Ophthalmology Research Articles

Artificial intelligence applications in ophthalmic surgery.

Technologies in healthcare incorporating artificial intelligence tools are experiencing rapid growth in static-image-based applications such as diagnostic imaging. Given the proliferation of artificial intelligence (AI)-technologies created for video-based imaging, ophthalmic microsurgery is likely to experience significant benefits from the application of emerging technologies to multiple facets of the care of the surgical patient. Proof-of-concept research and early phase clinical trials are in progress for AI-based surgical technologies that aim to provide preoperative planning and decision support, intraoperative image enhancement, surgical guidance, surgical decision-making support, tactical assistive technologies, enhanced surgical training and assessment of trainee progress, and semi-autonomous tool control or autonomous elements of surgical procedures. The proliferation of AI-based technologies in static imaging in clinical ophthalmology, continued refinement of AI tools designed for video-based applications, and development of AI-based digital tools in allied surgical fields suggest that ophthalmic surgery is poised for the integration of AI into our microsurgical paradigm.

Exploring Spectacle Usage Patterns: A Thematic Analysis of Refractive Disorder Patients in Medan, Indonesia

Objectives: This study explores the behavioral patterns of spectacle users with refractive errors in Medan City, Indonesia, and identifies the key factors influencing the decision-making process in choosing and using glasses, contributing to SDG 3 (Good Health and Well-being) by addressing vision health. Theoretical Framework: The research is guided by the Precede-Proceed model and the Theory of Planned Behavior, which provide a framework for understanding health-related behaviors, including spectacle usage and its impact on overall well-being. Method: A qualitative methodology was employed, involving in-depth interviews with 30 Medan City residents diagnosed with refractive errors. This was supplemented by focus group discussions and consultations with eyewear experts. Data were analyzed using a descriptive-analytical approach. Results and Discussion: Key themes influencing spectacle usage behavior were identified, including needs, comfort, fashion, quality, perception, economy, and knowledge. Among these, needs, comfort, and quality emerged as the most significant factors influencing users’ choices of glasses. The findings suggest that people with refractive errors should prioritize glasses that meet health standards to ensure comfort and improve visual impairments, aligning with the goals of SDG 3 to promote health and well-being. Research Implications: Health practitioners, particularly optometrists, play a critical role in educating the community about the importance of using high-quality eyewear and addressing common misconceptions related to spectacle use, thus contributing to SDG 3 (Good Health and Well-being). Originality/Value: This study provides novel insights into the behavioral patterns of spectacle users in a specific cultural context, offering valuable information for health professionals and policymakers to improve vision care services in Medan City in support of SDG 3.

Effective prism diopter for strabismus measurement: Conversion from anterior Prentice position to posterior parallel position and from glass prism to acrylic prism.

In clinical ophthalmology, prisms, commonly made of glass, are labeled based on the prism diopter (PD) value measured in the anterior Prentice position. However, they are often used in the posterior parallel position for practicality, causing a discrepancy between labeled and effective PD. This study proposes a conversion tool to address this issue. Geometric optical analysis was employed to calculate the effective PD of glass prisms in the posterior parallel position. A lookup table was created to convert the labeled PD of the anterior Prentice position to the effective PD when the prism is used in the posterior parallel position. Clinical data from 162 patients with horizontal strabismus were collected to validate the method. Glass prism measurements, converted to effective PD, were compared with acrylic prism results. The variations were significant in glass prism PD with rotation in the anterior Prentice position but stability in the posterior parallel position. Clinical deviations were larger with glass prisms, especially exceeding 30 PD, compared with acrylic prisms. Converted PD from glass prisms correlated well with acrylic prisms (R2 = 0.94, P = 0.002). The half-width of the 95% limit of agreement was ±12.32 PD. The proposed conversion table is valid, facilitating consistency between clinical and literature-based prism use in different positions and materials.

Racial/ethnic disparities in cost-related barriers to care among near-poor beneficiaries in Medicare Advantage vs traditional Medicare.

