APHA urges preservation of children’s access to comprehensive vision care

Aiming to bolster access and reinforce the essentialness of comprehensive vision care in early learning and development, a new policy statement from the nation’s public health advocate reflects optometry’s focus on prioritizing children’s vision.

Adopted by the American Public Health Association’s (APHA’s) Governing Council on Oct. 24, Policy Statement 20202, “Increasing Access and Reducing Barriers to Children’s Vision Care Services”, outlines 10 action steps for federal, state, local and community agencies to implement that enable greater access to comprehensive eye health and vision care services for America’s children. Such steps range from not only directing the U.S. Health Resources and Services Administration (HRSA) to allocate new resources and increase support to state health departments but also urging public and private insurance programs to maintain comprehensive vision care for children, birth to 18 years of age, and mobilizing local authorities to proactively educate and direct caregivers toward eye care services.

“Children’s vision has been an invisible public health crisis,” says Andrea P. Thau, O.D., APHA Vision Care Section (VCS) policy chair and AOA past president. “Many children do not receive comprehensive eye care despite the high prevalence of eye and vision problems in the pediatric population. Lack of or a delay in diagnosis and treatment of eye and vision problems can have a profoundly negative impact on a child’s development and academic performance. Furthermore, many parents are unaware that their children have a vision problem because children assume however they see is normal and many not complain.

“This comprehensive, 18-page policy calls for public awareness campaigns to educate parents using culturally competent messaging, data collection to help identify the extent of the problem accessing comprehensive care, providing access to comprehensive eye care for all children, including underserved populations, and calls on public and private insurance to provide annual, comprehensive eye care for children, from birth through age 18.”

The culmination of two years’ work by the APHA’s VCS—including AOA member doctors and volunteers, Chair Rick Savoy, O.D.; Chair-Elect Wilson McGriff, O.D.; Past Chair Pat Segu, O.D.; Governing Counselors Norma Bowyer, O.D., and Glenn Steele, O.D.; and Dr. Thau—this new policy statement represents a more comprehensive and timely approach to identifying children’s vision issues than the narrowly focused, “piecemeal” approach taken over the past four decades. The second APHA policy passed by the VCS in as many years, and the first policies passed in nearly a decade, this new policy supersedes the five previous children’s vision statements that were slated to be archived or obsolescent.

“Passing an APHA policy is an arduous process and the policy’s ultimate passage signifies the high caliber and importance of this public health policy,” Dr. Thau says.

10 action steps for children’s vision care

Specifically, the APHA policy statement now recommends 10 action steps, including:

1. Enhanced data collection. Noting that data will help better define the problem, the statement calls on federal agencies, such as HHS, collecting children’s health data to gather objective clinical data on eye health and vision care access and utilization.
   
   
2. Ensuring proper terminology. Although vision screenings can serve to complement early and periodic comprehensive eye exams as an approach to identifying certain children at high risk for vision disorders, these tests do not replace a comprehensive eye exam performed by an eye doctor. The statement calls for precise language when communicating screenings in health care recommendations.
   
   
3. Allocating new resources. Through HRSA’s Maternal and Children’s Health Bureau (MCHB), new resources can be used to improve access and reduce barriers for comprehensive vision care services for all children. The statement suggests HRSA increase resources to state health departments and prioritize expansion of comprehensive vision care services through community health centers, as well as utilize the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program to educate parents on the importance of vision health for school readiness and achievement.
   
   
4. Ensuring availability and accessibility of vision care services. The statement suggests the Centers for Medicare & Medicaid Services (CMS) ensure all vision care services as required health care under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) component of Medicaid.
   
   
5. Maintaining comprehensive vision care. Both public and private insurance programs are directed to maintain comprehensive vision care for children, birth to age 18, as an essential standard benefit with coverage including comprehensive vision and eye health exams.
   
   
6. Reaching underserved populations. Federal, state and local governments or organizations should encourage the provision of comprehensive vision care in all health settings to increase access for underserved populations, especially among federally qualified health centers and school-based health clinics.
   
   
7. Delivering vision care for children with learning, developmental difficulties. State governments and local school boards should encourage comprehensive vision care among students with individualized education plans, diagnosis of attention or other behavioral disorders, and other learning or developmental difficulties, to ensure vision problems don’t impede learning and development.
   
   
8. Enhancing public education. The statement suggests HHS engage stakeholders in a public awareness campaign on children’s vision and the availability of insurance coverage for comprehensive eye care.
   
   
9. Establishing a collaborative response to children’s vision. Professional vision-related associations should educate parents and care givers on the importance of children’s vision care and related medical or behavioral health services through culturally competent and literacy-appropriate eye and vision health education and health promotion programs.
   
   
10. Reinforcing sports eyewear considerations. State governments should mandate children’s use of protective eyewear that meet ASTM International standards for high-risk sports with community partners assisting in the funding of such eyewear for children who cannot afford them. Facilitators of such sports programs should teach the value of quality protective eyewear and the risks of eye injuries.

Importantly, current science and evidence is reflected in this policy statement. It reiterates the National Academy of Medicine’s (formerly Institute of Medicine’s) statement that “quality care must be safe, timely, effective, efficient, equitable and patient-centered,” and that a comprehensive eye examination by a doctor of optometry or ophthalmologist remains the gold standard of eye care, provided annually as an essential health benefit under the Affordable Care Act.

As a lifelong proponent for infant and children’s eye care, and a former member of the Vision Care Section Policy Committee, Dr. Steele says he’s proud to see APHA’s adoption of such a strong statement—one that he has personally advocated for quite some time.

“We know there are many groups identifying kids who might need care but there were insufficient efforts to actually get children to that care,” Dr. Steele says. “This policy is so important because it encourages all parties to get kids to the care that they need and deserve.”