The Impact of Lack of Government-Insured Routine Eye Examinations on the Incidence of Self-Reported Glaucoma, Cataracts, and Vision Loss

PURPOSE. We determined the impact of lack of government insured routine eye examinations on the incidence of self-reported glaucoma, cataracts and vision loss. METHODS. We analyzed data from the Canadian longitudinal National Population Health Survey (1994-2011). White respondents aged 65+ in 1994/1995 were included (n = 2618). Three cohorts were established at baseline: those free of glaucoma, cataracts, and vision loss (i.e., unable to see close or distance when wearing glasses or contact lenses). Incident cases were identified through self-reporting of these conditions during the follow-up period. RESULTS. The incidence (per 1000 person-years) of glaucoma was lower in uninsured provinces (8.1; 95% confidence interval [CI], 5.5-10.7) than in insured provinces (12.8; 95% CI, 10.5-15.1). The incidence of cataracts was also lower in the uninsured (67.2; 95% CI, 55.7-78.6) versus insured provinces (75.7; 95% CI, 69.2-82.2). The incidence of vision loss was higher in the uninsured (26.6; 95% CI, 20.2-33.0) versus insured provinces (22.5; 95% CI, 20.0-25.5). Adjusting for confounders, seniors in insured provinces had a 59% increased risk of glaucoma (incidence rate ratio [IRR], 1.59; 95% CI, 1.07-2.37), a 13% greater risk of cataracts (IRR, 1.13; 95% CI, 0.93-1.37), and a 12% reduced risk of vision loss (IRR, 0.88; 95% CI, 0.67-1.16). CONCLUSIONS. Lack of government-funded routine eye examinations is associated with a reduced incidence of self-reported glaucoma and cataracts, likely due to reduced detection. Lack of insurance also is associated with a higher incidence of self-reported vision loss, likely due to poorer access to eye care and late treatment.