Vision screening for preschoolers with commercial insurance: impact of geography.

Background: The American Academy of Pediatrics recommends pediatric vision screening to detect and refer vision disorders during the critical early years when intervention yields the greatest benefits. We determined the rate of vision screening for US children 3-5 years of age with commercial insurance and compared rates among those living in rural versus urban areas. Children in rural compared with urban areas were expected to have lower rates of vision screening.

Methods: A cross-sectional study using commercial claims for 3- to 5-year-olds derived from the Merative MarketScan Database (IBM, Armonk, NY), 2011-2020, was conducted. Primary outcome was the proportion of children with a claim for vision screening. Adjusted incident rate ratios (aIRR) of vision screening with 95% confidence intervals were computed for children living in rural compared with urban areas of the United States.

Results: Claims for 2,299,631 children were included. Most children (1,724,923 [75.0%]) were enrolled in preferred provider organization plans and lived in urban areas (2,031,473 [88.3%]). A total of 662,619 (28.8%) had a claim for a vision screening. Children living in rural versus urban areas had a lower adjusted incident rate of vision screening (15.1 vs 30.6%, aIRR 0.57; 95% CI, 0.53- 0.61) after adjusting for sex, age, region, and insurance type.

Conclusions: For preschool age children with commercial insurance, vision screening is low, especially in rural compared with urban areas.