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To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively). An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p =.03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p <.001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p =.04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p =.04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p =.02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p =.02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p <.001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p <.001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p <.05 for all). Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care. [ABSTRACT FROM AUTHOR]

Vision loss and blindness are among the top ten disabilities in the United States, yet access and utilization of eye care remains low. Vision Detroit aimed to address eye-care disparities via community-based screenings. By investigating burden of eye disease and barriers to eye-care utilization in an underserved urban community, we may direct efforts to improve access. Twenty-three screenings were conducted from March 2015-November 2017. Patient information gathered at screenings were demographics, medical and social history, eye exam/referral history, insurance status, primary care physician (PCP) status, and patient-perceived eye-care barriers. Three-hundred-eighty patients were screened, 42% African American and 51% Hispanic. Average age was 53 ± 16.4 years, 70% reported vision problems, 50% reported over two years of vision problems, and average habitual visual acuity in best-seeing eye was 20/37. Eye-care underutilization was reported in 61% of type-2 diabetics. Older age and PCP recommendations/referrals were associated with increased utilization in all patients. Insurance was the most common barrier (53%); of the 55% insured, 31% reported financial barriers. Employed patients were more likely than unemployed to report a time barrier (odds ratio = 1.76, 95% confidence interval 1.03–3.01). Those with high school or less education reported "unaware of need", "unsure where to go", "transportation", and "insurance" as barriers more often. Visual burden was pervasive, yet access was suboptimal. Financial, logistical, and awareness barriers were common. PCP referral and older age were associated with increased utilization. Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education. [ABSTRACT FROM AUTHOR]

Archaeological and archival data from a World War II internment camp where a predominantly Japanese American population was incarcerated offers a glimpse into the United States government's compliance with the Geneva Prisoners of War Convention of 1929. The Geneva Convention outlines the basic necessities afforded to prisoners of war and non-citizens, such as access to leisure activities; alcohol; dental and ophthalmological care; and medical facilities. The study of vision and eye-related artefacts, such as safety goggles and eye medicine, provides an opportunity to examine how prisoners' health was managed by the United States government during World War II. [ABSTRACT FROM AUTHOR]

The article offers insight to the laws governing health care under U.S. False Claims Act (FCA). Topics discussed include analysis of the misapplication of the FCA to health care quality cases; history of how health care came under the FCA; and United States v. NHC Healthcare Corp. case addressing the same.

Education about how to administer eye drops may improve a patient's ability to instill his or her eye drops correctly. Our objectives were to (a) document the methods providers use to educate glaucoma patients about eye drop technique; (b) determine whether eye drop technique education varies by provider and patient characteristics; and (c) evaluate whether education predicts improved patient technique. We conducted an 8-month longitudinal study of 279 glaucoma patients and 15 providers in which we recorded on videotape the content of glaucoma office visits at two time points (baseline and 4- to 6-week follow-up) and videotaped patient eye drop technique at three time points (baseline, 4- to 6-week followup, and 8-month follow-up). Mann-Whitney rank sum tests were used to determine whether education was associated with improved patient eye drop technique over time. Ninety-four patients (34%) received technique education at either visit; 31% received verbal education and 10% received a technique demonstration. Only 24 patients (47%) who were new to eye drops received technique education at the baseline visit. Patients who were new to drops at baseline (p = .008) and patients who asked a question about drops (p < .001) were more likely to receive technique education. Education was not associated with improved technique. Eye drop technique education occurs infrequently during glaucoma office visits. Future studies should compare the effectiveness of different educational methods, such as patient demonstration versus provider verbal instruction, to determine which method is best at improving patient eye drop technique. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have provided population-based estimates of the vision impairment, eye disease and eye care in the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) this study reports the overall and age-race-specific prevalence of self-reported vision impairment, eye diseases, and eye care utilization among older adults. Methods: Between 2005 and 2008 residents aged 50 and older in 17 states responded to BRFSS questions concerning difficulty with distance and near vision-related tasks, self-reported eye diseases and reported eye care insurance and service utilization. Results: The overall prevalence of difficulty with distance and near vision was 16.6 and 32.8%, respectively with no meaningful change with increasing age. The prevalence of cataract, glaucoma, and macular degeneration was 19.6%, 6.4, and 5.8%; all of which increased dramatically with age. Nearly 69% of Whites and Blacks and 65% of Hispanics visited an eye care provider in the past year. Overall, among the approximately one-third of participants who did not visit an eye care provider in the past year, half indicated that they did not have any reason to go and 20% cited it was due to cost/insurance. Conclusion: The continued and expanding use of the BRFSS Visual Impairment and Access to Eye Care module represents a unique opportunity to obtain population-based estimates of vision impairment, eye disease and perhaps most uniquely, eye care utilization. Moreover, the integration of this and other BRFSS modules will provide researchers the opportunity to evaluate the relationship between these estimates and other measures of health status and health care utilization. However, the self-reported nature of the BRFSS data is an important limitation that must be considered when interpreting the results. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess if rates of reported visual impairment (VI) in the United States (US) are declining. The 1997-2005 National Health Interview Survey is an annual probability survey of US households (n = 289,442 adults 18 years of age and older). Participants responding yes to either question were classified as visually impaired: 1) “Do you have any trouble seeing, even when wearing glasses or contact lenses?” 2) “Are you blind or unable to see at all?” Prevalence rates were adjusted for survey design; weighted linear regression models were used to examine VI trends. Annual rates of any VI ranged from 8.6% to 10.0% with a non-significant annual downward trend of -0.04%. Significant downward trends were noted in adults who reported an eye care provider contact in the previous 12 months (-0.18%; [standard error = 0.08], p = 0.047), adults with diabetes (-0.81%; [standard error = 0.30], p = 0.01) and adults 80 years of age and older (-0.46% [0.19]; p = 0.021). Pooled analyses with adjustment for sociodemographic and diabetes status suggested that reductions in VI tended to occur in adults with eye care provider contacts. Downward trends in reported VI in older adults may be due to improvements in the treatment of ocular disease, increased eye care utilization in those with VI, or both. These findings require verification in population-based studies with clinical acuity measures in order to specifically assess the effect of eye care utilization on VI prevalence trends. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various reports within the issue on topics such as racial and ethnic disparities, genetic differences, and socioeconomic disparities in eye health and care.