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Susan Vitale, Robert Sperduto, Emily Chew, Frederick Ferris; Risk factors for lacking adequate refractive correction in the U.S., NHANES 1999-2008. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5957.
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To compare individuals having adequate, inadequate, or lacking corrective lenses for refractive error.
In 1999-2008, the National Health and Nutrition Examination Survey included a vision exam: autorefractor measurement (Nidek ARK-760) of presenting visual acuity (PVA) with usual distance corrective lenses, if any; objective refraction; and, if PVA 20/30-, re-measurement of VA aided by automated refraction results (corrVA). Participants were defined as having adequate refractive correction (ADEQ) (PVA with corrective lenses 20/40+); inadequate refractive correction (INAD) (PVA with corrective lenses 20/50-, corrVA 20/40+); lacking correction (NONE) (no use of corrective lenses, PVA 20/50-, corrVA 20/40+); or forgot correction (FORGOT) (corrective lenses not brought to exam, PVA 20/50-, corrVA 20/40+). Analyses incorporated weights to account for the complex sampling design (SAS 9.2, Cary, NC).
There were 11,334 ADEQ, 370 INAD, 740 FORGOT, and 1,410 NONE individuals (ages 12-19 (9.9%), 20-39 (26.1%), 40-59 (36.2%), and 60+ (27.8%); 56.6% female; 8.7% non-Hispanic (NH)-Black, 76.6% NH-White, and 14.7% Other race/ethnicity). Compared with ADEQ, INAD were older, less likely to have private health insurance (OR, 0.49, 95%CI (0.34-0.72)), more likely to be NH-Black (1.68 (1.06-2.66)) or Other (2.03 (1.18-3.47)), and have myopia <=-5.0D (3.56 (1.16-10.90), vs spheq >=+3.0). Compared with ADEQ, NONE were less likely to be female (0.62 (0.50-0.78)), have >HS education (vs HS diploma) (0.59 (0.44-0.80)), have private health insurance (0.48 (0.40-0.59)), and have myopia <=-5.0 (0.18 (0.06-0.53)), and more likely to be younger, NH-Black (2.69 (2.06-3.51)) or Other (2.42 (1.88-3.12)), have <HS education (2.01 (1.47-2.75)), lack access to health care (1.59 (1.18-2.15)), and have less refractive error. Compared with ADEQ, FORGOT were more likely to be younger, NH-Black (2.93 (2.21-3.88)) or Other (2.48 (1.78-3.44)), and have less refractive error, and less likely to have private health insurance (0.59 (0.45-0.76)) and >HS education (0.63 (0.44-0.90)).
Lacking private health insurance and access to health care and being of non-White race/ethnicity, among other factors, were significantly associated with lacking, or having inadequate, refractive correction. Policies to reduce visual impairment due to refractive error may need to include efforts tailored to specific subgroups.
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