Children’s Vision care In Southeastern Pennsylvania A child’s eyesight is critically important to his or her academic achievement. As much as 80% of a child’s learning is dependent upon his or her eyesight.1 However, many children experience vision impairments that can impede learning and contribute to developmental disabilities.2 Despite the important role of vision in children’s development, there is limited research about the prevalence of vision impairments or access to vision care among children.
hile eye health care professionals agree that children should
be screened for vision impairments, recommendations regarding
impairment symptoms.5 Finally, some families may face barriers in accessing eye health care for their children.
when and how often children should be examined vary. Disagreement among eye health professionals has contributed to differ-
This Brief from PHMC’s Community Health Data Base (CHDB) pro-
ences in state and municipal policies regarding mandatory vision
vides information about access to eye exams and use of eyeglasses
screening for children.
among children ages 4-17 living in the five-county Southeastern Pennsylvania region, including Bucks, Chester, Delaware, Mont-
Although many visual health conditions can be corrected through use
gomery, and Philadelphia Counties. The data presented in this Brief
of eyeglasses or contact lenses, some children who need vision correc-
come from CHDB’s 2008 Southeastern Pennsylvania Household
Some children may have untreated
Health Survey. This survey is a random digit dialed telephone survey
visual impairments because they have not had a vision screening or
of 10,000 households in the region, which includes about 3,000 in-
eye exam. In addition, their parents may be unaware of their visual
terviews about children’s health.
tion treatment do not receive it.
Eye exams among Children in Southeastern PennsylvaniA The data show that about one-half (45%) of children ages 4-17 in
FIGURE 1 Children (4-17) who Received an Eye Exam by a Specialist in Previous Year by SEPA County, 2008 60
Southeastern Pennsylvania (SEPA) received an eye exam from an eye specialist, such as an ophthalmologist or optometrist, in the previous year. This percentage represents about 330,000 children. Among the
five counties of the SEPA region, Philadelphia has the highest proportion of children who have received a recent eye exam (50%), followed by Chester (46%), Delaware (44%), Montgomery (41%), and Bucks (40%) Counties (Figure 1).
30 20 10
Several studies have shown disparities in both access to eye examinations and corrective care based on age, gender, race/ethnicity, and poverty status.
Data from the 2008 SEPA Household Health Survey
show some notable differences among subgroups of children who have
FIGURE 2 SEPA Children (4-17) who Received an Eye Exam in Previous Year by Selected Access to Care Indicators, 2008
received recent eye examinations, including:
Age Older children are more likely than younger children to have
received an eye exam in the previous year. Among children ages 12-17, approximately 54% received a recent eye examination, compared to 38% of children ages 4-11.
Gender Girls are slightly more likely than boys to have had an eye
exam in the previous year (47% and 43%, respectively). 20
Race/ethnicity Approximately 50% of Black/African-American
children and 50% of Latino children received an eye exam in the previous year, compared to 43% of White children, 35% of Asian children, and 32% of multiracial children.
No Health Insurance
Regular Source of Care
No Regular Source of Care
Poverty level Children living in poverty are more likely to have had a recent eye exam than children living above the Federal Poverty Level (50% and 44%, respectively).
Access and Barriers to Eye Exams Not having health insurance coverage is a significant barrier to chil-
compared to 31% of uninsured children (Figure 2). Among children with
dren’s access to eye care. 7 Medical insurance plans vary widely in their
health insurance, one-half (49%) of children with Medicaid, CHIP, and
coverage of eye exams and corrective lenses, and parents often face out-
other public insurance received an eye exam in the previous year in
of-pocket costs associated with children’s eye care. Insured children in
contrast to 44% of children with private insurance (Figure 3).
Southeastern Pennsylvania are almost two times more likely than uninsured children to have received an eye exam in the previous year. Ap-
In addition to those with insurance, children with a regular source of
proximately 46% of children with insurance received a recent eye exam
care—a place the child usually goes to if he or she is sick or in need
Children’s Access to Dental Care
of medical care—are more likely to have had a recent eye exam (45%)
FIGURE 3 SEPA Children (4-17) who Received an Eye Exam in Previous Year by Insurance Type, 2008
than children without a regular source of care (36%)(Figure 2). The 2008 SEPA Household Health Survey also examined the reasons
why children did not receive an eye exam in the previous year. Seven in ten (72%) parents/guardians of children who did not receive an eye
exam reported that it was not needed. The other frequently reported
reasons were the high cost of care or lack of insurance (4%) and the 30
belief that the child is too young (4%).
Use of Eyeglasses Among Children in Southeastern Pennsylvania
Many conditions that harm children’s vision may be corrected through use of prescription eyeglasses.3 The 2008 Southeastern Pennsylvania
FIGURE 4 Frequency of Eyeglasses Use Among SEPA Children (4-17) who were Prescribed Eyeglasses, 2008 60
Household Health Survey collects information about children’s use of prescription glasses. The data show that three in ten (31%) children ages 4-17 in our region have been prescribed eyeglasses to correct vision problems, representing about 221,200 children.
