Vision problems in children often remain undetected, although regular check-ups are required –

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Jessica Oberoi, 13, can’t remember exactly when her eyes became blurry. All she knows is that she had to squint to see the blackboard at school.

It wasn’t until last fall, during her eighth grade eye exams in Bloomington, Indiana, that Jessica’s extreme nearsightedness and amblyopia, or lazy eye, were discovered.

Since then she has been treated intensively and her optician Dr. Katie Connolly said Jessica has made great strides – but her lazy eye, which causes problems with depth perception, may never go away. The chances of full correction would have been much higher if her condition had been identified earlier, said Connolly, director of pediatric and binocular vision services at Indiana University’s School of Optometry.

Jessica is one of the countless students who fall through the cracks in the nation’s failed efforts to identify and treat children’s vision problems.

The Centers for Disease Control and Prevention estimate that more than 600,000 children and adolescents are blind or have a visual impairment. A recent opinion piece published on JAMA Network notes that a large number of these children could be helped simply with glasses, but due to the high cost and lack of insurance, many do not receive this help.

But the National Survey of Children’s Health, funded by the Federal Health Resources and Services Administration, found that in 2016-17, a quarter of children were not regularly screened for vision problems.

And a large majority of these vision disorders could be treated or cured if caught early, Connolly said.

“Screening is important for children because children don’t recognize what is abnormal,” Connolly said. “They don’t know what their peers – or even their parents – are watching to realize their experiences are different.”

Eye exams for children are required by federal law and are covered by most private health plans and Medicaid. According to the National Center for Children’s Vision and Eye Health of the nonprofit advocacy Prevent Blindness, 40 states and the District of Columbia require eye screening for school-age children, and 26 states require it for preschool-age children.

Still, many children who have trouble seeing clearly are overlooked. The pandemic has only exacerbated the problem since classes moved online, and for many students, eye tests at school are the only time they get their eyes checked. Even when the campus reopened, school nurses were so swamped with Covid testing that universal screening had to be put aside, said Kate King, president-elect of the National Association of School Nurses.

“The only kids who had their eyesight checked were the ones who complained that they couldn’t see,” King said.

According to the national center, the problem is most prevalent among preschool children. It points out that the state child survey found that 61% of children under the age of 5 had never had an eye test.

Kindergarten, Connolly said, is a critical time to check a child’s eyesight because not only are they old enough to participate in eye exams, but also when vision problems are more noticeable.

The CDC survey also found that 67% of children with private health insurance had their eyesight tested, compared to 43% of those who did not have insurance.

Optometrists, doctors and school nurses are concerned not only with children’s visual acuity, but also with their ability to learn and their overall quality of life. Both are strongly related to sight.

“There seems to be an assumption that if kids can’t see, they’ll just tell someone — that the problems will come up on their own and that they don’t need to be found,” Kelly Hardy said. Senior Managing Director of Health and Research for a California-based children’s advocacy group, Children Now. But that’s mostly not the case because children aren’t the best advocates for their own vision problems.

And if left untreated, these problems can worsen or lead to other serious and long-lasting illnesses.

“It feels like a fairly simple intervention to ensure kids have a chance to succeed,” Hardy said. “And yet there are children who haven’t had vision tests or eye exams and that seems unacceptable, especially when there are so many other things that are more difficult to resolve.”

Connolly’s visit to Jessica’s school last year was the first time Jessica had her eyesight checked.

Her brother, Tanul Oberoi, 7, accompanied her on her follow-up visit to Connolly’s clinic and had his vision checked for the first time. His severe astigmatism has been identified and he now wears glasses. Because his condition was detected early, there is a good chance that his vision will improve with glasses and that his vision will be reduced over time.

“It was surprising to me that they have vision problems because they didn’t say anything to me before,” said Sonia Oberoi, Jessica and Tanul’s mother. “Usually they tell me when they have a problem and I watch them when they read something. I did not know it.”

Getting eye tests is only part of the battle, Connolly said. Buying glasses is a challenge for many uninsured families, as the average cost without insurance is $351 per pair. The JAMA article points out that sturdy eyewear can be made from flexible steel wire and plastic lenses in developing countries for about $1 a pair, but this option is not widely available in the US

Because Jessica and Tanul don’t have insurance, their mother said the family would have to pay for their glasses. Connolly’s clinic worked with multiple programs to fully cover her treatment and glasses and contacts for Jessica.

The problem goes beyond poor eyesight and overlooked vision problems. There is a strong link between children’s vision and their development – particularly the way they learn. Difficulty seeing clearly can be the start of many downstream problems for children, such as: B. Bad grades, misdiagnosed attention disorders or lack of self-confidence.

In a 2020 study by researchers in Spain, published by the International Journal of Environmental Research and Public Health, students with “low academic performance” were twice as likely as those with “high academic performance” to admit that they read the blackboard can’t see properly. In addition, those who underperformed in school, became tired while reading, or suffered from headaches were twice as likely, according to the study.

“Children do better at school and do better socially when they’re not walking around with uncorrected vision problems,” Hardy said. “And so it feels like a no-brainer that we have to make sure we do better to make sure kids get the care they need.”

King, who works at a middle school in Columbus, Ohio, said students’ vision problems were being overlooked even before the pandemic.

She said that of all the eye doctor referrals she sends home, only about 15% of children are taken to an eye doctor without having to contact the parents again. “An overwhelming majority actually goes no further and cannot be fully examined,” King said.

Another problem is that Medicaid and private insurance typically cover glasses every year or two, which King says isn’t ideal for growing and clumsy kids.

“School nurses are experts at eyeglass repairs,” King said, with a chuckle. “Often we have to put in a new nose piece or put in a new screw or have it fixed because a classmate sat on it.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation. n

Kaiser Health News

Kaiser Health News (KHN) is a non-profit news service dedicated to providing in-depth coverage of health policy and policy. And we report on how the healthcare system – hospitals, doctors, nurses, insurers, governments, consumers – works.


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