Eye care in the United States - Do we deliver to high-risk people who can benefit most from it?

Objective: To estimate the levels of self-reported access of eye care services in the nation. Methods: We analyzed data from the 2002 National Health Interview Survey ( 30 920 adults aged >= 18 years). We estimated the number of US adults at high risk for serious vision loss and assessed factors associated with the use of eye care services. Results: An estimated 61 million adults in the United States were at high risk for serious vision loss ( they had diabetes, had vision or eye problems, or were aged >= 65 years); 42.0% of the 78 million adults who had dilated eye examinations in the past 12 months were among this group. Among the high-risk population, the probability of having a dilated eye examination increased with age, education, and income ( P <. 01). The probability of receiving an examination was higher for the insured, women, persons with diabetes, and those with vision or eye problems ( P <. 01). Approximately 5 million highrisk adults could not afford eyeglasses when needed; being female, having low income, not having insurance, and having vision or eye problems were each associated with such inability ( P <. 01). Conclusions: There is substantial inequity in access to eye care in the United States. Better targeting of resources and efforts toward people at high risk may help reduce these disparities.