Children’s Vision Problems Often Go Undetected, Despite Calls for Regular Screening

Jessica Oberoi, 13, can’t exactly remember when her eyesight started getting blurry. All she knows is that she had to squint to see the whiteboard at school.

It wasn’t until last fall when her eighth grade class in Bloomington, Indiana, got vision screenings that Jessica’s extreme nearsightedness and amblyopia, or lazy eye, were discovered. She’s been going through intense treatment since then, and her optometrist, Dr. Katie Connolly, said Jessica has made great improvements — but her lazy eye, which causes depth perception problems, may never go away. The chances of it being completely corrected would have been much higher if her condition had been caught earlier, said Connolly, chief of pediatric and binocular vision services at Indiana University’s School of Optometry. Jessica is one of the countless students falling through the cracks of the nation’s fractured efforts to catch and treat vision problems among children.

The Centers for Disease Control and Prevention estimates that more than 600,000 children and teens are blind or have a vision disorder. A recent opinion article published on JAMA Network notes that a large number of these children could be helped simply with glasses, but because of high costs and lack of insurance coverage, many are not getting that help. Yet the National Survey of Children’s Health, funded by the federal Health Resources and Services Administration, found that in 2016-17 a quarter of children were not regularly screened for vision problems. And a large majority of those vision impairments could be treated or cured if caught early, Connolly said. “Screenings are important for kids because kids don’t realize what’s abnormal,” said Connolly. “They don’t know what their peers around them — or even their parents — are seeing to realize their experience is different. ”Eye exams for children are required under federal law to be covered by most private health plans and Medicaid. Vision screenings are mandated for school-age children in 40 states and the District of Columbia, and 26 states require them for preschoolers, according to the National Center for Children’s Vision and Eye Health at the nonprofit advocacy organization Prevent Blindness.

Still, many children who are struggling to see clearly are being overlooked. The pandemic has only exacerbated the issue since classes moved online, and for many students in-school vision screenings are the only time they get their eyes checked. Even when campuses reopened, school nurses were so swamped with covid testing that general screenings had to be put to the side, said Kate King, president-elect of the National Association of School Nurses. “The only kids who were getting their vision checked were the ones who were complaining about not being able to see,” King said. The problem is most prevalent among preschoolers, according to the national center. It points out that the federal survey of children found that 61% of children 5 and younger had never had their vision tested. Kindergarten, Connolly said, is a critical time to check a child’s vision because not only are they old enough to cooperate with eye exams, but it’s when vision problems are more likely to be identifiable.

The CDC survey also found that 67% of children with private health insurance had their vision screened, compared with 43% of those who were uninsured. Optometrists, physicians, and school nurses are concerned not only about children’s visual acuity, but also their ability to learn and overall quality of life. Both are strongly linked to vision. “There seems to be an assumption that maybe if kids can’t see, they’ll just tell somebody — that the problems will sort of come forward on their own and that they don’t need to be found,” said Kelly Hardy, senior managing director of health and research for a California-based child advocacy group, Children Now. But that’s not the case most of the time because children aren’t the best advocates for their own vision problems. And when left untreated, those problems can worsen or lead to other serious and permanent conditions. “It feels like a pretty low-tech, pretty easy intervention to make sure that kids have a chance to succeed,” Hardy said. “And yet there’s kids going around that haven’t had their vision screenings or haven’t had an eye exam, and that seems unacceptable, especially when there’s so many other things that are harder to solve.

”Connolly’s visit to Jessica’s school last year marked the first time Jessica had her vision checked. Her brother, Tanul Oberoi, 7, tagged along on her follow-up visit to Connolly’s clinic and had his vision screened for the first time. His serious astigmatism was identified, and he now wears glasses. Since his condition was caught early, there is a good chance his eyesight with glasses will improve and that over time his prescription will be reduced. “It was surprising to me that they have trouble seeing because they didn’t say anything to me before,” said Sonia Oberoi, Jessica and Tanul’s mom. “They usually tell me when they have a problem, and I watch them when they read something. I didn’t know. ”Getting vision screenings is only part of the battle, Connolly said. Purchasing glasses is a stretch for many families lacking coverage since the average cost without insurance is $351 a pair. The JAMA article points out that in developing countries, sturdy glasses made from flexible steel wire and plastic lenses can be manufactured for about $1 a pair but that option is not generally available in the U.S. Since Jessica and Tanul are not insured, their mom said the family would have to pick up the cost of their glasses. Connolly’s clinic worked with several programs to completely cover their treatment and glasses, plus contacts for Jessica.

