Prioritizing Children’s Vision Health This School Year

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By Megan Collins, MD, MPH and Mark Ruchman, MD

This August, many children and families are excitedly—some nervously—preparing for the return to the classroom and filling up shopping carts with new notebooks, pencils and other back-to-school essentials. However, there is one item on their back-to-school checklist that stands out as one of the most important steps for ensuring children’s long-term learning success—a vision screening or eye exam. 

During the pandemic, screen time for children increased significantly as many schools switched to virtual learning and social activities moved online—giving rise to cases of myopia (also known as nearsightedness) and digital eye strain in children. For instance, one study identified a significant increase in the number of children with progression in their myopia over just the last 18 months—and suggested a link between this rise in cases and more screen time and less outdoor time. 

This rise of vision conditions in children is also expected to lead to a rise in vision benefits utilization. As August is not only back-to school season, but also National Eye Exam Month, Children’s Eye Health and Safety Month and National Vision and Learning Month, health plans should use this moment to educate members on vision health’s impact on long-term academic, social and athletic success and encourage members to schedule eye exams for any family members suspected of having an eye problem or due for an eye exam. After all, eye exams are critical to not just clear sight, but overall health, wellness and lifestyle.

Why Eye Exams are Important for Children’s Health and Success

Although around 80% of classroom learning is visual, fewer than 15% of preschool children receive an eye exam by a professional, according to the American Optometric Association. And while caregivers may assume that school vision screenings sufficiently detect vision concerns, it’s estimated that only about 25% of these school vision screenings catch all vision issues. 

Further highlighting the issue, although as many as 1 in 10 children has a vision problem significant enough to impact learning, many of these children are misdiagnosed as having learning disorders like ADD or ADHD, putting them on an academic track without the necessary, simple interventions to aid their learning. 

Vision health impacts essential skills like reading, and poor vision can impair hand-eye coordination needed for writing, drawing and even athletics. However, early detection and treatment can, in many cases, prevent permanent vision loss and correct problems, positively impacting children’s ability to participate in the classroom.  

Warning Signs of Vision Issues in Children Post-Pandemic

Children’s vision changes more rapidly than an adult’s, meaning that a vision issue can appear quickly without children or caregivers recognizing it. Because children have no basis of comparison for their vision, they often do not acknowledge symptoms of vision issues like eye strain or blurriness. With many children unable to let caregivers know that they are struggling, it is up to caregivers to watch out for warning signs of potential issues.  

Here are a few signs that children may be having vision issues:

  • Eye rubbing
  • Light sensitivity
  • Chronic redness
  • Difficulty reading
  • Behavioral problems such as avoiding reading, inattentiveness, fatigue and acting out

Although most states in the U.S. have mandated vision screenings for children, many of these vision screenings have been delayed over the past 12-18 months—meaning that children today could have been struggling with undetected vision issues for more than a year. Because the earlier a vision issue is detected, the better the chances are that it can be successfully treated, this delay in diagnosis can lead to additional potential problems down the road for children.  

Steps Caregivers Can Take to Protect Children’s Vision this School Year

In addition to scheduling eye exams for children who need them, there are steps caregivers can take to help promote vision health. For instance, for myopic patients, one hour per day of outdoor physical activity has shown to slow the condition’s progression. 

A few other steps to prevent eye damage include:

  • Limiting screentime and following the 20-20-20 rule, where children look at an object 20 feet away for 20 seconds every 20 minutes
  • Wearing a hat or sunglasses when outside
  • Wearing sports goggles for contact sports that could result in an eye injury
  • Encouraging children to participate in non-digital activities like board games, books and outdoor play
  • Eating a balanced diet that includes some leafy green vegetables and carrots

For eye care providers, eye exams serve as a window into the body, and they are important for children with systemic issues, such as diabetes, juvenile arthritis, or even underlying neurologic problems. For this reason, and to help prevent costly long-term complications from undiagnosed vision issues, vision screenings or eye exams should be considered an essential part of any regular health checklist. As we approach the start of the next school year, health plans should use this moment in time to connect with members on the value of eye exams when indicated and vision benefits for children’s long-term success. The result could be significant savings in both costs and concerns for health plans and their members.

Co-authors: Megan Collins, MD, MPH, pediatric ophthalmologist at the Johns Hopkins Wilmer Eye Institute, assistant professor of ophthalmology at Johns Hopkins, faculty member at The Berman Center for Bioethics, co-founder of the Johns Hopkins Consortium for School Based Health Solutions and member of Versant Health’s Medical Policy Council; Mark Ruchman, MD, Chief Medical Officer, Versant Health.

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