Eye Exams/Vision Screenings
We recently came across this article about a team of dedicated doctors providing specialized medical care to individuals with disabilities and individuals with mental illness. The article focused on the eye care being given to Kevin Fitzgerald, a 56 year old man with severe autism who suffers from cataracts. There is a huge need for specialized eye care for individuals with ID/DD. The article states that “as many as 50 percent of people with intellectual disability have vision problems. And a far higher proportion of these disabled patients have severe vision problems compared to the general population.” However, there are also documented barriers and obstacles to utilization of health care such as vision care faced by individuals with ID/DD.
The article prompted us to look at NCI data on eye/vision difficulties and access to eye exams/vision screening. For the purposes of this blog, we looked at the 2011-2012 administration of the Adult Consumer Survey.
Seven percent (7%) of the total sample (n=11621) had limited vision or was legally blind. The NIH estimates that approximately 3% of the general population over the age of 40 has blindness or low vision. The US Preventative Service Task Force guidelines state that individuals with ID should get vision screenings at least yearly, as vision problems are more common in adults with ID than in the general population. Yearly vision screenings are also important because individuals with ID may be less likely to report vision issues, so vision screenings may be necessary to spot symptoms[ii]. Furthermore, individuals with ID may rely heavily on sensory input, so vision issues may disproportionately impact those with ID[iii].
The following table demonstrates that a little under half of the sample with limited vision/legal blindness had not gotten a vision screening in the past year.
|
Last eye exam or vision screening |
limited or no vision- legally blind |
|
|
no |
yes |
|
|
within past year |
48.0% |
54.6% |
|
within past 2 years |
19.7% |
18.3% |
|
within past 3 years |
3.9% |
4.1% |
|
within past 5 years |
2.3% |
2.0% |
|
5 or more years ago |
3.1% |
7.3% |
|
has never had a vision screening |
1.9% |
1.4% |
|
don't know |
21.1% |
12.4% |
Studies have shown that there may be differences in preventative healthcare utilization by residence type. Therefore, we decided to look at frequency of vision screening by residence type. The dataset used in the following analysis is composed of only those respondents who were reported to have limited vision or legal blindness.
|
Last Eye Exam or Vision Screening |
Residence Type |
|||||
|
Institution |
Community-based residence |
Independent home/apt |
Parents/relatives home |
Foster care/host home |
Other |
|
|
Within past year |
56.3% |
64.0% |
56.1% |
40.7% |
48.4% |
61.3% |
|
Within past 2 years |
20.0% |
20.5% |
22.7% |
14.2% |
9.7% |
29.0% |
|
Within past 3 years |
5.0% |
4.2% |
3.0% |
3.5% |
8.1% |
|
|
within past 5 years |
2.5% |
0.9% |
3.0% |
4.0% |
|
|
|
5 or more years ago |
11.3% |
1.8% |
1.5% |
15.9% |
8.1% |
3.2% |
|
Has never had a vision screening |
|
1.5% |
|
1.8% |
3.2% |
|
|
Don't know |
5.0% |
6.9% |
13.6% |
19.9% |
22.6% |
6.5% |
|
N |
80 |
331 |
66 |
226 |
62 |
31 |
As is evident from the above table, there appear to be differences in how recently an individual with ID/DD and diagnosed vision impairment/legal blindness has had a vision screening based on residence type. Based on a chi-squared analysis, there is a statistically significant relationship (residence type and most recent vision screening. For example, it appears that individuals living in a parent/relatives home are less likely to have had a screening within the past year or two years, and more likely to have had a screening 5 or more years ago.
Interestingly, in a recent blog post we looked at racial and ethnic differences in utilization of preventive healthcare such as vision screenings. We found that African American, Non-Hispanic respondents were significantly more likely than White, Non-Hispanic respondents to have had an eye exam in the past year.
Delving into the particulars of data can aid in the development of more targeted policies to address differences and disparities in receipt of healthcare such as vision screenings.
As always, we’d love to hear your questions/comments. Dhiersteiner@hsri.org
Wilkinson, J., Culpepper, L & Cerreto, M. (2007). Screening tests for adults with intellectual disabilities. J Am Board Fam Med: 20(4): 399-407
[ii] Ibid.
[iii] Ibid.