Children’s vision problems often go undetected despite calls for regular screening

The Centers for Disease Control and Prevention estimates that more than 600,000 children and teens are blind or have a vision disorder.

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The National Survey of Children’s Health found that in 2016-17 a quarter of children were not regularly screened for vision problems.

The National Survey of Children’s Health found that in 2016-17 a quarter of children were not regularly screened for vision problems.

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Jessica Oberoi, 13, can’t remember when her eyesight started getting blurry. All she knows is that she had to squint to see the whiteboard at school.

It wasn’t until last fall, when her eighth-grade class in Bloomington, Indiana, got vision screenings that Jessica’s extreme nearsightedness and amblyopia, or lazy eye, were discovered.

She’s been going through intense treatment since then. Her optometrist, Dr. Katie Connolly, said Jessica has made great improvements — but her lazy eye, which causes depth-perception problems, might never go away. The chances of completely correcting it would have been much higher had her condition been caught earlier, said Connolly, chief of pediatric and binocular vision services at Indiana University’s School of Optometry.

Jessica is amonge countless students falling through the cracks of the nation’s fractured efforts to catch and treat vision problems among children. The federal Centers for Disease Control and Prevention estimates more than 600,000 children and teenagers are blind or have a vision disorder. A recent opinion article published by JAMA Network notes that a large number of them could be helped with glasses, but, because of cost and lack of insurance, many aren’t getting them.

Yet the National Survey of Children’s Health found that in 2016-17 a quarter of children weren’t regularly screened for vision problems. Most of those impairments could be treated or cured if caught early, Connolly said.

Eye exams for kids are required under federal law to be covered by most private health plans and Medicaid.

Still, many children struggling to see clearly are being overlooked. The pandemic made things worse, as classes moved online. For many students, in-school vision screenings are the only time their eyes get checked.

“The only kids who were getting their vision checked were the ones who were complaining about not being able to see,” said Kate King, president-elect of the National Association of School Nurses.

Kindergarten, Connolly said, is a critical time to check a child’s vision because they’re old enough to cooperate with eye exams, and it’s when vision problems are more likely to be identifiable.

The CDC survey found that 67% of children with private health insurance had their vision screened, compared with 43% of those who were uninsured.

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

“There seems to be an assumption that maybe, if kids can’t see, they’ll just tell somebody — that the problems will sort of come forward on their own and that they don’t need to be found,” said Kelly Hardy, senior managing director of health and research for Children Now, a California-based child advocacy group.

But that’s not the case most of the time.

Left untreated, vision problems can worsen or lead to other serious and permanent conditions.

Getting vision screenings is only part of the battle, Connolly said. Buying glasses is a stretch for many families who lack coverage since the average cost without insurance is $351 a pair. The JAMA article noted that, in developing countries, sturdy glasses made from flexible steel wire and plastic lenses can be manufactured for about $1 a pair ,but that option generally isn’t available in the United States.

The issue goes beyond poor eyesight and overlooked vision problems. There is a strong link between children’s vision and development — especially the way they learn. Struggling to see clearly can be the beginning of many downstream problems for children, such as low grades, misdiagnosed attention-deficit disorders or lack of self-confidence.

King, who works at a middle school in Columbus, Ohio, said that, of all of the optometrist referrals she sends home, only about 15% of those children are taken to an eye doctor without her having to contact their parents again.

“An overwhelming majority actually don’t follow up and don’t get a comprehensive exam,” King said.

Another issue is that Medicaid and private insurance usually cover one pair of glasses every year or two, which King said isn’t ideal for growing and clumsy kids.

“School nurses are experts at glasses repair,” King said. “Often, we need to put in a new nosepiece or put in a new screw, or get them fixed because a classmate sat on them.”

Kaiser Health News is a national newsroom that produces in-depth journalism on health issues.

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