Access to eye care remains low in the United States, which is especially troubling since vision loss and blindness are among the top 10 disabilities in the country. Vision Detroit, a community-based program from the Kresge Eye Institute that provides vision screening, eye-health education and follow-up care to the underserved population there, investigated eye care disparities to determine the burden of disease and barriers to access. They found that visual burden was pervasive and access was suboptimal.

The investigation included 23 screenings that took place between March 2015 and November 2017. Collected information included demographics, medical and social history, eye exam/referral history, insurance status, primary care physician status and patient-perceived eye care barriers.

A total of 380 patients (average age 53) were screened, of which 42% were Black and 51% were Hispanic. Vision problems were reported by 70% of the patients, with 50% reporting over two years of vision problems. The average habitual visual acuity in the better-seeing eye was 20/37. Regarding type 2 diabetics, 61% reported eye care underutilization.

The researchers found that older age and primary care provider recommendations/referrals were associated with increased utilization in all patients. The most common barrier to care was insurance (53%); 55% of patients were insured and 31% of these patients reported financial barriers. Additionally, employed patients were more likely to report a time barrier than unemployed patients, and those with a high school or less education reported “unaware of need,” “unsure where to go,” “transportation” and “insurance” as the most common barriers to accessing care.

“Understanding the utilization patterns of eye care by patients is important to consider when attempting to increase access, especially among high-risk groups,” the researchers wrote in their paper. “We found that 5% of all patients and 24% of diabetics had diabetic retinopathy (DR), while the estimated prevalence of DR in the U.S. among everyone and diabetics is 3.4% and 40%, respectively. Based on the American Academy of Ophthalmology’s annual screening recommendations, we found 61% of diabetics were underutilizing eye care. This is comparable to the Los Angeles Latino Eye Study’s findings of 65% noncompliance among type-2 diabetics. Additional studies have found high rates of eye-care underutilization among diabetics, with minority groups and those with lower income disproportionately affected.”

The researchers concluded that access to eye care did not correspond to the current visual burden, and cited financial, logistical and awareness barriers as the most common reasons. “Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education,” they wrote.

Goyal A, Richards C, Patel V, et al. The Vision Detroit Project: visual burden, barriers, and access to eye care in an urban setting. Ophthalmic Epidemiol. February 12, 2021. [Epub ahead of print].