Vision Screening and Vision Loss-Related Conditions Among American Indian or Alaska Native Children.

Importance: Early vision screening plays a critical role in detecting and treating vision loss-related 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. Objective: To measure annual rates of vision screening at well-child care (WCC) visits and the prevalence of vision loss-related conditions among children aged 3 to 17 years, focusing on American Indian or Alaska Native children. Design, Setting, and Participants: 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. Exposures: 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 "some other race" as an option). Main Outcomes and Measures: Primary outcomes were (1) annual vision screening rates during WCC visits and (2) the prevalence of 9 vision loss-related 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). Results: Overall, 209 775 children (mean [SD] age, 10.8 [4.6] years; 103 605 [49.4%] female) were evaluated, with 1358 children self-identifying as American Indian or Alaska Native (0.6%) and 203 197 (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%]). Conclusions and Relevance: 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-related 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.