New research suggests a lack of access to vision care services has contributed to racial, ethnic and socioeconomic disparities in visual function among Black, Hispanic and poorer adolescents.
Findings of a new study published Thursday in JAMA Ophthalmology reveals approximately 16% of Black and 18% of Mexican American adolescents had worse than 20/40 vision in their better-seeing eye compared to 7% of white adolescents. After correcting for visual impairment, 3% of Black and 3% of Mexican American adolescents still had worse than 20/40 vision compared to 1% of white adolescents.
The findings are based on data from the Centers for Disease Control and Prevention’s 2005-2008 National Health and Nutrition Examination Survey, where researchers analyzed the questionnaire responses and vision examination results of nearly 3,000 adolescents between the ages of 12 and 18.
In addition to visual acuity, study researchers measured adolescent perceptions about their own vision to gauge how those views aligned with their actual eyesight function..
Approximately 12% of Black and 12% of Mexican American adolescent children perceived their visual function as being poor, according to the study, compared to just 4% of white adolescents. Perceptions of poor visual function were also more prevalent among children living in lower-income households, in households with six or more individuals, and among those with non-U.S. citizen status, the study found. But researchers found the racial disparities in children’s perceptions of their visual function remained present even after adjusting for socioeconomic status.
Study co-author Dr. Idsin Oke, a clinical scientist and pediatric ophthalmologist at Boston Children’s Hospital, says studying both the actual vision acuity of adolescents as well as their feelings about their vision could provide opportunities to examine how their perceptions might impact their ability to socially interact, and whether they contribute to elevated levels of depression and anxiety. Longer term, poor vision has been associated with increased risk of injury, social isolation, loss of productivity and premature death.
“It’s really hard to quantify how much of an impact living your whole life with subtly decreased vision compared to your peers is, but it certainly could be considered a disadvantage,” Oke says. “The big goal of this is to try to figure out the best ways to make interventions that can address these differences.”
Previous studies have highlighted disparities in visual function between white and non-white adults. A 2012 study published in the American Journal of Ophthalmology found white adults had a higher prevalence of age-related macular degeneration and cataract surgery but a lower prevalence of glaucoma and retinopathy related to diabetes compared to Black adults.
Oke says the findings highlight the importance of addressing barriers that could hinder access to vision care services for racial and ethnic minority youth.
“We really should be more aware of the existence of these racial and ethnic disparities in visual function,” Oke says. “What we are identifying among adults may actually be present from a very early age and it’s certainly detectable by adolescence.”
The findings also suggest most of the vision impairments found among adolescents can be addressed by increasing access to eye exams where poor vision can be spotted and most cases can be corrected with eyeglasses or contact lenses.
Dr. Victoria Tseng, assistant professor in the Department of Ophthalmology at UCLA Health, says a separate recently published review of research literature she took part in authoring for the American Academy of Ophthalmology had similar findings as the JAMA Ophthalmology study, concluding racial and ethnic disparities could be found in visual impairment from a variety of conditions, with the most common being higher untreated rates of refractive error, commonly known as the need for eye glasses or contact lenses.
Since the 1970s, UCLA Health has operated its Mobile Eye Clinic that provides free vision care outreach services to medically underserved communities throughout Los Angeles County. Much of the program’s work is spent on weekdays conducting vision screenings in preschools checking children who may be at risk for common eye conditions like amblyopia, or lazy eye. Children with vision issues are seen by a clinic ophthalmologist who can prescribe free eyeglasses and give instructions for follow-up visits.
Tseng describes the mobile eye clinic as being the ‘frontline’ for vision care services in many communities where residents may have never visited an eye care provider. While some services like providing eyeglasses can be done immediately on-site, for more complex eye conditions, the clinic helps connect patients for follow-up care at a health system clinic and provides assistance in signing up uninsured patients with health care coverage.
“That’s kind of the best we can do in that scenario,” Tseng says.