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Study compares eye care use with vision problems
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CHICAGO—Americans with vision problems who have health insurance appear equally or more likely to access eye care services than Canadians with vision problems, whereas Americans without health insurance visit eye care professionals at lower rates, according to a report in the August issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

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Although Canada has a national health program, individuals with vision problems in both Canada and the United States sometimes have difficulty accessing eye care, according to background information in the article. “In both Canada and the United States, general health insurance covers medical payment for eye injury and various eye diseases such as cataract, glaucoma and diabetic retinopathy, and optional vision insurance provides additional insurance coverage for eye examinations, contact lenses and eyeglasses and/or frames, and, in some instances, part of the costs for elective laser surgery for vision correction,” the authors write. “Many Americans and Canadians have publicly funded or private coverage for optional vision care.”

Xinzhi Zhang, M.D., Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues examined differences in use of eye care service among 2,018 Canadians and 2,930 Americans with vision problems who responded to a survey between 2002 and 2003.

Overall, 8.2 percent of Americans with vision problems did not have health insurance. Americans without health insurance had the lowest rate of eye care service use (42 percent), while 67 percent of American with private health insurance, 55 percent with public health insurance and 56 percent of Canadians had visited an eye care professional in the previous year. Individuals with optional vision insurance and with higher incomes were most likely to use eye care services.

Americans with any type of health insurance accessed eye care at approximately the same rate as Canadians. “The difference in use of eye care services between Americans without health insurance and Canadians narrowed when adjusted for income level and was almost eliminated when adjusted for having optional vision insurance,” the authors write.

“Among adults with vision problems, a public health gap exists in actual access to eye care services between Canada and the United States, primarily owing to the population without health insurance in the United States,” they continue. “However, although health insurance is associated with increased use of preventive services and recommended treatments, simply providing health insurance to all persons may be insufficient to increase the percentage of individuals who use eye care services or to improve vision-related outcomes; economic status and optional vision insurance are also significantly associated with rates of use of eye care services.”

“Therefore, public health interventions targeting adults with vision problems without health insurance might be more beneficial if they focused on those at risk for serious vision loss, especially those in the lowest income group,” the authors conclude.
(Arch Ophthalmol. 2008;126[8]:1121-1126.

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .

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