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—Dr Snydacker has made an excellent point regarding the importance of nonmedical factors on the out-come of clinical conditions, such as those that result in blindness or visual impairment. He also identified income as an important factor in access to medical care. Unfortunately, income is not always directly associated with accessibility to medical care in the US population. Very-low-income residents are often eligible for and use Medicaid benefits to pay for medical services. The people whose incomes are too high to qualify for medical assistance but who are unable to afford adequate health insurance are those for whom financial barriers are a significant factor in access to health care.Information about household income is extremely difficult to obtain in a reliable fashion and may result in the termination of the participation of a research subject due to the sensitive nature of the questions. Because of these difficulties and
Tielsch JM, Sommer A, Katz J. Blindness and Visual Impairment in an American Urban Population-Reply. Arch Ophthalmol. 1990;108(10):1377. doi:10.1001/archopht.1990.01070120023007