Kids and vision care: Why millions of children still lack access to eye exams

Why today’s kids have difficulty accessing eye care

About 80% of everything a child learns is through their vision.

Unfortunately, not every child is born with perfect vision. Researchers say more than 600,000 children in the U.S. are living with uncorrected vision problems or blindness. And around the world, an estimated 17.8 million kids go to school every day with uncorrected vision. This makes it hard for them to read or see the blackboard. 

Today, in the U.S., kids and parents still face barriers to basic vision screenings. These screenings can help detect eye problems, and more in-depth eye exams are performed by an eye doctor.

The good news is there are eye doctors and organizations working to help close this vision care gap. This can help ensure kids receive the eye care they need to have a successful life.

Why kids need vision screenings and eye care

Vision is important for a child's education and development. However, parents may not understand why their child needs a vision screening or a comprehensive eye exam at a young age. 

Past studies found that the majority of parents’ knowledge about children’s eye health is poor. Some parents think only older adults need eye care. Another myth is that eye problems like strabismus — or crossed eyes — will correct themselves. This may keep children from getting the important eye care they need.

“When children don’t have access to comprehensive eye exams and appropriate treatment, we’re asking them to perform at their best without giving them one of the most basic tools they need,” explained Terri A. Gossard, OD, MS, optometrist and current vice president of the American Optometric Association (AOA). “It’s a little like asking someone to run a marathon without shoes,” Dr. Gossard added. “They may still reach the finish line, but they’re going to face unnecessary obstacles every step of the way.”

The impact reaches past reading and the blackboard. Uncorrected vision in childhood is linked to measurable learning loss. By one global estimate, a child with uncorrected vision learns about half as much as a peer with corrected vision. It can affect coordination, social development and later earning potential. Early correction is one of the most cost-effective interventions in child health.

Kids often assume what they see is normal, explains Jennifer Haddox, chief program officer of Sight Savers America. This may cause them not to complain about vision issues, as they don’t have another frame of reference. 

“They do not understand that they’re not seeing as they should be seeing,” Haddox said. “So, oftentimes, problems can go unnoticed, undetected and untreated without any kind of a screening.”

Vision screenings also help pick up on a whole category of vision problems for kids classified under amblyopia, says Megan Collins, MD, MPH, pediatric ophthalmologist and Alan and Claire Jensen Professor of Ophthalmology at Johns Hopkins School of Medicine and vice chair of the All Children See Committee, program of the Children’s Eye Foundation of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). 

Amblyopia, also known as “lazy eye,” is a visual impairment caused when the eyes and brain don’t work together properly.

“Amblyopia is a vision-threatening condition,” Dr. Collins explained. “If not detected early in life, it can have permanent vision consequences. Early in life means before the age of 7 or 8.”

Dr. Collins says vision screenings help detect kids who might be at risk for a vision problem, like amblyopia. This can help them connect with a pediatric ophthalmologist early.

LEARN MORE: Are nearsightedness and lazy eye the same thing?

Barriers to vision screenings and eye care

Parents and their children face other barriers to accessing vision screenings. 

Donna Fishman is the executive director of the National Center for Children’s Vision and Eye Health at Prevent Blindness. She says that 40 states require vision screenings for children in schools. However, not all call for vision screenings for preschoolers. And others have different laws for which grades receive vision screenings. 

“Some (states) have screening in kindergarten, first and third,” Fishman said. “Some in kindergarten, second, fifth and eighth. So, it’s all over the place — there’s no uniformity.”

“And so not all children get a screening and not all children get screened at the same time,” she continued. “That’s a barrier because that’s early identification that a child might be at risk for a vision condition.”

Dr. Collins says there’s also some social inequality that can impact a child’s access to vision screenings. “Your more socioeconomically disadvantaged communities,” she explained. “Your communities where English may not be the primary language. Where household education level might be high school or less. We’re seeing that those kids may not be accessing recommended vision screenings,” she explained. 

Dr. Gossard adds that another big barrier is what happens after a child fails a vision screening. "Screenings are valuable because they help identify children who may be at risk for a vision problem and need further evaluation," she explains. "However, identifying a problem is only the first step. Across the country, we've seen data showing that follow-through after a failed vision screening can be surprisingly low. In some analyses, the completion rate for recommended follow-up care has been as low as 25%. In other words, only about one out of every four children identified as being at risk for a vision impairment can be shown to have actually received the eye care they need."