To compare racial and ethnic disparities in cost-related medical care and dental care barriers and use of vision care among near-poor Medicare beneficiaries in Medicare Advantage (MA) vs traditional Medicare (TM) overall and stratified by supplemental insurance enrollment. Cross-sectional analysis of 2015-2019 data from the nationally representative Medicare Current Beneficiary Survey. Propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM among near-poor Medicare beneficiaries with incomes between 101% and 250% of the federal poverty level. We assessed differences in cost-related medical care barriers and cost-related dental care barriers as well as receipt of annual eye exams in MA vs TM. For cost-related barriers to medical care, Hispanic-White disparities were narrower by 8.8 (95% CI, -14.0 to -3.6) percentage points in MA relative to TM but differences in Black-White disparities were not statistically significant. MA was not associated with narrower differences in Hispanic-White or Black-White disparities in dental care access. Higher proportions of Black and Hispanic beneficiaries in MA received an annual eye exam vs White beneficiaries in both MA and TM. MA was associated with narrower racial disparities primarily compared with TM without supplemental insurance. Among near-poor Black and Hispanic Medicare beneficiaries, MA was associated with greater use of vision care and narrowing of some disparities in cost-related access barriers vs TM. However, MA did not uniformly narrow racial/ethnic disparities in access and use. These findings highlight the importance of maintaining and enhancing features of Medicare coverage that may promote equitable access to care, including additional benefits and lower cost sharing.

Vision Care as A Strategy to Prevent Falls Among People with Moderate or Severe Intellectual Disability in the Hostel Setting in Hong Kong

Background: Factors contributing to the higher fall risk among people with intellectual disabilities (PIDs) are complex due to their discrete patterns of multimorbidity. Visual impairment, such as cataract, was common at old age and could be a crucial risk factor. Given the insufficient evidence regarding this relationship, the present study aimed at investigating this issue in a hostel setting in Hong Kong. Methods: This study was conducted in four hostels which served people with moderate to severe intellectual disability. Health data of residents collected in the year of 2022-23 was utilized for the current analysis. Data included fall risk, assessed by Morse Fall Scale, as well as other health conditions (osteoporosis, osteoarthritis, cataract) and demographics (age and gender) among residents. Results: The sample consisted of 199 residents (85 were males and 114 females), with an age range of 22 to 76 years. Around 40% (85; 42.7%) of them aged above 45 years old. Among the whole sample, cataract was the most common health condition and its prevalence reached 27.14%. Those who aged 45-year or above were 4.61 times (95%CI 2.09-11.07) more likely to have cataract. Bivariate analysis results showed that presence of fall risk was associated with older age (above 45 years old; OR 2.38; 95%CI 1.28-4.49), diagnosis of cataract (OR 3.3; 95%CI 1.71-6.33) and osteoarthritis (OR 12.68; 95%CI 1.70-564.75). Logistic regression analysis further illustrated that cataract (p = 0.04) remained as a significant predictor of fall risk after controlling age, gender, osteoarthritis and osteoporosis in the model. Conclusion: Our data showed that presence of cataract diagnosis was significantly associated with higher fall risk among PIDs in hostel setting. Given cataract was a prevalent condition especially among aging PIDs, early screening and intervention could be crucial components of fall prevention strategy in a hostel setting.

Dmitry S. Gorbachev – the path of a military doctor

The name of Dmitry S. Gorbachev has a worthy place in the list of teachers and ophthalmic surgeons of the Department of Ophthalmology of the Kirov Military Medical Academy and military ophthalmology in general.D.S. Gorbachev dedicated his life to military medicine, training and education of future military doctors. He is a student of Professor V.V. Volkov, and was deeply immersed in the complex problem of orbital surgery. At the Department, D.S. Gorbachev, due to his deep scientific immersion in the problem, brought the field of orbital surgery to a modern multidisciplinary level. He constantly passed on his knowledge and skills to his students, who are currently continuing his work.

Deprivation and NHS General Ophthalmic Service sight testing activity in England in 2022-2023.

