Children’s vision problems are often not detected despite regular calls

Jessica Oberoi, 13, can’t remember exactly when her vision began to blur. All he knows is that he had to go to school to see the whiteboard.

It wasn’t until the last fall that Jessica’s extreme foresight and amblyopia or lazy eyes were discovered in her eighth grade in Bloomington, Indiana.

Since then she has been undergoing intensive care, and her ophthalmologist, Dr. Katie Connolly, says Jessica has improved a lot – but her lazy eyes, which cause problems with perception of depth, may never go away. Connolly, head of pediatric and binocular vision services at Indiana University’s School of Optometry, said if her condition had been diagnosed earlier, it would have been much more likely to have been completely cured.

Jessica is one of the countless students who have fallen through the cracks of the nation’s fragile efforts to diagnose and treat vision problems in children.

The Center for Disease Control and Prevention estimates that more than 600,000 children and adolescents are blind or visually impaired. A recent opinion piece published in the Jama Network states that this huge number of children can be helped only with spectacles, but due to high cost and lack of insurance coverage, many are not getting that help.

Yet the National Survey of Children’s Health, funded by the Federal Health Resources and Services Administration, found that a quarter of children in 2016-17 did not receive regular screening for vision problems.

And a large majority of these visually impaired people can be treated or cured if caught early, Connolly said.

“Screening is important for kids because kids don’t understand what’s unusual,” Connolly said. “They don’t realize that their peers around them – even their parents – are trying to understand that their experiences are different.”

Eye examinations for children are required under federal law which are mostly covered by personal health plans and Medicaid. According to the non-profit advocacy organization Prevent Blindness’s National Center for Children’s Vision and Eye Health, vision screening is mandatory for school-age children in 40 states and the District of Columbia, and for pre-schoolers in 26 states.

Still, many children who struggle to see clearly are being ignored. The epidemic has exacerbated the problem since the start of online classes, and for many students the only time their eyes are tested is at a school vision screening. Even after campuses reopened, school nurses were so overwhelmed by the Covid test that general screenings had to be put aside, says Kate King, president-elect of the National Association of School Nurses.

“Only the kids who were testing their eyesight complained that they couldn’t see,” King said.

According to the National Center, the problem is most prevalent among pre-schoolers. This indicates that a federal survey of children found that 61% of children under 5 years of age did not have their vision checked.

Kindergarten said kindergarten is an important time to examine a child’s vision because they are not old enough to cooperate in eye examinations alone, but when they are more likely to identify vision problems.

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

Ophthalmologists, physicians, and school nurses are concerned not only with children’s visual acuity, but also with their learning ability and overall quality of life. Both are strongly associated with vision.

“One of the assumptions is that if kids don’t see, they’ll just tell someone – problems that will come up on their own and they don’t need to find out,” said Kelly Hardy, of a California-based child advocacy group, Children Now. Its senior managing director of health and research. But most of the time that doesn’t happen because children are not the best advocates for their own vision problems.

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

“It’s like a fantastic low-tech, fairly simple intervention to make sure kids have a chance to succeed,” Hardy said. “And there are still kids out there who haven’t had their eyes screened or had their eyes checked, and that seems unacceptable, especially when there are so many other issues that are hard to solve.”

Connolly’s visit to Jessica’s school last year tested Jessica’s vision for the first time.

Her brother, Tanul Oberoi, 7, tagged Connolly’s clinic with his follow-up visit and had his vision checked for the first time. Her serious vision was marked, and she now wears glasses. Since her condition was diagnosed early, she has a good chance of improving her eyesight with glasses and her prescription will decrease over time.

“It was amazing to me that they had trouble seeing because they hadn’t told me anything before,” said Sonia Oberoi, mother of Jessica and Tanul. “They usually tell me when they have a problem, and I see them when they read something. I didn’t know.”

The only part of the battle found in vision screening, Connolly said. Purchasing glasses is an extension for many families who lack coverage because the average cost without insurance is $ 351 per pair. The JAMA article noted that in developing countries, hard glasses made from flexible steel wire and plastic lenses can be made for about $ 1 per pair, but this option is not commonly found in the United States.

Since Jessica and Tanul were not insured, their mother said the family would have to bear the cost of their glasses. Connolly’s clinic worked with a number of programs to fully cover their treatment and glasses and Jessica’s contacts.

The problem overcomes the problem of poor eyesight and neglected vision. There is a strong link between children’s vision and their development – especially the way they learn. Struggling to see clearly can be the beginning of many low-grade problems for children, such as low grades, misdiagnosis, attention deficit disorder or lack of confidence.

In a 2020 study by Spanish researchers published by the International Journal of Environmental Research and Public Health, students who had “poor academic performance” were twice as likely to have “good academic performance” as they admitted they could not see the blackboard. In addition, those who performed poorly academically were twice as likely to have fatigue or headaches while reading, according to the study.

“Kids do better in school and they do better socially if they don’t have uncorrected vision problems,” Hardy said. “And so it feels like a no-brainer that we need to make sure the kids are getting the care they need. We’re doing better.”

King, who works at a middle school in Columbus, Ohio, says students’ vision problems were ignored even before the epidemic.

Of all the ophthalmologist referrals he sent home, he said about 15% of pediatricians were taken to the ophthalmologist without having to contact their parents again. “An overwhelming majority doesn’t actually follow and get a comprehensive test,” King said.

Another problem is that Medicaid and private insurance usually cover a pair of glasses every year or two, which King said is not ideal for growing and inexperienced children.

“The school nurses specialize in spectacle repair,” King said with a smile. “Often we have to put a new nose piece or a new screw or fix them because a classmate was sitting on them.”

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