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 > or =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 > or =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 high-risk 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.