Insurance Access to Eye Care Services and Association with Visual Impairment Among US Adults

Background: Serious visual impairment affects about 3.3 million adults aged over 40 years for a prevalence rate of 2.85%, costing over $51 billion annually. The leading causes are cataract, followed by glaucoma and age-related macular degeneration.

Objectives: To test the hypotheses that: 1. Having eye care insurance is associated with eye care utilization within the past 12 months. 2. People without eye care coverage are more likely to have severe visual impairment both among the general sample (n=23,512), and among the subsample with cataract, glaucoma, or macular degeneration (n=2,643).

Research Design: The Behavioral Risk Factor Surveillance Survey (BRFSS) data 2008 on adults aged over 40 years from Alabama, Georgia, Iowa, New York, and West Virginia were used. Having eye care insurance (independent variable), eye care utilization in the last 12 months, and visual impairment (dependent variables) were the key variables. The BRFSS assesses visual impairment in terms of difficulty level in a) recognizing friends across the street, and b) reading a newspaper or magazine or numbers on the phone. We studied difficulty in recognizing friends at two levels: extreme difficulty, and little/moderate difficulty (combined), each compared to “no difficulty” as the reference group. For all analyses, binomial logistic regression analysis with survey weights was used, controlling for regular physician, income, state, general health insurance, age, marital status, education, employment, gender and race..

Results: Adults without eye care insurance are less likely than those with insurance to utilize eye care (OR=0.448, 95%CI: 0.446, 0.449), and are more likely to have extreme difficulty in recognizing friends across the street (OR=1.722, 95%CI: 1698, 1.746), and in reading printed matter (OR=1.983, 95%CI: 1.969, 1.997). Similar results are observed for little/moderate difficulty in recognizing friends (OR=1.379, 95%CI: 1.374, 1.384) and in reading printed matter (OR=1.128, 95%CI: 1.125, 1.131). Among the subsample with one of the three diagnoses, persons without eye insurance are more likely to have extreme difficulty recognizing friends across the street (OR=1.674, 95%CI: 1.632, 1.716) and reading printed matter (OR=1.485). A similar association was found for little/moderate difficulty in recognizing friends. For reading printed matter, persons without eye care insurance are more likely to have extreme difficulty relative to little/moderate difficulty.

Conclusions: People without eye care insurance may be endangering their long term vision sue to utilization of care. Our study findings suggest the need to require a defined level of eye care coverage for all adults under all health plans.