Children’s vision screening has dropped during the pandemic

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

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

She’s been undergoing intense treatment since then, and her optometrist, Katie Connolly, said Jessica has made big improvements – but her lazy eye, which causes depth perception issues, may never go away.

The odds of him being fully corrected would have been much higher had his condition been detected earlier, said Connolly, chief of pediatric and binocular vision at Indiana University’s School of Optometry.

Jessica is one of countless college students falling through the cracks of the nation’s fractured efforts to catch and treat vision problems in children.

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The Centers for Disease Control and Prevention estimate that more than 600,000 children and adolescents are blind or have vision impairment. A recent opinion piece published on JAMA Network notes that many of these children could be helped with just glasses, but due to high costs and lack of insurance coverage, many are not getting them.

Yet the National Survey of Children’s Health, funded by the US Health Resources and Services Administration, found that in 2016-2017, a quarter of children were not regularly screened for vision problems.

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

“Screenings are important for kids because kids don’t realize what’s abnormal,” Connolly said. “They don’t know what their peers around them – or even their parents – are seeing to realize their experience is different.”

Eye exams for children must, by federal law, be covered by most private health plans and Medicaid. Vision screenings are mandatory for school-aged children in 40 states and the district, and 26 states require them for preschoolers, according to the National Center for Children’s Vision and Eye Health at Prevent Blindness, an organization non-profit advocacy.

Yet many children who have difficulty seeing clearly are neglected. The pandemic has only exacerbated the problem as in many places classes have been moved online, and for many students, school vision screenings are the only time they get their eyes checked. . Even when campuses reopened, school nurses were so overwhelmed with coronavirus testing that general screenings had to be shelved, said Kate King, president-elect of the National Association of School Nurses.

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

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The problem is more prevalent in preschoolers, according to the national center. He points out that the Federal Children’s Survey found that 61% of children 5 and under had never had a vision test.

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

The CDC survey also found that 67% of children with private health insurance had had an eye exam, compared to 43% of those who were uninsured.

Learning ability issues

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

“There seems to be an assumption that maybe if kids can’t see they’ll just tell someone – that the problems will sort of present themselves and they don’t have don’t need to be found,” said Kelly Hardy, senior managing director of health and research for 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 issues.

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

“It looks like a pretty straightforward, simple enough intervention to make sure kids have a chance to succeed,” Hardy said. “And yet there are children 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 go on. are more difficult to resolve.

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

Her brother, Tanul Oberoi, 7, accompanied her on her follow-up visit to Connolly Clinic and had her vision tested for the first time. His severe astigmatism has been identified and he now wears glasses. Since his condition was caught early, chances are his sight with glasses will improve and over time his prescription will decrease.

“It surprised me that they had trouble seeing because they didn’t tell me before,” said Sonia Oberoi, Jessica and Tanul’s mother. “They usually tell me when they have a problem, and I watch them when they read something. I didn’t know.

Getting vision screenings is only part of the battle, Connolly said. Buying eyeglasses is a difficult exercise for many families without coverage, as the average cost without insurance is $351 per pair. The JAMA article points out that in developing countries, sturdy glasses made from flexible steel wire and plastic lenses can be made for around $1 a pair, but this option is generally not available to people. United States.

Since Jessica and Tanul are uninsured, their mother said the family should cover the cost of their glasses. Connolly’s clinic worked with multiple programs to fully cover their treatment and glasses, as well as Jessica’s contacts.

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The problem goes beyond poor eyesight and neglected vision problems. There is a strong connection between children’s vision and their development, especially the way they learn. Struggling to see clearly can be the start of many downstream issues for children, such as low grades, misdiagnosed attention deficit disorder, or lack of self-confidence.

In a 2020 study, students who had “poor grades” were twice as likely as those with “good grades” to admit they couldn’t see the blackboard properly. What’s more, those with lower grades in school were also twice as likely to get tired or suffer from headaches while reading, according to the study.

“Kids do better in school and they do better socially if they’re not walking around with uncorrected vision problems,” Hardy said. “And so, it seems obvious that we need to make sure that we do better to ensure that children get the care they need.”

King, who works at a college in Columbus, Ohio, said students’ vision problems were ignored even before the pandemic.

Of all the optometrist referrals she sends home, she said about 15% of children are taken to an eye doctor without her having to contact the parents again. “An overwhelming majority don’t follow up and don’t get a full review,” King said.

This article was produced by Kaiser Health News, a program of the Kaiser Family Foundation, an endowed nonprofit organization that provides information on health issues to the nation.

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