Socioeconomic deprivation is associated with an increased incidence of sight-loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight-testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England. Data on NHS sight-test claims for the financial year 2022-2023 were sought from NHS England (NHSE), including number of sight-tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age-bands of patients accessing sight-testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight-tests for all contractors within each IMD decile calculated, allowing rate of sight-testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid-year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII). Overall, 12.94 million NHS sight-tests were provided by 5622 GOS contractors in England in 2022-2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight-tests, while in the most deprived decile, average NHS sight-tests per contractor was ~1100. Rate of sight-testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27-5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight-tests. Overall, SII and RII were 333.5 (95% CI 333.52-333.53) and 6.4 (95% CI 6.39-6.40), respectively, findings reflective of substantial inequality in uptake. There remains substantial unwarranted variation in uptake of NHS sight-testing, with those in more affluent areas accessing sight-testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare.

Global Health Security in Vision Care: Health Systems Strengthening During Ebola Virus Disease Outbreak Responses.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications.

Preface: Global Health Security in Vision Care: Addressing Disparities, Outbreaks, and Conflict.

Preface: Global Health Security in Vision Care: Addressing Disparities, Outbreaks, and Conflict.

Development, Validity, and Reliability of the Primary Eye Care Questionnaire (PECQ) Among Optometrists in Malaysia.

Visual impairment and vision loss are preventable or treatable if there is access to eyecare services for early detection and if proper interventions are given.Optometristsplay a vital role in the early detection of eye and visual-related issues.As healthcare professionals, optometrists are trained to provide comprehensive eye and vision care encompassing dispensing and refraction, detection of abnormalities in the vision and eye, and the rehabilitation of conditions of the visual system, as suggested by the World Council of Optometry.In the current practice of primary eye care, optometrists are not fully utilized and are mostly restricted to refractive correction. Therefore, the optometrists' practice level, scope, and challenges to practice primary eye care must be identified before strengthening optometrists' role in the community. The present study aimed to develop and validate a questionnaireto determine the contributing factors and challenges to the practice of primary eye care by optometrists in Malaysia. The Primary Eye Care Questionnaire (PECQ) was developed through an extensive literature search to identify the domains and to construct the items. The items were then scrutinized further through focus group discussions with experts (n = 10) from various sectors of eye care. Content validation was conducted with ophthalmologists and optometrists as panels (n = 10), followed by face validation (n = 10) by optometrists from the public and private sectors. Construct validation was performed with exploratory factor analysis and reliability was evaluated by using Cronbach's alpha coefficient and the test-retest reliability. In total, the PECQ questionnaire was constructed with 123 itemsunder three main domains: contributing factors, challenges, and continuous education. The content validity index (CVI) for each item (I-CVI) score ranged from 0.9 to 1.0 for each item and the CVI for average scale (S-CVI/Ave) was above 0.8 for each domain, with internal consistency of 0.948 and Cronbach's alpha coefficient of 0.971. The PECQ is a valid and reliable tool for assessing the optometrists' scope of practice, challenges, and contributing factors to the practice of primary eye care.

Ocular Manifestations in Children with Special Needs Presenting in a Tertiary Eye Hospital of Central Nepal

Background Children with special needs are at a substantially higher risk of visual impairment (VI) (10.5% compared with 0.16%) but also of ocular disorders of all types, including refractive errors and strabismus. VI and other potentially correctable ocular disorders are frequently unidentified in children with complex needs. Although assessment may be more challenging, identifying these potential additional barriers to learning and development may be critical.MethodsDetailed ophthalmic examination was carried out in all children with special needs presenting to the Pediatric OPD of Bharatpur Eye Hospital over 6 months (January to June 2023). Ophthalmic examination included case history, presenting distance visual acuity, cycloplegic refraction, binocular vision examination, anterior and posterior segment evaluation.ResultsOut of the total of 55 participants, mean age was 9.74 ± 5.07 years, majority were male 32 (58.18%). Quantitative visual acuity could be assessed only in 19 (34.55%) children, using picture chart 9 (16.36%) and Snellen chart 10 (18.18%). Strabismus 21 (38.18%) and refractive error 14 (25.45%) were the commonest visual disorders in our study children.Conclusions With patience, suitably adapted methods, visual assessment is feasible in the majority of children with special needs. It is hoped that the formulation of proper vision care guidelines at a national level may help in early detection and management of visual disorders in this special population and enhance their quality of life.

