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Yaping Jin, Elizabeth Badley, Graham Eric Trope, Yvonne M Buys, Christina Chan; Association between government-insured general eye exams and incidence of self-reported glaucoma, cataracts and uncorrectable vision loss. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5561.
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To determine if there is an association between government-insured general/routine eye exams and incidence of self-reported glaucoma, cataracts and uncorrectable vision loss (i.e. unable to see close or distance with eyeglasses).
We analyzed self-reported data from the Canadian longitudinal National Population Health Survey run from 1994/1995 to 2010/2011, which represents a 16-year follow-up. Standardized questionnaires were used to collect data every two years. White respondents aged 65+ in 1994/1995 were included (n=2,618). Three cohorts were established at baseline: those free of glaucoma, those free of cataracts and those free of uncorrectable vision loss. Incident cases were identified through self-reporting of the conditions in question in the follow-up period. Government insurance for general/routine eye exams was assigned based on reported respondent's province of residence in 1994/1995 and their corresponding provincial health insurance policy. Incidence rate ratios (IRRs) were calculated to compare the risk of incidence in government insured versus uninsured populations, controlling for age, sex, education, and smoking.
The incidence rate (per 1000 person-years) of self-reported glaucoma was higher in government-insured seniors (12.8, 95% confidence interval [CI] 10.5-15.1) than uninsured seniors (8.1, 95% CI 5.5-10.7). For cataracts, the incidence was also higher in the insured: 75.7 (95% CI 69.2-82.2) versus 67.2 per 1000 person-years (95% CI 55.7-78.6). For uncorrectable vision loss, the incidence was lower in the insured: 22.5 (95% CI 20.0-25.5) versus 26.6 per 1000 person-years (95% CI 20.2-33.0). Adjusting for confounding factors, insured seniors were associated with a 59% increased risk of being diagnosed with glaucoma (IRR 1.59; 95% CI 1.07-2.37), a 13% greater risk of being diagnosed with cataracts (IRR 1.13, 95% CI 0.93-1.37) and a 12% reduced risk of reporting uncorrectable vision loss (IRR 0.88, 95% CI 0.67-1.16).
Government-funded general/routine eye exams are associated with a higher incidence of self-reported glaucoma and cataracts, likely due to better detection. Insured eye exams are also associated with a lower incidence of uncorrectable vision loss, likely due to better access to eye care and earlier treatment for preventable/avoidable vision loss.
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