Sociodemographic Disparities in Uncorrectable Visual Impairment Among US Adolescents.

Purpose: To estimate the prevalence of uncorrectable visual impairment and to identify sociodemographic factors associated with such impairment among US adolescents.

Design: Cross-sectional study.

Setting: 1999 to 2008 National Health and Nutrition Examination Survey.

Study Population: Adolescents (age 12-19 years).

Observation: Best-corrected visual acuity.

Outcome Measures: Prevalence of unilateral uncorrectable visual impairment, defined as best-corrected visual acuity of 20/40 or better in one eye with greater than 2 lines of visual acuity asymmetry, and of bilateral uncorrectable visual impairment, defined as best-corrected visual acuity worse than 20/40 in both eyes. Multivariable logistic regression was used to identify sociodemographic factors (race and ethnicity, caregiver education, household income, food security, citizenship status, health insurance type, and healthcare access) associated with uncorrectable visual impairment, adjusting for age and sex.

Results: The survey identified 9949 participants (mean [SD] age, 15.86 [2.27] years; 4914 female participants [49%]). The prevalence estimate of uncorrectable visual impairment was 4.0% (491 participants, 95% confidence intervals [CI] 3.4%-4.7%). After adjusting for age and sex, there were increased odds of uncorrectable visual impairment among those with family income below poverty level (odds ratio [OR], 1.59; 95% CI, 1.14-2.22) compared to poverty level and above, those with Mexican-American ethnicity (OR, 1.64; 95% CI, 1.18-2.29) or non-Hispanic Black race (OR, 1.43; 95% CI, 1.03-1.99) compared to non-Hispanic White race, those with food insecurity (OR, 1.67; 95% CI, 1.21-2.32), those with caregiver education below high school (OR, 1.68; 95% CI, 1.24-2.28), those with public insurance (OR, 1.67; 95% CI, 1.21-2.30), and those with no insurance (OR, 1.71; 95% CI, 1.12-2.59) compared to those with private insurance.

Conclusions: Socioeconomic disparities in the prevalence of uncorrectable visual impairment are evident by adolescence. Interventions to treat amblyopia, the most common cause of uncorrectable vision loss, have limited efficacy in late childhood. Efforts are needed to identify and treat amblyopia in socioeconomically disadvantaged populations at an earlier age to prevent permanent vision loss.