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Racial, ethnic, and socioeconomic disparities in vision outcomes were apparent in adolescents, according to a cross-sectional study using data from the National Health and Nutrition Examination Survey.

Among nearly 3,000 participants representing a survey-weighted 57 million U.S. adolescents, those who were Black (OR 2.85, 95% CI 2.00-4.05) or Mexican American (OR 2.83, 95% CI 1.70-4.73) were more likely to self-report poor vision compared with their white counterparts, reported Isdin Oke, MD, of Boston Children's Hospital and Harvard Medical School, and colleagues.

Low-income individuals were also more likely to self-report poor vision (OR 2.44, 95% CI 1.63-3.65; all P<0.001), they noted in .

There were also increased odds of worse objective visual acuity (worse than 20/40 in the better-seeing eye) among Black (OR 2.13, 95% CI 1.41-3.24, P=0.001) and Mexican-American (OR 2.13, 95% CI 1.39-3.26, P=0.001) adolescents versus whites, and among non-U.S. citizens (OR 1.96 compared with citizens, 95% CI 1.10-3.49, P=0.02).

"Our findings likely represent underlying social and economic inequities in access to vision care services. Children from disadvantaged backgrounds may have fewer ocular diagnoses, lower vision care utilization, and a higher chance of being lost to follow-up," Oke and team wrote. "By adolescence, the combination of underdiagnosis and undertreatment may contribute to the observed differences in subjective and objective visual function."

"Much of the visual impairment in this study appears correctable, which emphasizes the importance of access to refractive correction in adolescence, a time when poor vision may affect academic performance, future employment, and economic opportunities," they added.

Visual impairments have been found to be more likely in , often due to preventable causes. "Understanding the association of race, ethnicity, and socioeconomic status with visual impairment in childhood may provide insight into the emergence of vision health inequities and reveal opportunities for intervention," the authors suggested.

For this study, Oke and colleagues used data from the 2005-2008 National Health and Nutrition Examination Survey on 2,833 participants ages 12 to 18, who completed visual function questionnaires and underwent eye examinations.

Mean age was 15.5 years, 49% were female, 14% were Black, 11% were Mexican American, and 63% were white. Five percent of participants were not U.S. citizens, and 19% had a family income below the poverty threshold.

Self-reported vision was determined by asking participants how they would assess their own eyesight with glasses or contact lenses, if needed. Visual acuity was measured at distance with participants' usual refractive correction using the acuity chart of the Nidek Autorefractor, model ARK-760.

The prevalence of poor subjective visual function was greater among non-U.S. citizens compared with U.S. citizens (13.1% vs 6.0%), low-income families compared with higher-income families (13.8% vs 4.6%), and large households compared with small households (8.8% vs 6.0%), while the prevalence of visual acuity worse than 20/40 in the better-seeing eye was greater among non-U.S. citizens compared with U.S. citizens (21.3% vs 9.7%) and those from large households compared with those from small households (13.9% vs 9.6%).

Oke and team acknowledged that using survey data from 2005-2008 was a limitation to their study, since it may no longer reflect the current U.S. adolescent population.

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