The issue goes beyond poor eyesight and overlooked vision problems. There is a strong link between children’s vision and their development — especially the way they learn. Struggling to see clearly can be the beginning of many downstream problems for children, such as low grades, misdiagnosed attention-deficit disorders, or lack of self-confidence. In a 2020 study by researchers in Spain published by the International Journal of Environmental Research and Public Health, students who had “bad academic performance” were twice as likely as those with “good academic performance” to admit that they can’t see the blackboard properly. Additionally, those who performed poorer academically were also twice as likely to get tired or suffer headaches while reading, according to the study. “Kids do better in school and they do better socially if they’re not going around with uncorrected vision problems,” said Hardy. “And so it feels like a no-brainer that we need to make sure that we’re doing better to make sure that kids are getting the care they need.

”King, who works at a middle school in Columbus, Ohio, said that even before the pandemic students’ vision problems were being overlooked. Of all the optometrist referrals she sends home, she said just around 15% of children are taken to an eye doctor without her having to reach out to parents again. “An overwhelming majority actually don’t follow up and don’t get a comprehensive exam,” King said. Another issue is that Medicaid and private insurance usually cover one pair of glasses every year or two, which King said is not ideal for growing and clumsy kids. “School nurses are experts at glasses repair,” King said, while chuckling. “Often we need to put in a new nosepiece or put in a new screw, or get them fixed because a classmate sat on them.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Effect of Combining 0.01% Atropine with Soft Multifocal Contact Lenses on Myopia Progression in Children



Combining 0.01% atropine with soft multifocal contact lenses (SMCLs) failed to demonstrate better myopia control than SMCLs alone.


The Bifocal & Atropine in Myopia (BAM) Study investigated whether combining 0.01% atropine and SMCLs with +2.50-D add power leads to greater slowing of myopia progression and axial elongation than SMCLs alone.


Participants of the BAM Study wore SMCLs with +2.50-D add power daily and administered 0.01% atropine eye drops nightly (n = 46). The BAM subjects (bifocal-atropine) were age-matched to 46 participants in the Bifocal Lenses in Nearsighted Kids Study who wore SMCLs with +2.50-D add power (bifocal) and 46 Bifocal Lenses in Nearsighted Kids participants who wore single-vision contact lenses (single vision). The primary outcome was the 3-year change in spherical equivalent refractive error determined by cycloplegic autorefraction, and the 3-year change in axial elongation was also evaluated.


Of the total 138 subjects, the mean ± standard deviation age was 10.1 ± 1.2 years, and the mean ± standard deviation spherical equivalent was −2.28 ± 0.89 D. The 3-year adjusted mean myopia progression was −0.52 D for bifocal-atropine, −0.55 D for bifocal, and −1.09 D for single vision. The difference in myopia progression was 0.03 D (95% confidence interval [CI], −0.14 to 0.21 D) for bifocal-atropine versus bifocal and 0.57 D (95% CI, 0.38 to 0.77 D) for bifocal-atropine versus single vision. The 3-year adjusted axial elongation was 0.31 mm for bifocal-atropine, 0.39 mm for bifocal, and 0.68 mm for single vision. The difference in axial elongation was −0.08 mm (95% CI, −0.16 to 0.002 mm) for bifocal-atropine versus bifocal and −0.37 mm (95% CI, −0.46 to −0.28 mm) for bifocal-atropine versus single vision.


Adding 0.01% atropine to SMCLs with +2.50-D add power failed to demonstrate better myopia control than SMCLs alone.

Jones, Jenny Huang PhD, OD, MPH1∗; Mutti, Donald O. OD, PhD, FAAO1; Jones-Jordan, Lisa A. PhD, FAAO1; Walline, Jeffrey J. OD, PhD, FAAO1

Optometry and Vision Science: May 2022 – Volume 99 – Issue 5 – p 434-442doi: 10.1097/OPX.0000000000001884

Orthokeratology for Myopia Control: A New Review

Orthokeratology  has been proven to decrease the progression of myopia in school-aged children, according to a number of studies. Orthokeratology has recently been regarded among the most effective optical treatments for myopia management.

This study examined peer-reviewed research on the effectiveness of Orthokeratology in the treatment of myopia. However, even while myopia advancement cannot be halted completely, Ortho-K it has been shown to have an inhibitory effect of between 32% and 63% compared to single-vision glasses and soft contact lenses over the course of two years.

