title: Vision insurance, eye care visits, and vision impairment among working-age adults in the United States.
abstract: OBJECTIVE
  To compare rates of eye care visits and vision impairment among working-age adults with vision insurance vs without, among the total sample of Behavioral Risk Factor Surveillance Survey respondents and among a subsample of respondents who had diagnoses of glaucoma, age-related macular degeneration (ARMD), and/or cataract.
  
  
  METHODS
  Using the Behavioral Risk Factor Surveillance Survey 2008 vision module data, we examined the likelihood of an eye care visit within the past year and of self reported visual impairment among 27 152 adults aged 40 to 65 years and among a subset of 3158 persons (11.6%) with glaucoma, ARMD, and/or cataract. Multivariate logistic regression models were used.
  
  
  RESULTS
  About 40% of both the study population and the subsample with glaucoma, ARMD, and/or cataract had no vision insurance. Respondents with vision insurance were more likely than those without to have had eye care visits (general population adjusted odds ratio [AOR], 1.90 [95% CI, 1.89-1.90]; glaucoma-ARMD-cataract subsample AOR, 2.15 [95% CI, 2.13-2.17]), to have no difficulty recognizing friends across the street (general population AOR, 1.24 [95% CI, 1.22-1.26]; eye-disease subsample AOR, 1.45 [95% CI, 1.42-1.49]), and to have no difficulty reading printed matter (general population AOR, 1.34 [95% CI, 1.33-1.35]; eye-disease subsample AOR, 1.37 [95% CI, 1.34-1.39]). Respondents from the total sample who had an eye care visit were better able to recognize friends across the street (AOR, 1.07) and had no difficulty reading printed matter (AOR, 1.70), and respondents from the eye-disease subsample who had an eye care visit also were better able to recognize friends across the street (AOR, 1.71) and had no difficulty reading printed matter (AOR, 1.45).
  
  
  CONCLUSIONS
  Lack of vision insurance impedes eye care utilization, which, in turn, may irrevocably affect vision. Vision insurance for preventive eye care should cease to be a separate insurance benefit and should be mandatory in all health plans.
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA.
authors.forename: Yi-Jhen
authors.initials: YJ
authors.lastname: Li
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.forename: Chaiporn
authors.initials: C
authors.lastname: Pumkam
authors.forename: Malavika
authors.initials: M
authors.lastname: Krishnaswamy
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D002386:Cataract / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D004522:Educational Status; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006296:Health Services / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008268:Macular Degeneration / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D009885:Ophthalmology / Q000706:statistics & numerical data*; D011314:Preventive Health Services; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000175:diagnosis* / Q000453:epidemiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*