{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:28:45Z","timestamp":1789439325159,"version":"build-2803163510"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Early vision screening plays a critical role in detecting and treating vision loss\u2013related conditions in children. Despite this, few studies have examined pediatric vision screening rates alongside vision health outcomes using large primary care electronic health record (EHR) datasets.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To measure annual rates of vision screening at well-child care (WCC) visits and the prevalence of vision loss\u2013related conditions among children aged 3 to 17 years, focusing on American Indian or Alaska Native children.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study used patient-level EHR data from a large Minnesota-based health system and included children aged 3 to 17 years with at least 1 WCC visit between January 1, 2018, and December 31, 2023. Analyses were conducted between January 2024 and April 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Patient age, self-identified race and ethnicity, and insurance type. Race and ethnicity categories included American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Pacific Islander, White, and other (those who selected \u201csome other race\u201d as an option).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were (1) annual vision screening rates during WCC visits and (2) the prevalence of 9 vision loss\u2013related conditions identified using diagnostic codes in the EHR. Two-proportion Z tests were used to test for statistical significance between children who identified as American Indian or Alaska Native and those who did not (ie, those who identified as any other race or ethnicity category).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall, 209\u202f775 children (mean [SD] age, 10.8 [4.6] years; 103\u202f605 [49.4%] female) were evaluated, with 1358 children self-identifying as American Indian or Alaska Native (0.6%) and 203\u202f197 (96.9%) identifying as any other race or ethnicity category. The annual vision screening rate at WCC visits was 88.7% (95% CI, 88.6%-88.8%), with small differences by race and ethnicity and insurance type and larger differences by age. Rates were lowest among those aged 3 to 5 years. Screening rates did not differ significantly between children who identified as American Indian or Alaska Native compared with those who did not; however, American Indian or Alaska Native children had a higher prevalence of amblyopia (5.2% [95% CI, 3.8%-6.5%] vs 3.7% [95% CI, 3.6%-3.8%]) and several refractive error conditions, including astigmatism (17.4% [95% CI, 15.3%-19.7%] vs 12.5% [95% CI, 12.3%-12.6%]), hyperopia (13.3% [95% CI, 11.2%-15.3%] vs 10.7% [95% CI, 10.6%-10.9%]), and myopia (11.1% [95% CI, 9.3%-12.9%] vs 8.3% [95% CI, 8.1%-8.4%]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of children aged 3 to 17 years, American Indian or Alaska Native children experienced a higher burden of vision loss\u2013related conditions despite comparable screening rates; across all race and ethnicity groups, screening rates were lowest among young children. These findings highlight opportunities to strengthen early vision screening and to better understand factors associated with observed inequities in pediatric vision health.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.23006","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:00:19Z","timestamp":1783954819000},"page":"e2623006","source":"Crossref","is-referenced-by-count":1,"title":["Vision Screening and Vision Loss\u2013Related Conditions Among American Indian or Alaska Native Children"],"prefix":"10.1001","volume":"9","author":[{"given":"Laurel E.","family":"Cederberg","sequence":"first","affiliation":[{"name":"Department of Pediatrics, HealthPartners, St Paul, Minnesota"},{"name":"Vision Health Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael L.","family":"Rivard","sequence":"additional","affiliation":[{"name":"Research, HealthPartners Institute, Bloomington, 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Accessed January 6, 2026. https:\/\/www.uspreventiveservicestaskforce.org\/home\/getfilebytoken\/TrAeYwKbgDwzYZCE_wLzD8","DOI":"10.1001\/jama.2017.9900"},{"key":"zoi260642r20","unstructured":"Child and Adolescent Health Measurement Initiative. 2022\u20132023 National Survey of Children\u2019s Health (NSCH) data query: vision screening received from a provider other than an eye doctor (Indicator 4.6b), nationwide. Data Resource Center for Child and Adolescent Health. Accessed January 6, 2026. https:\/\/www.childhealthdata.org\/browse\/survey\/results?q=11121&r=1"},{"key":"zoi260642r25","unstructured":"Child and Adolescent Health Measurement Initiative. 2022\u20132023 National Survey of Children\u2019s Health (NSCH) data query: received a vision screening from a provider other than an eye doctor (Indicator 4.6b), nationwide and by race\/ethnicity. Data Resource Center for Child and Adolescent Health. 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