There is a public health emergency with respect to child vision care. Millions of children are not receiving essential eye care services that can prevent eye disease, developmental delays, school achievement and other social problems.
The country needs to provide all children with comprehensive vision care to ensure optimal health outcomes.
That was the message from Deborah Klein Walker, EdD, the keynote speaker at Western University of Health Sciences’ third annual Dr. Robert L. Austin Endowed Lectureship in Pediatric Medicine and Pediatric Health Policy on March 15, 2012.
Walker is a Vice President, Senior Fellow and the Practice Leader for Public Health and Epidemiology in the Health Division of Abt Associates, Inc. She has more than 40 years of experience in developing and implementing programs, policies and system change, research and evaluation on a broad range of health policy issues. She examined child vision care from a public health perspective at the Austin Lecture.
Child vision care in this country is abominable, she said. Undetected and untreated eye disorders such as amblyopia, strabismus and uncorrected refractive errors are major child health problems that are associated with poor reading and poor school outcomes.
“Shame on us because many of these can be prevented,” she said.
Twenty-five percent of school-age children suffer from vision problems that could have been eliminated or addressed with appropriate screening and referral in place, Walker said.
Early detection and treatment is essential for addressing child vision problems, but one challenge is the U.S. does not have uniform regulations. Professional optometry and ophthalmology associations support screening and examinations but the recommendations are not consistent. State requirements for vision screenings for preschool and above are not consistent across the country.
In 2007, 16 states had no vision requirement for children entering school or throughout the school years. Most states require some vision screening in public school settings but do not set standards for screenings or follow up, Walker said.
Those people with the biggest unmet need gaps are those in racial and ethnic minority groups, lower-income households, and households with no insurance. Twenty-three percent of kids without health insurance for more than a year had unmet vision care needs as compared with 5 percent of children who were insured for a year or more, Walker said.
The country needs to act to ensure all children get comprehensive services, she said. To this end, Walker recommends a uniform standard of care for all children from birth through adolescence. This requires public health experts and clinicians to work together.
“Public health is the catalyst, the convener,” she said. “Public health can do nothing without really outstanding clinicians, but clinicians need to work with public health and vice versa and all be part of one team.”
To build a comprehensive child vision care system, Walker recommends:
– Including child vision health in key pieces of legislation at the federal and state levels
– Ensuring adequate comprehensive coverage of child vision care services by all public and private insurers and payers
– Ensuring a “point of accountability” in the U.S. public health system through the establishment of a child vision health
categorical program linked to the Title V Maternal and Child Health Block Grant
– That each state hire a child vision care coordinator
– Developing a national set of children’s vision guidelines for screening and examinations and ensure that these
guidelines are adopted by all states in school health codes and mandates
– Implementing and funding a national clearinghouse or center for child vision health
– Enhancing and fully funding an ongoing national campaign to make people aware of childhood vision problems.
– Developing and facilitating a broad coalition of child-oriented stakeholder groups to work towards the establishment and
maintenance of a comprehensive child vision system across the country.
Any time you want to change something you need three things: a knowledge base, social strategy and political will, Walker said.
“The problem is today in many areas, especially in children’s health, we have a fantastic knowledge base but we don’t act on it,” she said. “You need both social strategies in how to do it and you need political will. It needs to come from all of us, especially people who are really committed to child health coming together.”
The Austin Lectureship is presented by Clinton E. Adams, DO, FAAFP, FACHE, dean of the College of Osteopathic Medicine of the Pacific (COMP), and by Elizabeth Hoppe, OD, MPH, DrPH, dean of the College of Optometry.
The lectureship was established in Austin’s memory by his wife, Gloria, their children, Charles, Douglas and Lynette, and their families, and is designed to honor and perpetuate his lifelong love of medical practice and his pursuit of pediatric knowledge in the health professions. He was a faculty member at COMP until his retirement in 1981.