Skip to main content
  • Comprehensive Ophthalmology, Pediatric Ophth/Strabismus

    Review of: Five-year trends in pediatric vision screening and access in the United States

    Chauhan M, Elhusseiny A, Samarah E, et al. Ophthalmology, January 2023

    A recent report, originally presented at the AAO 2022 Annual Meeting, focused on trends in pediatric vision screening in the United States from before the COVID-19 pandemic through the first year of the pandemic.

    Study design

    Researchers analyzed data related to vision care access from the 2016 to 2020 US-based National Survey of Children's Health. More than 174,000 children aged ≤17 years were included in the cohort. Longitudinal data were pooled into a single dataset, and 3 confounder-adjusted logistic regression models were fitted to examine possible changes in trends associated with the onset of the COVID-19 pandemic. The first model tested trends over the 5-year period, the second model evaluated trends in the 4 years prior to the pandemic, and the third model compared prevalence estimates between 2019 and 2020.


    While decreases in vision screening preceded the pandemic, vision screening prevalence significantly and steadily declined from 2016 to 2020 (13.6% relative decrease). Furthermore, of those children who had undergone vision screening, there was a significant 5-year decrease (9.4% relative decrease) in the proportion who were screened by a specialist, a trend exacerbated by the pandemic. Prior to the pandemic (2016–2019), a nonsignificant decrease in reports of unmet access for vision care was noted, but after pandemic onset there was a significant increase (85.7%) in reports of unmet vision care.


    The way trends were analyzed in this report could conceal distinct subpopulation patterns. Further study may evaluate the degree to which access to vision care has changed in distinct subpopulations over the past 5 years. Second, with regard to the vision screening variable, the reported prevalence may exclude children who received instrument-based screening. Finally, the data do not permit determination of causality from the impact of the COVID-19 pandemic on screening.

    Clinical significance

    Information about vision screening and access trends in the U.S. pediatric population—such as those provided in this report—will be important for policymaking and patient care. Overall, the analysis revealed significant decreases in vision screening and specialist use from 2016 to 2020. There was also a significant increase in unmet vision health care needs after the COVID-19 pandemic onset, despite downward trends in the preceding years. The authors hypothesize that the documented decline in preventative medical visits (not vision screening) from 2019 to 2020 could be extrapolated to vision-related access. Future studies should explore health insurance status among US children as it relates to both vision care access and need and the expansion of certain methods of healthcare access (e.g., virtual visits).

    Financial Disclosures: Dr. Phoebe Lenhart discloses no financial relationships.