Blinded by inequity: a scoping review of income-related and structural disparities in eye care in the United States
- 1Department of Health Sciences, College of William & Mary
Abstract
Background: Visual impairment is a leading cause of preventable disability in the United States, despite the availability of effective screening, corrective, and surgical procedures. Lower household income has been associated with timely access to eye care, with low-income populations bearing a disproportionate burden.
Objective: This scoping review characterizes evidence on income, socioeconomic, and structural barriers to eye care access in the United States, identifies interventions designed to address these barriers, and applies Kingdon’s Multiple Streams Framework to examine how problem recognition, policy solutions, and political factors shape progress toward equitable eye care.
Methods: A scoping review was conducted following the Arksey and O’Malley methodological framework and PRISMA-ScR reporting guidelines. PubMed, Scopus, CINAHL, and Google Scholar were searched for studies published between 2001 and 2025 examining income-related disparities in U.S. eye care access. The review included 19 sources: 17 identified through database searches and two grey literature sources identified outside the search. Data were extracted, synthesized thematically, and interpreted using Kingdon’s Multiple Streams Framework.
Results: Studies directly measuring income or poverty generally found that lower income was associated with reduced access to preventive and routine eye care and poorer vision outcomes. Across the broader evidence base, income-linked insurance measures and structural barriers, including inadequate coverage and limited availability of affordable services, were also associated with disparities in access. Community-based vision screening, integrated eye care within community health centers, and teleophthalmology were associated with improved access or service utilization in specific populations but were typically localized and resource-dependent. Application of Kingdon’s Multiple Streams Framework identified greater representation of the problem and policy streams, while politics-stream evidence was less frequently represented. Given the literature-identification strategy, this pattern may reflect characteristics of the included evidence base rather than an absence of political activity.
Conclusion: Income-related disparities in eye care access are associated with structural and financial barriers linked to reduced access to timely services. Addressing these inequities may require greater alignment among recognized needs, promising interventions, and policy priorities, as well as enhanced integration of eye care within broader health systems. Establishing eye care as a more integrated component of health policy represents a potential approach to improving outcomes among low-income populations.
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BibTeX
@article{lersten2026blinded,
title = {{Blinded by inequity: a scoping review of income-related and structural disparities in eye care in the United States}},
author = {Alexandra K. Lersten and Carrie B. Dolan},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1885854},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1885854/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Blinded by inequity: a scoping review of income-related and structural disparities in eye care in the United States
AU - Alexandra K. Lersten
AU - Carrie B. Dolan
PY - 2026
DA - 2026/10/19
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1885854
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1885854/full
AB - Background: Visual impairment is a leading cause of preventable disability in the United States, despite the availability of effective screening, corrective, and surgical procedures. Lower household income has been associated with timely access to eye care, with low-income populations bearing a disproportionate burden. Objective: This scoping review characterizes evidence on income, socioeconomic, and structural barriers to eye care access in the United States, identifies interventions designed to address these barriers, and applies Kingdon’s Multiple Streams Framework to examine how problem recognition, policy solutions, and political factors shape progress toward equitable eye care. Methods: A scoping review was conducted following the Arksey and O’Malley methodological framework and PRISMA-ScR reporting guidelines. PubMed, Scopus, CINAHL, and Google Scholar were searched for studies published between 2001 and 2025 examining income-related disparities in U.S. eye care access. The review included 19 sources: 17 identified through database searches and two grey literature sources identified outside the search. Data were extracted, synthesized thematically, and interpreted using Kingdon’s Multiple Streams Framework. Results: Studies directly measuring income or poverty generally found that lower income was associated with reduced access to preventive and routine eye care and poorer vision outcomes. Across the broader evidence base, income-linked insurance measures and structural barriers, including inadequate coverage and limited availability of affordable services, were also associated with disparities in access. Community-based vision screening, integrated eye care within community health centers, and teleophthalmology were associated with improved access or service utilization in specific populations but were typically localized and resource-dependent. Application of Kingdon’s Multiple Streams Framework identified greater representation of the problem and policy streams, while politics-stream evidence was less frequently represented. Given the literature-identification strategy, this pattern may reflect characteristics of the included evidence base rather than an absence of political activity. Conclusion: Income-related disparities in eye care access are associated with structural and financial barriers linked to reduced access to timely services. Addressing these inequities may require greater alignment among recognized needs, promising interventions, and policy priorities, as well as enhanced integration of eye care within broader health systems. Establishing eye care as a more integrated component of health policy represents a potential approach to improving outcomes among low-income populations.
SN - 2296-2565
ER -