New US Initiative Provides Vision Care for All Children – Almost

In late February 2013, the US Department of Health and Social Services approved a new requirement that provides guaranteed vision care services for all US schoolchildren. This means all children can have a comprehensive vision examination paid for by public health each year up to and including age 18. This service has been available through provincial health authorities in Canada for some years now, but is underutilized.

Research shows that from 15-35% of children in Elementary classrooms are now struggling with impediments to vision that interfere with their ability to read and learn. In many cases, vision is so difficult and strenuous that children appear to have attention and impulse control problems. For others, vision problems lead to false diagnoses of health concerns and needless medical and psychological testing. Vision is clearly a key element to learning, development, and behaviour.

A child with visual impediments to learning is not necessarily legally ‘blind’, so-called visual impairment, though this is sometimes the case. Most concerns relate to uncorrected farsightedness, astigmatism, alignment, and targeting problems – issues that strongly interfere with a child’s achievement and growth.

Currently, even though the Province does fund exams for children, most parents never get the chance to bring children to see qualified optometrists. As a result, fewer than 20% of children are ever checked before it’s academically ‘too late’. There comes a point in later Elementary where a child will have simply missed too much of the foundation to ever hope to succeed in primary education. Most children with undetected visual problems will fall into this category to some degree, with some completely missing out on life opportunities. Most children with vision problems go undetected.

The fact that we systematically ignore the needs of so many children and go on to prescribe treatments, including drugs, for children who would be much better served by basic vision care is professionally embarrassing.

Schools, for their part, have no clear direction from the Province regarding vision needs. It’s not uncommon to find community nurses in schools giving flu vaccines, and this with a dubious return on investment. In contrast, a simple comprehensive vision exam for a child as he enters school school provides the greatest health return on investment of any intervention in early childhood. Even more than socioeconomic status, vision is the most important determinant of academic success. The fact that we systematically ignore the needs of so many children and go on to prescribe treatments, including drugs, for children who would be much better served by basic vision care is professionally embarrassing.

Parents don’t know to look for vision problems and family doctors and schools are not requiring vision assessment. My day-to-day clinic experience tells me this is a big mistake.

Both the Province and the US Department of Health and Social Services recognize that strong vision is essential for child development. But even with the service in place, too few children are checked. For the children who struggle but are never checked, this is a violation of their basic rights as Canadians. Parents don’t know to look for vision problems, and family doctors and schools are not requiring vision assessment. My day-to-day clinic experience tells me this is a big mistake.

The solution is to require vision assessment for all children in school … Without that, thousands of children will continue to struggle needlessly while schools and health care waste millions chasing problems that aren’t there.

The solution is to require vision assessment for all children as they enter school or as soon as possible after that. Schools for their part need to facilitate the process to help parents with their busy schedules. Without a strong standard, thousands of children will continue to struggle needlessly while schools and health care go on wasting millions chasing problems that aren’t there.

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