Inequities in access to visual field testing and their outcome consequences

This audio article is from VisualFieldTest.com.Read the full article here: https://visualfieldtest.com/en/inequities-in-access-to-visual-field-testing-and-their-outcome-consequencesTest your visual field online: https://visualfieldtest.comSupport the show so new episodes keep coming: https://www.buzzsprout.com/2563091/supportExcerpt:Inequities in Access to Visual Field Testing and Their Consequences Visual field testing (also called perimetry) is a key tool eye doctors use to catch vision-threatening diseases like glaucoma early. In glaucoma, for example, people usually feel no symptoms until serious vision loss has occurred, so doctors rely on tests to measure the full field of a person’s vision (). Routine visual field tests help detect early damage to the optic nerve before it causes blindness. However, not everyone has equal access to these tests. In many parts of the country, people – especially those in rural areas or with low income – face barriers to getting regular eye exams and visual field tests. This article maps out how geography and socioeconomic factors affect who gets tested, how late disease is caught, and what can be done to close these gaps. Uneven Access Across Communities Geographic Barriers Living far from an eye clinic can make testing hard. A recent large study found glaucoma patients in isolated rural areas were far less likely to get the recommended follow-up eye exams than those in cities (). In fact, rural patients’ odds of receiving a needed optic nerve evaluation were 56% lower than urban patients (). Similarly, research of insured patients across the U.S. found wide variation by community in whether newly diagnosed glaucoma patients get any visual field test: in some places as few as 51% got tested within two years of diagnosis, while in others 95% did (). Some communities had over 25% of new glaucoma patients receive no visual field testing at all in the first two years after diagnosis (). These findings show that where a person lives – and the resources of that community – can make a big difference in whether they get basic vision testing. Socioeconomic and Insurance Factors Money matters too. Patients with lower income or without good insurance often get tested less. For example, one study showed that people on Medicaid (public insurance for low-income individuals) with glaucoma were much less likely to get visual field tests compared to patients with commercial insurance (). Only about 35% of Medicaid patients received a visual field test within 15 months of diagnosis, versus 63% of privately insured patients (). This means Medicaid patients were over three times as likely to get no glaucoma testing at all after diagnosis (). Because Medicaid patients are disproportionately low-income and include many racial minorities, these insurance disparities contribute greatly to unequal care. Racial and Ethnic Disparities Race and ethnicity intersect with income and location. Studies have found that Black, Hispanic, and Asian patients with glaucoma often receive fewer visual field tests than White patients, even after accounting for age and severity () (). For instance, Black and Asian glaucoma patients in one clinic-based study underwent about 3–5% fewer tests per visit than White patients, despite having more advanced disease at baseline (). Another analysis showed Black patients had a 17% lower chance of getting the recommended optic nerve exams than White patients, and Hispanic patients also lagged in follow-up visits (). These differences may reflect factors like lower insurance coverage, less access to specialists, or other social determinants of health that vary by race. Consequences: Later DiaSupport the show