Importance of Grading Cataracts in Predicting Recovery Time and Final Visual Outcomes After Cataract Surgery.

Cataracts have been considered as one of the major causes for reducing the vision-related quality of life and increasing the risk of comorbidities and mortality among the general population. This study aimed to assess the importance of grading cataracts in predicting recovery time and final visual outcomes after cataract surgery. A retrospective consecutive case review of elective cataract surgeries performed in a tertiary care hospital during a three-year period from 2019 to 2021 was studied. The postoperative visual status was correlated with grading. The reports of this study implicate the fact that 16.4% of the patients had grade 1 anterior segment cataracts. Visual acuity of perfect vision (6/6P) was obtained in 24% of patients, and 41.2% of patients had grade 1 anterior segment cataract surgery on day 1 (p<0.005). Perfect vision at 6/6 visual acuity was obtained in 24% of patients, and 27.5% of patients had grade 2 anterior segment cataract surgery in week 1 (p<0.05). The study shows that patients with grade 1 anterior segment cataract surgery had a better visual recovery time and visual outcome. The grading system of cataracts has further shown improvement in the vision care of the patients, along with showing reliability and monitoring of cataract formation.

Prevalence, sociodemographic risk factors, and coverage of myopia correction among adolescent students in the central region of Portugal

BackgroundKnowing the prevalence of myopia at school age is essential to implement preventive measures and appropriate interventions, ensure access to vision care, promote a healthier educational environment and improve academic performance. The purpose of this study was to determine the prevalence of myopia and its associated sociodemographic risk factors, as well as to estimate the coverage of myopia correction among adolescents in center of Portugal.MethodsThis cross-sectional study evaluated 1115 adolescents from the 5th to the 9th year of school, with an average of 12.9 years (SD = 1.5) ranging from 10.0 to 18.0 years. Optometric evaluations were carried out in a school environment and consisted of the evaluation of distance visual acuity, assessed using a logarithmic visual acuity chart (ETDRS charts 1 and 2) at 4 m, and measured by refractive error with a pediatric autorefractometer (Plusoptix), by non-cycloplegic. Myopia was defined as spherical equivalent (SE ≤ -0.50 diopter (D)) and uncorrected visual acuity (UVA ≤ 95VAR). Adjusted logistic regression analysis was applied to investigate risk factors.ResultsWe found a myopia rate of 21.5% and a high myopia rate of 1.4%. Higher school level and attendance at urban schools were associated with myopia, but no association was found with age or sex. Only 34.6% of myopic adolescents use the best optical correction and 26.4% do not use any type of optical correction.ConclusionsData on the prevalence of refractive problems in Portugal are scarce and heterogeneous. This study, although regional, provides a valuable contribution with a clear and reproducible methodology, following international guidelines and filling gaps in the existing literature. The results show that the rate of myopia in this age group is similar to reports from other European studies. The high rate of adolescents with uncorrected or under-corrected myopia in Portugal is a problem that deserves attention.

Polypseudophakia: from "Piggyback" to supplementary sulcus-fixated IOLs.

