Building a comprehensive child vision care system

www.visionandhealth.orgAug 13 2009

Even though universal comprehensive eye exams for children prior to starting school would result in more children being diagnosed and successfully treated for vision problems and eye diseases, requirements vary widely from state to state and only three states require eye examinations for school-age children, according to a new report from the National Commission on Vision and Health.

The report, "Building a Comprehensive Child Vision Care System," found that children are being screened at low rates and those who are screened do not often receive the necessary follow-up and treatment they may require. Children without health insurance and those living in poverty are at the greatest risk. Although the majority of states do require some type of vision screening prior to children entering public schools, they often fail to use the best screening tests and to assure important follow-up for those who fail the screening. Only three states, Kentucky, Illinois and Missouri, require comprehensive eye exams for children entering school. Currently fifteen states do not require any form of screenings or exams, resulting in a public health emergency for millions of children.

"Children from low-income families lack the health care resources necessary to break the cycle of poverty," said David Rosenstein, DMS, MPH, Oregon Health & Science University professor emeritus. "This lack of vision care is handicapping our most vulnerable populations. Research from the Centers for Disease Control and Prevention shows that 83 percent of families earning less than 200 percent of the federal poverty level have children who have not seen an eye care provider during the prior year. This must change now for the sake of our children."

According to doctors, early detection and treatment are essential in treating eye diseases and disorders in children and can lead to better school achievement and overall health outcomes which can lead to prevention of eye disease and developmental delays. Vision screenings vary in scope and are not designed to detect many visual problems. A comprehensive exam by an eye doctor does, and an eye doctor can also provide follow-up treatment.

"This report finds that vision screenings are not the most effective way to determine vision problems," said Deborah Klein Walker, EdD., principal author of the report and past-president of the American Public Health Association. "Screenings missed finding vision conditions in one-third of children with a vision problem and most of the children who are screened and fail the screening don't receive the follow-up care they need. This, despite the fact that many of the vision problems affecting children can be managed or even eliminated if they receive proper care right away."

Millions of children are without adequate care and preventable eye diseases and correctable vision problems are neglected. Many eye and vision disorders lack obvious signs and symptoms and can be prevented or treated through early detection, follow-up care and ongoing treatment. Undiagnosed and untreated vision problems in children can potentially limit the range of experiences and kinds of information to which the child is exposed. Visual learning plays an important role in how a child learns to understand and function in the world.

Studies indicate that one in four children have an undetected vision problem. Additionally, a quarter of school-age children suffer from vision problems that could have been addressed or eliminated if appropriate eye assessment programs and follow-up care had been in place when they started school.

"Starting school with good vision should be a part of every child's back-to-school plan," said Commission chair Edwin C. Marshall, O.D., M.P.H., Vice President for Diversity, Equity, & Multicultural Affairs at Indiana University. "Clear and comfortable vision is essential for learning, and the country would be well-served to make sure children's eye exams are accessible and required."

Given the data surrounding this public health emergency, the Commission recommends agencies at the federal, state and local levels collaborate with academia, business, providers and the public to create a comprehensive child vision care system to ensure all children are assessed for potential eye and vision problems before entering school and throughout the school years. In addition to universal access to vision care, the Commission recommends a point of accountability within local public health agencies, a national education campaign, and ongoing data collection to monitor the use and efficacy of child vision exams.

Specifically, the commission supports a national child vision care system that:

• Includes child vision health care in key legislation at the federal and state levels.
• Assures adequate comprehensive coverage of child vision care services by all public and private insurers and payers.
• Establishes a child vision health categorical program linked to the Title V MCH Block Grant within the Maternal and Child Health Bureau in the Health Resources Service Administration (HRSA), Health and Human Services (HHS).
• Develops a national set of children's vision guidelines for screening and examinations and assure these guidelines are adopted by all states.
• Implements and funds a national clearinghouse for child vision health within the Department of Health and Human Services.
• Enhances and fully funds national campaigns to encourage early identification of child vision problems and to prevent injuries from sports and toys.
• Designs and implements an ongoing data system that monitors prevalence of child vision problems together with access and utilization of child vision care services.
• Develops and facilitates a broad coalition of child-oriented stakeholder groups to work towards the establishment and maintenance of a comprehensive child vision system across the country.