There are some race/ethnicity, income, and insurance status disparities
among children in our region who have been prescribed eyeglasses. 29.1%
Race/ethnicity Black, White, and Latino children are equally likely
to have been prescribed glasses (31%); however, Asian children are
less likely than other children in our region to have been prescribed
Always/Most of the time
Wear contact lenses instead
Source: PHMC’s Community Health Data Base, 2008 Southeastern Pennsylvania Household Health Survey
glasses (22%). Poverty level Poor children in SEPA are less likely to have been prescribed eyeglasses than children in households above the Federal Poverty Line (25% and 31%, respectively). Insurance status Children without health insurance are also less likely to have been prescribed glasses; less than a quarter (24%) of children without medical coverage have been prescribed glasses, compared to 31% of those with insurance.
42% of children who have been prescribed
Among children in Southeastern Pennsylvania who have been prescribed eyeglasses, more than two out of five (43%) do not wear their glasses rou-
eyeglasses in Southeastern Pennsylvania do
tinely (Figure 4). The most frequently cited reason for why children do not wear their prescription eyeglasses all or most of the time is need. About
not wear their glasses routinely.
40% of children with glasses do not need them for all activities. About 13,200 children in our area, 15% of those who have been prescribed eyeglasses, do not wear their glasses routinely because they do not like them.
Conclusion The 2008 PHMC Household Health Survey data show that in SEPA, less than one-half of children (45%) received an eye exam from an eye specialist in the previous year.
mong the five counties of the SEPA region, Philadelphia has the
The data highlighted in this Brief underscore the fact that it is critical-
highest proportion of children who have received a recent eye exam
ly important that research into children’s vision health is supported,
(50%). In SEPA, older children are more likely than younger children
educational programs are offered to teach the importance of vision
to have received an eye exam in the previous year and children living
screening to children and their families, and that uniform standards
in poverty are more likely to have had a recent eye exam than children
for screening children for visual impairments are established in order
living above the Federal Poverty Level.
to ensure the best outcomes for children in our region.
References and Resources 1 American Optometric Association. (n.d.) School-aged vision: 6-18 years of age.
5 American Optometric Association. (2009). Make eye exams part of the back to school routine.
http://www.aoa.org/x9451.xml#3. Accessed 8/18/2009.
http://www.aoa.org/x13200.xml. Accessed 8/18/2009.
2 Centers for Disease Control and Prevention. (1996). Prevalence of selected developmental
6 Kemper, A.R., Bruckman, D., & Freed, G.L. (2003). Receipt of specialty eye care by children.
disabilities in children 3-10 years of age: The Metropolitan Atlanta Developmental Disabilities
American Pediatrics, 3(5), 270-274.
Surveillance Program, 1991. Morbidity and Mortality Weekly Report, 45(SS-2), 1-14. 7 Kemper, A.R., Bruckman, D., & Freed, G.L. (2004). Prevalence and distribution of corrective 3 Centers for Disease Control and Prevention. (2005). Visual impairment and use of eye-care
lenses among school-age children. Optometry and Vision Science, 81(1): 7-10.
services and protective eyewear among children—United States, 2002. Morbidity and Mortality Weekly Report, 54(17), 425-429.
For further information and resources related to children’s vision health in Philadelphia, please see A Guide to Vision Care Services for Philadelphia’s Children & Adolescents pro-
4 Hodges, L.E., & Berk, M.L. (1999). Unmet need for eyeglasses: Results from the 1994 Robert Wood John-
duced by Public Citizens for Children & Youth (2009), www.pccy.org.
son Foundation Access to Care Survey. Journal of the American Optometric Association, 70(4), 261-265.
The Community Health Data Base thanks the Eagles Youth Partnership, the Philadelphia Department of Public Health, and Public Citizens for Children & Youth for contributing their insights and expertise to this report.
About the Household Health Survey and the Community Health Data Base The Southeastern Pennsylvania Household Health Survey, the largest local health survey in the country, is the centerpiece of PHMC’s Community Health Data Base (CHDB). The survey collects data from 10,000 households in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. It has been conducted 11 times since 1982, and is currently conducted every two years. In 2008, CHDB expanded the Household Health Survey’s geographic reach to include Berks, Lancaster, and Schuylkill Counties, and, in 2009, the survey was also fielded in Centre County. For more information on CHDB go to www.CHDBdata.org or contact Francine Axler at email@example.com or 215.985.2521. PHMC is a nonprofit public health institute that builds healthier communities through partnerships with government, foundations, businesses and other community-based organizations. For more information on PHMC, please visit PHMC.org. This report was made possible by the support of the following organizations: The Pew Charitable Trusts, William Penn Foundation, United Way of Southeastern Pennsylvania, The Hospitals and Higher Education Facilities Authority, and CHDB Member agencies. PHMC is a United Way of Southeastern Pennsylvania community partner | Donor Code: 2050
© 2009 Public Health Management Corporation