Polypseudophakia, the concept of using a second intraocular lens (IOL) to supplement an IOL that has already been placed in the capsular bag, was first used as a corrective measure where the power requirement was higher than that of available single IOLs. Subsequently, the technique was modified to compensate for post-operative residual refractive errors. In these early cases, an IOL designed for the capsular bag would be implanted in the sulcus.Although these approaches were less than ideal, alternative means of correcting residual refractive errors were not without their limitations: IOL exchange can be traumatic to the eye and is not easily carried out once fibrosis has occurred, while corneal refractive surgical techniques are not suitable for all patients.Piggyback implantation was the term first coined to describe the use of two IOLs, placed together in the capsular bag. The term was later extended to include the procedure where an IOL designed for the capsular bag was placed in the sulcus. Unfortunately, the term piggyback has persisted even though these two approaches have been largely discredited.Intraocular lenses are now available which have been specifically designed for placement in the ciliary sulcus. As these newer IOLs avoid the many unacceptable complications brought about by both types of earlier piggyback implantation, it is time to employ a new terminology, such as supplementary IOL or secondary enhancement to distinguish between the placement of an unsuitable capsular bag IOL in the sulcus and the implantation of an IOL specifically designed for ciliary sulcus implantation.In addition to minimising possible complications, supplementary IOLs designed for the sulcus have expanded the options available to the ophthalmic surgeon. With these new IOLs it is possible to correct presbyopia and residual astigmatism, and to provide temporary correction of refractive errors in growing, or unstable, eyes. This article aims to review the literature available on supplementary IOL implantation in the ciliary sulcus and to summarise the evidence for the efficacy and safety of this intervention. KEY MESSAGES: What is known Polypseudophakia has been used for over 30 years to correct hyperopia or residual refractive error, but early techniques were associated with significant complications. What is new The development of specially designed sulcus-fixated supplementary IOLs significantly reduces the risks associated with these procedures, and has also opened up new opportunities in patient care. The reversibility of the procedure allows patients to experience multifocality, and to provide temporary and adjustable correction in unstable or growing eyes. The terms "secondary enhancement" or "DUET" to describe supplementary IOL implantation are preferential to "piggyback".

An Interdisciplinary Approach to Care of Veterans with Vision Impairment

This report describes the impact of vision impairment (VI) among veterans and how nurse practitioners (NPs) can assist patients with VI using an interdisciplinary approach. Evidence-based recommendations are presented. Early diagnosis and treatment of VI is critical. NPs can foster positive outcomes among veteran patients as they engage in interdisciplinary collaboration with vision care specialists and support patients in adjustment to blindness training. Current evidence supports the assessment of visual function among all veteran patients as part of routine evaluation. Suggestions are offered to assist NPs in identifying adjustment to blindness training and vision loss resources to improve care.

Quality of Life after Cataract Surgery.

Background: The impact of medical intervention on a patient's quality of life (QoL) is more and more important. Treatment success is defined not only in terms of the success of the procedure performed but also with regard to its impact on different areas of the patient's life. The aim of the study was to assess the QoL of patients after cataract surgery and identify factors that affect it. Methods: Between January and March 2018, a survey was carried out among 100 patients who had undergone cataract surgery with intraocular lens implantation at the 'Spektrum' Clinical Ophthalmology Centre in Wrocław. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and Illness Acceptance Scale (AIS) were used. Results: Most respondents (67%) rated their overall health as very good. The median score on the AIS was 34 (31.5-39), indicating a high level of illness acceptance. There was no statistically significant relationship (p > 0.05) between sex and QoL nor between the level of illness acceptance and QoL. We found no statistically significant relationships between place of residence and QoL (p > 0.05) nor between place of residence and AIS. Conclusions: The respondents reported the highest QoL scores for the environment domain and the lowest QoL scores for the social relationships domain. QoL had a positive impact on illness acceptance among the study patients. Younger patients (aged 50 or under) reported significantly higher scores for all the domains of QoL. Being employed was found to be associated with better QoL and greater illness acceptance.

Heterogeneity of patient-reported outcome measures in clinical research

BackgroundThe use of patient-reported outcome measures (PROMs) in clinical research increases and use of heterogeneous instruments reflects how well diverse traits are captured by a medical specialty. In order to reflect the heterogeneity of current PROM use in ophthalmology, we reviewed the available literature.MethodsThe medical literature database Web of Science was searched for the most cited articles in clinical ophthalmology. Titles, abstracts and full text articles were reviewed for the use of PROMs and a list of the 100 most cited articles using PROMs was obtained and stratified by year of publication.ResultsA total of 1,996 articles were screened. Seventy-seven out of the 100 articles identified included one PROM, and the average number of instruments was 1.5 ± 1.1. The most widely used PROMs were the National Eye Institute Visual Function Questionnaire (33%), the Ocular Surface Disease Index (14%) and the Medical Outcomes Study Short Form (13%). A simulation analysis suggested that the distribution of PROM use in ophthalmology study did not significantly differ from a power law distribution. Twenty-two percent and fifteen percent of articles did not reference and did not specify the PROM used, respectively. This rate decreased in the more recently published articles (p = 0.041).ConclusionsOur data suggest that the heterogeneity of PROMs applied in ophthalmology studies is low. The selection of PROMs for clinical studies should be done carefully, depending on the research goal.