Dr. Gossard says that's concerning because the children who fail screenings are the very children we've identified as most likely to have a vision problem. "If they never receive a comprehensive eye examination, the opportunity for diagnosis and treatment may be missed entirely," she adds. 

Note: While the primary purpose of a vision screening is to identify children who may need further evaluation, it does not diagnose eye disease, nor does a “passed” screening rule out every problem. Only a comprehensive, dilated eye exam by an optometrist or ophthalmologist can diagnose conditions and prescribe treatment. 

SEE RELATED: What to know about pediatric eye exams

How eye doctors and nonprofits are stepping up to help

Nonprofit organizations offer programs to bridge the access gap. These initiatives provide vision screenings to kids who need them.

Haddox says Sight Savers America conducts its own vision screenings. The organization also partners with other groups. 

“Vision screenings can help identify children who may need to see an eye care professional for a dilated eye exam,” she explained. “And they can highlight the kids that social workers, nonprofits such as ourselves, teachers, school nurses and concerned citizens can get behind trying to help close the gap in the access to care.”

Fishman says the National Center for Children’s Vision and Eye Health recently published national recommendations for preschool vision screenings. The Center also offers a children’s vision screening certification course. In this course, school nurses and early education staff learn how to perform accurate vision screenings. Primary health care providers also learn these skills.

“We teach evidence-based vision screening,” Fishman said. “But also the importance of educating parents. The importance of what we call closing the gap between a referral and an eye exam.” 

If a vision screening detects a problem, other groups are doing what they can to provide low- or no-cost eye exams to children who need them.

Many families may be eligible for coverage they don’t realize they have. Pediatric vision care is one of the 10 essential health benefits under the Affordable Care Act, so most Marketplace and small-group plans must cover children’s eye exams and glasses. Children in Medicaid and the Children’s Health Insurance Program (CHIP) allow coverage for vision screening, exams and glasses under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. Checking existing coverage first can help to remove a cost barrier.

AAPOS’s All Children See program also works to break down barriers to help families access eye care for kids. “There’s a website that they can go to and see if they’re eligible for an eye exam through the All Children See program,” Dr. Collins explained. “This would connect them to a pediatric ophthalmologist in their area for care.”

To ensure children receive eye care early, the AOA offers free vision exams for infants aged 6 to 12 months. These are provided through the AOA’s InfantSEE program, regardless of income or insurance, Gossard says.

“Most parents would never think twice about scheduling well-child visits or vaccinations,” she continued. “But many don’t realize that a baby’s eyes and visual system are developing rapidly during the first year of life. The program helps identify potential vision and eye health concerns at a very early age, when intervention can have the greatest impact.”

How eye doctors and parents can help

Children’s vision screening and eye exam experts are optimistic about the future. There are many ways eye doctors and parents can help continue to bridge the gap. 

Dr. Collins encourages parents, caregivers and teachers to have a two-way conversation about a child’s vision. “Parents should tell teachers if their child wears glasses, if they need specific seating in the classroom,” she said. “At the same time, if teachers are noticing things in the classroom, that children are squirmy, they’re squinting, they are seeming disengaged and complaining that they can’t see, they should flag that for parents as well.” 

Fishman advises parents to continue to advocate for their children by asking for vision screenings. “They need to ask their schools, their childcare, their pediatric care provider, their primary care provider, ‘Tell me about my kids’ eyes and are you screening for vision?’,” she said. “Does my child need an eye exam?”

As a way to give back to the community, Haddox encourages eye doctors to consider participating in Medicaid or their state’s children’s health insurance program whenever possible. Haddox suggested sliding scale fees, payment plans for uninsured families and partnering with nonprofits like Sight Savers, where the doctor either donates an exam or two a month or offers subsidized, discounted exams and glasses, are some ways doctors can make a difference. “Anything that can reduce the cost barrier for children and families that are under-resourced would be helpful.”

“Eye doctors can continue partnering with schools, pediatricians, family practice physicians, community organizations and public health programs to educate families and make care more accessible,” Dr. Gossard adds. “We can also work to reduce barriers by simplifying referrals, improving follow-up processes and supporting programs that bring care directly into communities.”

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