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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.

W

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.

3,4


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

50

49.9% 45.6%

45.1%

43.9%

41.1%

40.1%

40

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.

3,6

0

SEPA

Bucks

Chester

Delaware

Montgomery Philadelphia

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:

ƒƒ Age   Older children are more likely than younger children to have

60

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.

50

45.7%

45.3%

40

ƒƒ Gender  Girls are slightly more likely than boys to have had an eye

35.6% 30.7%

30

exam in the previous year (47% and 43%, respectively). 20

ƒƒ Race/ethnicity  Approximately 50% of Black/African-American

10

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.

0

Health Insurance

No Health Insurance

Regular Source of Care

No Regular Source of Care

ƒƒ 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).

7

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

60

49.0%

50

51.6% 48.1%

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

44.0%

exam reported that it was not needed. The other frequently reported

40

reasons were the high cost of care or lack of insurance (4%) and the 30

belief that the child is too young (4%).

20

Use of Eyeglasses Among Children in Southeastern Pennsylvania

10 0

Private

Medicaid

CHIP

Other Public

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

57.0%

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.

50

There are some race/ethnicity, income, and insurance status disparities

40

among children in our region who have been prescribed eyeglasses. 29.1%

30

ƒƒ Race/ethnicity  Black, White, and Latino children are equally likely

20

to have been prescribed glasses (31%); however, Asian children are

11.3%

less likely than other children in our region to have been prescribed

10

2.6% 0

Always/Most of the time

Sometimes/Rarely

Never

Wear contact lenses instead

Source: PHMC’s Community Health Data Base, 2008 Southeastern Pennsylvania Household Health Survey

glasses (22%). ƒƒ 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). ƒƒ 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.

www.CHDBdata.org


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.

A

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 francine@phmc.org 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

PHMC-00603-09


Children's Vision Care In Southeastern Pennsylvania