CHARACTERIZATION OF VAULT WITH TWO MODELS OF POSTERIOR CHAMBER PHAKIC INTRAOCULAR LENSES.

To evaluate and compare the dynamic vault range (DVR) as well as the asymmetry of the vault during a 3-month follow-up after the implantation of two posterior chamber phakic intraocular lenses (pIOLs). Aver Clinic, Madrid, Spain. Prospective comparative study. One hundred and nineteen eyes (65 patients) that underwent refractive surgical correction with implantation of one of two distinct pIOLs were enrolled: Eyecryl Phakic from Biotech Vision Care (Eyecryl group, 72 eyes) and Evo Visian Implantable Contact Lens from Staar Surgical (ICL group, 47 eyes). Besides evaluation of visual acuity, refraction, and ocular integrity, the pIOL vault was measured centrally and at 2 mm nasally and temporally as well as the DVR from photopic (50 lux) to mesopic (10 lux) illuminations conditions. No significant differences were found between pIOL groups in visual and refractive outcomes (p≥0.454). No significant differences between groups were found in central (523.72±168.4 vs. 494.16±156.7 µm, p=0.248) and temporal vault (499.43±155.8 vs. 431.28±150.5 µm, p=0.067). However, nasal vault was significantly lower in ICL group (465.6±149.1 vs. 375.4±144.0 µm, p=0.045). A trend to a larger DVR was observed in the ICL group, although differences between groups did not reach statistical significance (54.00±36.39 vs. 86.5±57.9 µm p=0.070). The pIOL diameter only correlated significantly with vault measurements in ICL group (r≥0.650, p<0.001). The Eyecryl pIOL shows more symmetric vaults and a trend to fewer light-induced changes in the central vault compared to the ICL pIOL. The clinical relevance of this finding should be investigated further.

Leaders at the Helm: Shaping the Future of Hospital Administration through Data-Driven Visionary Leadership

This study investigates the impact of various leadership and, management practices on hospital performance, focusing on transformational leadership, effective communication, decision-making ability, change management, emotional intelligence, strategic vision, innovation, employee engagement, resource management, and patient-centred care. Using a structured questionnaire, data were collected from 350, hospital administrators, senior management, department heads, and healthcare professionals. The results highlight the significant, positive effects of these practices on hospital performance, emphasizing the need for a holistic approach to healthcare management. The study fills a critical gap in existing, literature by examining the, combined effects of these factors and their interactions. These findings provide valuable insights for hospital, administrators and policymakers, offering practical strategies for improving healthcare quality and operational efficiency. The implications of the study are significant for addressing, global healthcare disparities and enhancing, healthcare outcomes, particularly in resource-constrained, settings like Pakistan. The study also identifies, challenges and barriers to the, implementation of these, practices, providing a, comprehensive understanding of the factors, influencing hospital performance

Most State Medicaid Programs Cover Routine Eye Exams For Adults, But Coverage Of Other Routine Vision Services Varies.

More than twelve million US adults ages forty and older are affected by vision impairment, and projections suggest that this number will double by 2050. Although most vision impairment can be eliminated with corrective lenses, many adults lack access to routine eye care. In this study, we analyzed detailed state-by-state Medicaid policies for 2022 and documented variability in coverage for adult vision services. Most fee-for-service Medicaid programs covered routine eye exams, although many did not cover glasses (twenty states) or low vision aids (thirty-five states), and about two-thirds of states with routine coverage required enrollee cost sharing. Managed care plans generally provided consistent or enhanced coverage relative to fee-for-service programs, although coverage sometimes varied between plans within a state. We estimated that about 6.5million and 14.6million adult enrollees resided in states without comprehensive coverage for routine eye exams and glasses, respectively. These findings reveal important gaps and opportunities for states to increase access to routine vision care.