What to do About Racial Disparities in Access to Glasses Among Children in the US?

In the current issue, Qiu et al.¹ report on data from the National Health and Nutrition Examination Survey (NHANES) documenting significant disparities in rates of correction of refractive error by race, with Mexican-Americans and non-Hispanic Blacks twice as likely as whites not to have glasses adequate to improve their vision to 20/40. Among children aged 12 to 19 years, the disparities were even more striking: Mexican-Americans and non-Hispanic Blacks were three times more likely not to have the glasses they needed. This latter statistic is particularly concerning in the face of recent trial evidence² that providing glasses leads to statistically significant improvements in educational outcomes for children.  

The authors suggest that educational programs designed to improve rates of spectacle wear may be the answer. Though cultures differ, large trials in China have found either no³ or very modest² effects of educational interventions on rates of purchase and wear of glasses. By contrast, providing free glasses more than doubled the rates of wear in a recent trial.² 

What programs does the United States offer to provide free glasses, which might remedy these disparities? While Medicaid is mandated nationwide to provide coverage for children's glasses, Medicaid coverage for adults is patchwork across various states,⁴ and Medicare generally only provides glasses after cataract surgery.⁵ Medicaid coverage, despite reforms under the Affordable Healthcare Act, still only covers those at or relatively near the poverty line.⁶ 

Mexican-American and Black children with refractive error are substantially more likely to be without the glasses they need,¹ glasses that have been shown to improve the educational attainment of children.² Available evidence^2,3 suggests that interventions explaining the importance of glasses are unlikely to be sufficient to redress these disparities. It is time for the United States to improve its patchy and incomplete coverage, and guarantee all children access to basic, inexpensive spectacles. The relatively modest costs involved represent an investment in equal access to education for all our children, irrespective of race.