Children from Non-English Speaking Households Less Likely to Undergo Vision Screening

Children from households where English is not the primary language spoken are approximately 20% less likely to undergo recommended vision screening compared to children from households where English is the primary language, according to findings from a recent study.

Results suggested differences in access to care by household language, with children from English-speaking households more likely to receive vision screening at school or from an ophthalmologist than children from non-English-speaking households.¹

“An estimated 12 million children in the US speak a language other than English at home. Previous studies demonstrate children whose families required a translator were less likely to seek pediatric ophthalmology care,” wrote Anne Kim, of the department of ophthalmology at Rush University Medical College, and colleagues.¹

The American Academy of Pediatrics recommends vision screening as a routine part of every primary care visit, including physical examination with inspection, red reflex evaluation, corneal light reflection, and cover-uncover test from birth, and formal chart-based acuity testing from 3 years of age on. Vision screening results may uncover health issues requiring a comprehensive eye exam, which could lead to earlier treatment and prevention if caught at a young age. Thus, understanding barriers to pediatric vision screening is important for providing affected patient populations with the proper resources and care.^2,3

Investigators sought to determine and compare rates of vision screening among children from non-English and English primary language households, further examining the setting and locations of vision screening. To do so, data was collected for children 3-17 years of age enrolled in the 2018-2020 National Survey of Children’s Health.¹

The primary outcome of interest was vision screening within the past 12 months, measured through parent responses to the question “During the past 12 months, has this child had his or her vision tested, such as with pictures, shapes, or letters?” Parents were also asked about the setting in which the vision screening was performed.¹

A total of 89,697 children enrolled in the 2018-2020 National Survey of Children’s Health were included in the present study. Among the cohort, 51.1% of participants were male, 49.9% were White, and 14.6% were from non-English primary language households. A total of 64,441 (70.9%) children received vision screening in the previous 12 months.¹

In multivariable logistic regression models adjusted for age, gender, race, parental education, income, insurance coverage, and geographic location, children from households where English was not the primary language had lower rates of vision screening compared to their English primary language counterparts (64.3% vs 72.0%; adjusted odds ratio [aOR], 0.83; 95% confidence interval [CI], 0.72-0.95).¹

Further analysis revealed children from households where English was not the primary language were more likely to receive vision screening at a health clinic compared to children from English primary language households (14.4% vs 3.1%; aOR, 3.25; 95% CI, 2.40-4.39; P < .0001). Investigators noted children from English-speaking households were more likely to receive vision screening at school (21.0% vs 16.1%; aOR, 0.72; 95% CI, 0.57-0.89; P = .003) and from an ophthalmologist (54.0% vs 49.0%; aOR, 0.72; 95% CI, 0.61-0.85; P = .0001). However, there were no differences in rates of screening by a physician (41.4% for non-English primary language vs 44.0% for English primary language; aOR, 1.05; 95% CI, 0.89-1.23; P = .60).¹

“Differences in vision screening by household language was driven by lower rates of screening by an ophthalmologist or optometrist and at schools. These findings suggest unequal access to care by household language and provide actionable data to inform policies and patient care,” investigators concluded.¹

References:

1. Kim AB, Cheng BT. Socioeconomic Disparities in Vision Screening Among United States Children. Paper Presented at: American Academy of Ophthalmology 2023. November 3-6, 2023.
2. Adam, H. Vision Screening. Point of Care Quick Reference. April 2, 2020. Accessed November 16, 2023. https://publications.aap.org/pediatriccare/article-abstract/doi/10.1542/aap.ppcqr.396022/127/Vision-Screening?redirectedFrom=fulltext
3. Gugdel, D. Eye Screening for Children. Tips & Prevention. March 23, 2021. Accessed November 16, 2023. https://www.aao.org/eye-health/tips-prevention/children-eye-screening