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Weixia Guo, Taylor Blachley, Paul P Lee, Paula Anne Newman-Casey; Prevalence of visual impairment and vision-threatening eye diseases in an underserved population . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2111. doi: https://doi.org/.
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To assess the prevalence of vision threatening eye diseases and visual impairment among patients referred for ophthalmologic consultation from a local free clinic (Hope Clinic, Ypsilanti, Michigan) through a collaborative program with the University of Michigan before and after the implementation of the Affordable Care Act (ACA). Free clinic patients are seen after hours at the university eye clinic by volunteer physicians and staff to facilitate access to specialty equipment not available at the Hope Clinic.
We conducted a retrospective cohort study to determine the prevalence of visual impairment and vision-threatening eye disease in this underserved population and compared the prevalence of visual impairment between those who did and did not obtain health insurance after the initiation of the ACA. We used logistic regression analysis to evaluate potential socio-economic and demographic risk factors for visual impairment.
335 subjects were included between 9/2012-3/2014, and their average age was 55. 22% presented with visual impairment as defined by a best-corrected visual acuity <20/40 in the better-seeing eye, compared to 2.9% of the general US population >age 40. Significant causes of visual impairment were cataract, glaucoma, and refractive error (p=0.002). 21% of those who presented with visual impairment had a primary diagnosis of refractive error compared to 5.3% of the general US population. 23% of subjects obtained insurance after the launch of the ACA and Medicaid expansion, and subjects with visual impairment were not more likely to have obtained insurance through the ACA than those without visual impairment (p=0.6). Those who were employed had a 74% reduced odds of visual impairment compared to those who were unemployed (OR=0.26, 95% CI 0.10, 0.67, p=0.002).
Despite improvements in healthcare access with the ACA and through community free clinics such as Hope, specialty eye care and spectacle correction continue to be in high need, given that they are not covered through private insurance. However, new spectacles for adults over the age of 21 every 24 months are now covered by Medicaid expansion. Thus, as visual impairment due to refractive error continues to pose a needless burden on uninsured populations in the US, it will be important to consider extending vision benefits as in Medicaid into the qualified health plans initiated through the ACA.
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