences, yet children often will not report symptoms – and may not even realize their vision is abnormal in the first place. Screening programs do exist, but screening is only the first step; the real question is whether children actually reach these eye care services.
A new population-based study published in the Journal of AAPOS examines that gap, using nationally representative US survey data to identify which sociodemographic factors are associated with receiving an eye examination. The findings highlight persistent inequities in pediatric eye care access – and point toward where interventions may be most urgently needed.
The University of Toronto researcher analyzed data from the 2022 National Health Interview Survey (NHIS), focusing on children under 18 for whom a caregiver reported whether the child had received an eye examination by an eye specialist within the previous 12 months. Of the 7,365 children included (mean age 8.8 years), only 39.5% had undergone an eye examination in the last year.
Age emerged as the strongest predictor. Compared with children aged 0–4 years, every older age group had markedly higher odds of receiving an eye exam, with adjusted odds ratios ranging from 4.16 to 6.91. This likely reflects a combination of increasing visual demands with school age, greater recognition of refractive errors, and the role of school screening and teacher referral in older children.
Parental education was also consistently associated with access. Children living in households where adults had completed high school, college, or postgraduate education were significantly more likely to have had an eye examination than those in households where the highest education level was less than high school. This finding echoes broader evidence that health literacy and familiarity with preventive care pathways strongly influence health care utilization, particularly for conditions where symptoms may be subtle.
Economic barriers were among the most clinically relevant determinants. Two factors stood out: lack of health insurance and forgoing medical care due to cost. In the multivariable model, uninsured children had substantially lower odds of an eye examination. Similarly, children whose caregivers reported avoiding medical care due to cost had an even lower likelihood of eye examination. In other words, when families are forced to triage healthcare spending, pediatric eye care is often not prioritized – even when clinically necessary.
One finding may surprise clinicians: children living with a parent who was neither married nor living with a partner had higher odds of receiving an eye examination than those with married/cohabitating caregivers. The study authors discuss possible explanations for this, including differences in eligibility for public insurance policies and healthcare utilization patterns, although the association persisted even after adjusting for insurance status.
Notably, race and geographic region were not independently associated with eye examination rates after multivariable adjustment, suggesting that disparities may be mediated more strongly through insurance, cost, and educational factors than through race or region alone.
For ophthalmologists, the study reinforces a critical reality: the children at highest risk of undetected visual problems – particularly younger children – are also the least likely to reach specialist eye care. It also underlines the importance of designing referral pathways that account for cost barriers and access friction, rather than assuming that a screening referral will automatically translate into an exam.
Ultimately, improving pediatric eye health across the US will require more than better screening tools. It will require systems that ensure follow-through – especially for families facing economic constraints – and public health strategies (e.g., targeted outreach initiatives) that make early eye examinations achievable, not just aspirational.
A new population-based study published in the Journal of AAPOS examines that gap, using nationally representative US survey data to identify which sociodemographic factors are associated with receiving an eye examination. The findings highlight persistent inequities in pediatric eye care access – and point toward where interventions may be most urgently needed.
The University of Toronto researcher analyzed data from the 2022 National Health Interview Survey (NHIS), focusing on children under 18 for whom a caregiver reported whether the child had received an eye examination by an eye specialist within the previous 12 months. Of the 7,365 children included (mean age 8.8 years), only 39.5% had undergone an eye examination in the last year.
Age emerged as the strongest predictor. Compared with children aged 0–4 years, every older age group had markedly higher odds of receiving an eye exam, with adjusted odds ratios ranging from 4.16 to 6.91. This likely reflects a combination of increasing visual demands with school age, greater recognition of refractive errors, and the role of school screening and teacher referral in older children.
Parental education was also consistently associated with access. Children living in households where adults had completed high school, college, or postgraduate education were significantly more likely to have had an eye examination than those in households where the highest education level was less than high school. This finding echoes broader evidence that health literacy and familiarity with preventive care pathways strongly influence health care utilization, particularly for conditions where symptoms may be subtle.
Economic barriers were among the most clinically relevant determinants. Two factors stood out: lack of health insurance and forgoing medical care due to cost. In the multivariable model, uninsured children had substantially lower odds of an eye examination. Similarly, children whose caregivers reported avoiding medical care due to cost had an even lower likelihood of eye examination. In other words, when families are forced to triage healthcare spending, pediatric eye care is often not prioritized – even when clinically necessary.
One finding may surprise clinicians: children living with a parent who was neither married nor living with a partner had higher odds of receiving an eye examination than those with married/cohabitating caregivers. The study authors discuss possible explanations for this, including differences in eligibility for public insurance policies and healthcare utilization patterns, although the association persisted even after adjusting for insurance status.
Notably, race and geographic region were not independently associated with eye examination rates after multivariable adjustment, suggesting that disparities may be mediated more strongly through insurance, cost, and educational factors than through race or region alone.
For ophthalmologists, the study reinforces a critical reality: the children at highest risk of undetected visual problems – particularly younger children – are also the least likely to reach specialist eye care. It also underlines the importance of designing referral pathways that account for cost barriers and access friction, rather than assuming that a screening referral will automatically translate into an exam.
Ultimately, improving pediatric eye health across the US will require more than better screening tools. It will require systems that ensure follow-through – especially for families facing economic constraints – and public health strategies (e.g., targeted outreach initiatives) that make early eye examinations achievable, not just aspirational.
