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J. E. Winters; Effects of Gender and Access to Health Care on Correctable Visual Impairment in a Low-Income Uninsured Population. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4452.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize patients examined through the Vision of Hope Health Alliance (VOHHA) classified as visually impaired based on entering distance visual acuity (EVA) whose visual impairment was eliminated through refractive correction (correctable visual impairment) and to examine the potential influence of gener and access to health care on the outcome.
VOHHA provided comprehensive eye care to uninsured, low-income adults which were referred by partners (service agencies (SAs) or Federally Qualified Health Centers (FQHCs)) or self referred (SR). Case workers obtained/recorded demographic and primary care physician (PCP) information. EVA and best corrected Snellen distance visual acuity (BVA) were obtained through retrospective record review. Corrected EVA was analyzed when available. Vision impairment was classified as VA <20/40 in the better seeing eye and Chi-square analysis was used to examine associations.
1753 patients were seen (921 (52.4%) were female and 832 (47.5%) were male.) 63.2% were referred from FQHCs, 28.7% from SAs and 8.0% were SR. 5.9% were 18-25 yrs. old, 8.7% 26-35, 19.2% 36-45, 34.2% 46-55, 26.1% 56-65 and 5.9% <65. 828 (47.2%) were African-American and 583 (33.3%) were Hispanic. 79.0% reported a current PCP. EVA and BVA were available for 1718 (98%) patients. Based on EVA, 278 (16.2%) were classified as visually impaired. Of those 278, 221 (79.5%) were no longer visually impairment when BVA was considered. A statistically significant association between visual impairment corrected by refraction and gender (p = 0.006), report of PCP (p=0.013), and referral source (p= 0.013) was found. Males were 1.5x more likely to have correctable visual impairment than females. Those who reported no current PCP were 1.5x more likely to have correctable visual impairment than those who reported a PCP. Those who were referred from SA or SR were 1.6x more likely to have correctable visual impairment than those referred from FQHCs. Age was not statistically associated with correctable visual impairment.
A large portion of visual impairment (based on EVA) was due to uncorrected refractive error. Although results cannot be generalized, these data suggest that gender and access to care significantly influence correctable visual impairment and that these factors should be considered in health access planning for the low-income unisured population.
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