Adolescent Visual Impairment Affected By Socioeconomic Status, Race

Adolescents who have Black or Hispanic ethnicity, live in a low-income household, or are not US citizens are more likely to report poor subjective visual functions and perform worse on objective visual acuity testing, according to a study published in JAMA Ophthalmology. Physician awareness of these disparities may be the first step in improving access and decreasing preventable impairments as this population transitions into adulthood. 

In a cross-sectional study, researchers analyzed data collected from The National Health and Nutrition Examination Survey 2005 to 2008, which included subjective and objective vision-related examinations for adolescent children. Subjective visual function was measured based on the response to the question: “at the present time, would you say your eyesight is…” with responses ranging from ‘very poor’ to ‘excellent.’ Objective visual function was measured based on the patient’s refractive correction, with poor vision being defined as visual acuity of worse than 20/40 in the better-seeing eye.

A total of 2833 adolescents (mean [SD] age, 15.5 years [2.0] years, 51% boys) participated in the study with most patients being non-Hispanic White participants (63%). A total of 5% of participants were not US citizens and 19% had a family income below the poverty rate. Compared with non-Hispanic White race and ethnicity, the prevalence of both poorer subjective and objective visual measures was greater in Black and Hispanic adolescents. Compared with non-Hispanic white adolescents, Black and Hispanic participants reported poorer visual function (11.8% and 11.9%, respectively vs. 3.8%; P <.001) and had worse visual acuity (15.6% and 17.9%, respectively vs 7.2%; P <.001).

Multivariable regression analysis revealed increased odds of poor subjective vision in black (OR 2.85 [2.00 – 4.05]; P <.001), Hispanic (OR 2.83 [1.70 – 4.73]; P <.001), and low-income (OR 2.44 [1.65 – 3.65]; P <.001) participates after adjusting for age, sex, and other covariates. There was increase odds of presenting with lower visual acuity for Black (OR 2.13 [1.41 – 3.24]; P =.001), Hispanic (OR 2.13 [1.39 – 3.26]; P =.001), and non-US citizens (OR 1.96 [1.10 – 3.49]; P =.02). 

“In this cross-sectional study using a nationally representative sample from NHANES 2005 to 2008, Black and Mexican American adolescent children had approximately 3 times the odds of poor subjective visual function and twice the odds of low objective visual acuity than non-Hispanic White adolescent children after adjusting for socioeconomic status indicators, including family income,” the researchers explain. “Participants from low-income households had more than twice the odds of poor self-reported vision.”

The primary limitation was the survey data was from 2005 to 2008, which may not reflect the visual function of the current US adolescent population.