n comparison with Canadians, Americans with vision problems are equally or more likely to access eye care services, if they have health insurance. Without health insurance, Americans visit eyecare professionals at lower rates, according to a report released August 11, 2008 in the Archives of Ophthalmology, one of the JAMA/Archives journals.

The article highlights barriers to access to regular eye care in both countries: "In both Canada and the United States, general health insurance covers medical payment for eye injury and various eye diseases such as cataract, glaucoma and diabetic retinopathy, and optional vision insurance provides additional insurance coverage for eye examinations, contact lenses and eyeglasses and/or frames, and, in some instances, part of the costs for elective laser surgery for vision correction." They continue, noting that "many Americans and Canadians have publicly funded or private coverage for optional vision care."

In order to analyze the differences between eye care access in Canada and the United States, particularly in light of health insurance status, Xinzhi Zhang, M.D., Ph.D., of the Centers for Disease Control and Prevention (CDC) in Atlanta and colleagues, conducted a survey to examine disparities in eye care service use in 2,018 Canadians and 2,930 Americans with vision problems between 2002 and 2003.

Of the Americans with vision problems surveyed 8.2% did not have health insurance. This group had the lowest eye care service rate, defined as a visit to an eye care professional in the last year, with 42%. In contrast, Americans with private health insurance had a service rate of 67% and Canadians had a rate of 55%. A higher likelihood of eye care service use was associated with higher incomes and with optional vision insurance. The authors summarize: "The difference in use of eye care services between Americans without health insurance and Canadians narrowed when adjusted for income level and was almost eliminated when adjusted for having optional vision insurance."

The authors conclude that the gap in health insurance status contributes significantly to the disparity in eye care. "Among adults with vision problems, a public health gap exists in actual access to eye care services between Canada and the United States, primarily owing to the population without health insurance in the United States," they say. "However, although health insurance is associated with increased use of preventive services and recommended treatments, simply providing health insurance to all persons may be insufficient to increase the percentage of individuals who use eye care services or to improve vision-related outcomes; economic status and optional vision insurance are also significantly associated with rates of use of eye care services."

They conclude that, to provide effective interventions in eye care, officials should take an approach that targets low income groups: "Therefore, public health interventions targeting adults with vision problems without health insurance might be more beneficial if they focused on those at risk for serious vision loss, especially those in the lowest income group."

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