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Area Deprivation and Social Vulnerability Are Associated with Pediatric Vision Screening Outcomes in the University
Jainam Shah1,2, John D Hong3, Kimia Rezaei3,4
1Gavin Herbert Eye Institute, University of California, Irvine, CA, USA. jainam.shah@einsteinmed.edu.
Background:
The Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are nationally validated neighborhood-level measures of socioeconomic disadvantage but remain understudied in pediatric ophthalmology. We examined associations between ADI/SVI and school-based vision screening outcomes, refractive error (RE), best-corrected visual acuity (BCVA), and amblyopia suspect status.
Methods:
We conducted a retrospective study of children aged 3-10 years screened by the UCI EyeMobile program (Orange County, California, United States) from 2021-2024. Among 15,842 children screened, 3,350 underwent comprehensive examination. School addresses were geocoded to ADI/SVI quartiles (Q1-Q4; higher quartiles indicate greater disadvantage). Outcomes included referral, 'fit-for-frames,' RE, amblyopia suspect status, and poor BCVA (>0.2 logMAR). Group differences were assessed using chi-square and Cochran-Armitage trend tests. Multivariable regression evaluated associations with ADI/SVI after adjustment for age, sex, race/ethnicity, and RE type and severity. Race × index interactions were evaluated, and stratified analyses were performed when significant.
Results:
Children in Q4 neighborhoods had higher referral rates and were more likely to require new spectacles despite passing screening. Myopia was less common, whereas astigmatism was more common in Q4. After adjustment, both poor BCVA and amblyopia suspect status increased across quartiles (p-trend < 0.001). Compared with Q1, Q4 was associated with higher odds of poor BCVA (aOR [95% CI]: 1.51 [1.13-2.01] for ADI; 1.61 [1.18-2.20] for SVI) and amblyopia suspect status (1.78 [1.30-2.43]; 1.82 [1.33-2.48]). Significant interactions were observed, with stronger Q4 versus Q1 effects among Hispanic (aOR: 1.87) and Asian (aOR: 1.62) children, but not among Caucasian children.
Conclusions:
Children from the most disadvantaged neighborhoods had higher odds of amblyopia suspect status and poor BCVA. These findings support incorporating ADI/SVI in pediatric vision care to identify underserved children proactively, allocate resources equitably, and reduce the risk of permanent visual impairment.
