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Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions
Victoria K Yu1, Kristina Tarczy-Hornoch2,3, Susan A Cotter4
1USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California.
Insights
Comprehensive eye exams are rare in preschool children, even those with vision issues. Factors like older age and vision insurance increase exam rates, highlighting the need for better access and parent education.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Public Health
Background:
- Comprehensive eye examinations are crucial for detecting vision impairments in early childhood.
- Undetected visual conditions can lead to long-term developmental and learning challenges.
Purpose of the Study:
- To determine the prevalence of comprehensive eye examinations in a multiethnic preschool population.
- To identify factors associated with receiving these examinations, particularly in children with existing eye conditions.
Main Methods:
- Analysis of data from 9,197 children aged 6-72 months in the Multi-Ethnic Pediatric Eye Disease Study (2003-2011).
- Logistic regression was used to identify independent factors linked to parent-reported comprehensive eye examinations.
Main Results:
- Overall prevalence of comprehensive eye examinations was low (6.3%).
- Prevalence was higher in children with strabismus (38.3%) and amblyopia (24.8%), but still low overall.
- Factors associated with higher examination rates included older age, higher caregiver education, vision insurance, prematurity, neurodevelopmental disorders, and existing ocular conditions.
Conclusions:
- Comprehensive eye examinations are significantly underutilized in preschool-aged children, including those at high risk for vision disorders.
- Interventions targeting parent education and expanding vision insurance coverage are essential to improve access and utilization for at-risk children.
Introduction:
The purpose of this study is to assess the prevalence of comprehensive eye examinations in multiethnic preschool children, including children with visually significant eye conditions, and identify factors associated with comprehensive eye examinations.
Methods:
A sample of 9,197 African American, Hispanic, Asian American, and non-Hispanic White children aged 6-72 months was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003 to 2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of comprehensive eye examinations. The proportion of children with previous comprehensive eye examinations and the proportion with undetected amblyopia or strabismus were measured.
Results:
The prevalence of comprehensive eye examinations was 6.3% overall and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior comprehensive eye examinations were more likely to have undetected amblyopia or strabismus than those with comprehensive eye examination history (ps<0.001). The prevalence of comprehensive eye examinations was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of non-Hispanic White, Asian American, African American, and Hispanic children having had prior comprehensive eye examinations, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all statistically significantly associated with a relatively higher prevalence of comprehensive eye examinations in multivariable analyses.
Conclusions:
Comprehensive eye examinations were uncommon among preschool children, including those with treatable vision disorders. Interventions, such as parent education and vision insurance, are needed to imaprove comprehensive eye examination access and utilization for at-risk preschool children.
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