Visual Acuity Outcomes and Loss to Follow-up in the Treatment of Amblyopia in Children From Lower Socioeconomic Backgrounds

Stephen Hawn, Sean M. Yuan, Andrew R. Lee, Susan M. Culican

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Purpose: To compare visual acuity outcomes and loss to follow-up after initiation of treatment for unilateral amblyopia in children from different socioeconomic backgrounds. Methods: Medical records of children diagnosed as having unilateral amblyopia at an initial encounter between 2015 and 2018 were reviewed. Medicaid and private insurance were used as proxies for socioeconomic status (SES). Data points were collected at the patients' initial, follow-up, and final visits. Visual acuity improvement was the primary outcome variable in patients with at least one follow-up appointment. In a separate analysis, failure to attend a single follow-up appointment was examined for associations with SES, race, sex, and distance traveled to appointments. Results: Seventy-three patients met the inclusion criteria; of these, 28 had Medicaid and 45 had private insurance. Visual acuity improved by 2.86 lines in the Medicaid group and 2.98 lines in the private insurance group (P = .84). Number of missed appointments and distance traveled did not correlate with visual acuity improvement. In the loss to follow-up subanalysis, 40 of 141 (28.4%) patients with Medicaid and 11 of 107 (10.3%) patients with private insurance failed to attend a single follow-up visit (P = .001). No association was found between loss to follow-up and race, sex, or distance traveled. Conclusions: Visual acuity outcomes of treatment for amblyopia did not differ between patients with Medicaid and patients with private insurance who followed up. However, patients with Medicaid were much more likely to be immediately lost to follow-up. Measures should be taken by eye care providers and pediatricians to increase follow-up in patients from low SES populations.

Original languageEnglish (US)
Pages (from-to)110-117
Number of pages8
JournalJournal of Pediatric Ophthalmology and Strabismus
Issue number2
StatePublished - Mar 2022

Bibliographical note

Funding Information:
From the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (SH); the Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, Missouri (SMY, ARL); and the Department of Ophthalmology, University of Minnesota Medical School, Minneapolis, Minnesota (SMC). © 2021 Hawn, Yuan, Lee, et al; licensee SLACK Incorporated. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International ( This license allows users to copy and distribute, to remix, transform, and build upon the article non-commercially, provided the author is attributed and the new work is non-commercial. Submitted: January 13, 2021; Accepted: June 2, 2021; Posted online: September 1, 2021 Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc to the Department of Ophthalmology & Visual Sciences at Washington University; and Vision Core Grant P30 EY 0268 from the National Institutes of Health (SMC, ARL). Disclosure: The authors have no financial or proprietary interest in the materials presented herein. Correspondence: Susan M. Culican, MD, PhD, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455. Email: doi:10.3928/01913913-20210714-01

Publisher Copyright:
© 2022 Slack Incorporated. All rights reserved.

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