Thousands of children have undetected and untreated vision problems

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

It wasn’t until last fall, when her eighth-grade class in Bloomington, Indiana, underwent eye exams that they discovered she had extreme nearsightedness and lazy eye (amblyopia).

Since then, she has received intensive treatment, and her optometrist, Dr. Katie Connolly, said Jessica has improved a lot, but her lazy eye, which causes problems with depth perception, may never go away.

The chances of it being completely corrected would have been much greater if his condition had been caught earlier, said Connolly, chief of binocular and pediatric vision services at the Indiana University School of Optometry.

Jessica is one of countless students harmed by the nation’s meager efforts to detect and treat vision problems in children.

The Centers for Disease Control and Prevention (CDC) estimates that more than 600,000 children and adolescents are blind or have a vision disorder. A recent opinion piece in the JAMA Network notes that a large number of these children could be helped with glasses alone, but due to high costs and lack of insurance, many are not helped.

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 had not been regularly screened for vision problems.

And a vast majority of those vision problems could be treated or cured if caught early, Connolly said.

“Screening tests are important for kids because they don’t realize what’s abnormal,” Connolly said. “They don’t know what their peers around them, or even their parents, see to realize that their experience is different.”

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Federal law requires that children’s eye exams be covered by most private health plans and Medicaid. They are required for school-age children in 40 states and the District of Columbia, and 26 states require them in preschool, according to the National Center for Children’s Vision and Eye Health of the nonprofit advocacy organization Prevent Blindness.

Still, many children are overlooked. The pandemic has only exacerbated the problem since classes went virtual, and for many students, the only time they get their eyes checked is for exams at school. Even when campuses reopened, school nurses were so overwhelmed with Covid tests that they had to put blanket screenings on the backburner, said Kate King, president-elect of the National Association of School Nurses.

The problem is most prevalent among preschool-age children, according to the national center. He notes that the federal survey of children found that 61% of children ages 5 and under had never had an eye test.

Kindergarten, Connolly said, is a critical time to check a child’s vision because not only are they old enough to cooperate with eye exams, but that’s when vision problems are most likely to be identifiable. .

The CDC survey also found that 67% of children with private health insurance had eye exams, compared to 43% of those without insurance.

Optometrists, doctors, and school nurses care not only about children’s visual acuity, but also about their ability to learn and their quality of life. Both are strongly linked to vision.

“There seems to be an assumption that if kids can’t see, they’ll just tell someone, as if problems reveal themselves and don’t need to be found,” said Kelly Hardy, senior general manager of health and research at a California-based children’s advocacy group, Children Now. But that’s not the case most of the time because kids aren’t the best advocates for their own vision problems.

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And when left untreated, those problems can worsen or lead to other serious and permanent conditions.

“It feels like a fairly easy, low-tech intervention to ensure kids have a chance to succeed,” Hardy said. “And yet there are kids who haven’t had their eye exams or haven’t had an eye exam, and that seems unacceptable, especially when there are so many other things that are harder to figure out.”

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

Her brother, Tanul Oberoi, 7, accompanied her on her follow-up visit to Connolly’s clinic and had his first eye exam. She was identified as having severe astigmatism and now she wears glasses. Since her condition was caught early, there is a good chance her vision will improve with glasses.

“I was surprised that they had trouble seeing because they didn’t tell me before,” said Sonia Oberoi, the mother of Jessica and Tanul.

Getting eye exams is only part of the battle, Connolly said. Buying glasses is a luxury for many uninsured families, as the average cost without insurance is $351 per pair. The JAMA article notes that in developing countries, sturdy glasses made of flexible steel wire and plastic lenses can be made for $1 a pair, but that option isn’t generally available in the United States.

Since Jessica and Tanul do not have insurance, their mother said the family would have to bear the cost of their glasses. Connolly’s clinic worked with various programs to fully cover her treatment and glasses, as well as contacts for Jessica.

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The problem goes beyond poor eyesight and unidentified vision problems. There is a strong link between children’s vision and their development, especially the way they learn. Difficulty seeing clearly can be the beginning of many problems, such as poor grades, misdiagnosed attention deficit disorder, 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 “poor academic performance” were twice as likely to admit they couldn’t see the board well, compared to those with good performance.

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

Of all the optometrist referrals she sends out, she said only about 15% of children see an ophthalmologist without her having to contact parents again. “An overwhelming majority don’t follow up and don’t have a full exam,” King said.

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

“School nurses are experts at repairing glasses,” King said, laughing. “We often need to put in a new part or a new screw, or fix them because a classmate sat on them.”

KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of KFF, a nonprofit organization that analyzes the nation’s health and public health issues.

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