Equity gaps in screening utilization for chronic eye conditions: Evidence from a population-based survey in Germany

To examine sociodemographic and health-related factors associated with the utilization of preventive ophthalmologic examinations in Germany and to explore determinants of out-of-pocket payment, with attention to equity gaps among different socioeconomically groups.

Data were derived from a population-based, demographically representative self-reported online survey of 1,008 adults conducted in Germany. All data were analysed descriptively, followed by binary logistic regression analyses. Sociodemographic and health-related factors were assessed. The primary outcome was the utilization of preventive eye examinations within the past 12 months; out-of-pocket payment served as the secondary outcome.

Overall, 35.8% of respondents reported having undergone a preventive ophthalmologic examination within the previous 12 months. In multivariable binary logistic regression models, being in a relationship (OR 1.49, p = 0.036), existing eye disease (OR 3.81, p < 0.001), and recent general practitioner visits (OR 7.27, p < 0.001) or optician visits (OR 4.22, p < 0.001) were significantly associated with higher utilization of preventive services. In univariable binary logistic regression, younger age, employment status, academic degree, higher income, good self-rated health and optician visits were each associated with a higher likelihood of paying out-of-pocket for preventive ophthalmologic examinations, not reaching significance in a multivariable model.

Preventive ophthalmologic examinations in Germany are primarily utilized by individuals who already have established contact with the healthcare system or have diagnosed eye diseases, while sociodemographic differences in out-of-pocket payments for preventive eye examinations were observed mainly in univariable analyses and should be interpreted cautiously. The findings may inform future prevention strategies aimed at improving low-threshold access to preventive eye care, particularly among individuals without regular contact with healthcare providers.