Health Reform Offers Better Children’s Vision Care in the U.S.

Undiagnosed and untreated vision problems among school-aged children in the United States are urgent national public health challenges[1] that, for the first time in U.S. history, are directly being addressed through insurance benefits of the Affordable Care Act (ACA). Beginning in January, 2014, vision care for children will be covered by many health plans as an essential benefit, no longer standing alone in separate vision plans, and no longer restricted by flawed vision screening.

Direct access to vision care provided by optometrists for children from birth through age 18, including comprehensive eye exams and glasses, becomes the new standard of medical coverage offered through the state insurance exchanges, at every level.

Past reliance on inherently flawed vision screening lessened a child's access to needed vision care by as much as 73 percent[2]. When vision problems are missed by vision screening, children are often misdirected into Individualized Education Plans (IEPs) and/or ADHD treatments unaware that they actually need vision care instead.

Vision screening is not an eye exam. Vision care, now defined as annual access to eye examination and glasses, is essential to a child's overall physical, mental health, social development and educational advancement opportunities.

Our nation's historical misreliance on vision screening has plagued our education, mental health and juvenile justice systems for too long, serving as major contributive factors to children's inability to perform and conform to the demands of school and society. With an estimated 75 to 90 percent of all classroom learning coming to students via the visual pathways, nearly all tasks a child is asked to perform in the classroom depend on good visual skills; visual skills that can only be assessed through a comprehensive optometric eye examination[3] and which are not assessed through vision screening. Interference with these essential vision pathways results in a child experiencing difficulty with learning tasks[4] and are significant contributors to early reading difficulties and ultimately to special education classification. 

Vision screening, by falsely telling too many children that they have no vision problem, when they actually do, has long closed the door to vision health and education opportunities, especially for children from families whose socio-economic status is at or below 400 percent Federal Poverty Level (FPL), already burdened by being 3 times more likely to have permanent vision problems, by going without vision examination.[5] The ACA makes a historic change to this unfortunate situation by removing the screening barrier for many children, whose insurance will now cover a comprehensive eye exam annually from an optometrist.

Vision screening's low  sensitivity of 27 percent indicates that among 100 children with vision problems (e.g. requiring optometric treatment to correct vision and the visual system, allowing children to success in school and life without being mislabeled) provided vision screening and not assessed through eye examination, 73 of those 100 children having  refractive errors hyperopia (farsightedness), astigmatism (irregular curvature of the eye), and significant strabismus (eye turn) will be misdirected away from the eye examination they need, and  forced to continue to suffer visual impairment that has permanent social and health implications.

Alarmingly, recent data shows that in the U.S. only 7 percent of children beginning first grade report having received an eye exam, when parent or caregiver is surveyed[6]. Research shows that children with Individualized Education Plans (IEPs), in the age range of 6- 16 years, and juvenile offenders, have high rates of undiagnosed and untreated eye problems including hyperopia (farsightedness) affecting reading speed and comprehension. The research concludes that all students being considered for an IEP should have a comprehensive eye examination, because often all the student requires is optometric treatment[7]. Additionally, these children should not receive vision screening due to high rates of false negatives, which falsely imply to parents that no vision problem is present. 

In conclusion, our nation's children all deserve a clear future.  Parents should make sure their child has the tools needed to succeed in school and later in life. If children are not assessed early and regularly, through comprehensive eye examination, greater levels of preventable disease disparity and disability will result.  The ACA allows parents to access these comprehensive eye exams.  The new vision care provisions of the ACA now assure that Children's Vision Care in U.S. will never be the same, only better.

To learn about the new ACA Optometric Care Essential Health Benefit, visit www.aoa.org


[1] National Institutes of Health The Multi-Ethnic Pediatric Eye Disease and Baltimore Pediatric Eye Disease Studies (NEI.2011)

[2] www.visionandhealth.org/documents/Child_Vision_Report.pdf

[3] Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls, Patrick Quaid and Trefford Simpson, Graefes Arch Clin Ophthalmology (2013) 251:169-187.

[4] Learning Related Visual Problems, ERIC Publication, n.d

[5] Medical Expenditure Panel Survey, 2006

[6] 2002 National Health Interview Survey as cited in CDC MMWR, 54(17), 425-9

[7] Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls, Patrick Quaid and Trefford Simpson, Graefes Arch Clin Ophthalmology (2013) 251:169-187.