Material Deprivation and Eye Exams in Ontario Children: A Population-based Cohort Study.

Abstract

Purpose : Despite universal recommendations for comprehensive eye exams (CEE), uptake has been poor, with as few as 14% of children receiving a CEE in Ontario – Canada, despite coverage through provincial health insurance (PHI). Poor access to or use of vision care services may exacerbate health inequities. We performed a population-based, longitudinal, repeated measures study to test the association between material deprivation and receiving a CEE before age 7 years in Ontario using health administrative d

Methods : We followed 128,091 members of a birth cohort from birth until each child’s 7^th birthday. Children were included if they were born in Ontario, Canada on or between January 1^st and December 31^st 2010, and eligible for PHI. Children were excluded if: they became eligible for PHI more than 6 months after birth, were without insurance for more than 6 months during follow up, moved out of the province, did not access the health care system for more than 5 years during follow up, and/or had invalid encoded insurance identification numbers. Also excluded were children who died. Descriptive and logistic regression methods were employed.

Results : Sixty-five percent (82,833/128,091) of children had at least one CEE (56.9% and 70.5% in the most and least deprived neighbourhoods, respectively). Most children had their first CEE at 4 to 5 years of age representing 16.4% (20961/128091) of the cohort. After adjusting for clinical and demographic variables, low material deprivation was associated with a higher odds of receiving an eye exam (AOR 1.43; 95%CI 1.36, 1.51). The association was greatest in the 1^st (AOR 1.73; 95%CI 1.55, 1.55) and 4^th year of life (AOR 1.67; 95%CI 1.59, 1.59).

Conclusions : Uptake of CEEs is poor, with inequities in care delivery. Universal school-based vision screening could identify children at risk for vision impairment and facilitate the provision of referrals for diagnosis and treatment. Public education on the importance of CEEs for children 1 to 3 years is key.

This is a 2021 ARVO Annual Meeting abstract.