In addition, multiple studies with up to ten years of data have verified the efficacy and acceptable safety of the therapy.

Myopia progression following Orthokeratology discontinuation may or may not see a rebound phenomenon. It’s also not obvious how long each patient should continue treatment to get the most out of it.

Longer follow-up periods across a broader range of people are needed in the near future to better examine if myopia progression rebounds.

Myopia Control With Orthokeratology: A Review

Hiraoka, Takahiro M.D.

Eye & Contact Lens: Science & Clinical Practice: March 2022 – Volume 48 – Issue 3 – p 100-104

doi: 10.1097/ICL.0000000000000867

Top Experts Weigh In about Eye Care Monitors

Blue light filtering

First, marketers begin with the statement that blue light is dangerous to our eyes, skin, and sleep patterns. This is factually correct, but somewhat intellectually dishonest.

Let’s turn to an expert for a better explanation. As Dr. Norman Shedlo, Optometrist and owner of the Eyecare Center of Maryland, puts it:

“It’s true that blue and ultraviolet light are dangerous to eyes, but only at very high intensities.  The amount of blue light produced by a computer monitor or phone screen is so dim that it has no effect on the health of the eyes.  The blue and UV light from the sun is very dangerous and is a documented source of skin cancer, cataracts and retina disease to millions.  This is why doctors recommend sunglasses and sunscreen to people spending significant time outdoors.”

– Dr. Norman Shedlo

Flicker Rates

If you have ever noticed the flicker of a monitor or other display, you will agree that the flicker can be aggravating and unpleasant to look at. But the important question here is whether or not a “flicker-free” monitor does anything to protect your eyes.

Again, we turn to the experts. Dr. Shedlo tells us that “flicker rates between 70-90 Hz will present a screen that does not appear to ‘flicker’. The flickering itself is not dangerous to your eyes, it’s just annoying. Flicker rates above this are outside the range of human perception and make absolutely no difference. These rates have no effect on eye strain.”

We discussed the topic with Dr. Yuna Rapoport, an Ophthalmologist and owner of Manhattan Eye.

Most of the eye strain that occurs happens because of dry eye and decreased blink. So, while special flicker free monitors and monitor lamps seem fancy and may provide a better user experience, from a medical point of view they do not ‘save the eyes.’

– Dr. Yuna Rapoport

We asked our experts a few simple questions: Would you recommend a special eye care monitor for a friend or family member? And would you pay extra for an eye saving monitor?

Dr. Rapoport stated that she does not “think that they are worth the extra price,” and she “would not get one for myself or for a loved one.”

Dr. Shedlo replied that he “would not pay extra for any eye health benefits claimed by these technologies.”

If we are looking solely at the science and the expert advice, there is insufficient evidence to suggest that eye care monitors actually improve eye health.

Monitor Lamps

The concept behind monitor lamps, monitor light bars, and monitor bias lighting is relatively simple. These products minimize the lighting contrast between your monitor and the surrounding area. A bright display in a dark room causes strain on the eyes, so it is better to have some ambient lighting near your computer.

So, these products probably help minimize eye strain when compared to using no monitor lighting at all. But that doesn’t mean that it makes sense to spend $100+ for a specialty monitor light bar that claims it will save your eyes. Ultimately, these monitor lamps and light bars are simply, as Dr. Shedlo puts it, “smaller lamps placed on the monitor to provide lighting to certain places on the desk. Their function can be substituted for by any suitable desk lamp pointed in the right direction.”

However, much of this “eye saving” technology is actually just marketing hype. As Dr. Shedlo puts it, these computer companies use language that is “scientific and technical [to give] the impression of legitimate benefits based on scientific data.” But “the claims about the relationship of new monitors to eye health have no basis in reality.”

How do I know myopia control is working?

One of the most difficult challenges in myopia control is identifying whether or not patients are receiving a significant therapy benefit. This has been a problem because patients of different ages progress at varying rates, and we can never truly know how far an individual patient would have advanced if they hadn’t received treatment.

A good example of this is the typical 7-year-old non-Asian patient progressing by –1.00D in refractive error and 0.35mm in axial length per year, but the average 12-year-old non-Asian patient progresses by –0.40D in refractive error and 0.21mm in axial length per year.

Individuals of Asian descent make slightly more progress than patients of non-Asian descent. The prevalent thinking that a myope develops 0.50D per year on average only holds true for people of a specific age and racial group (those under the age of ten).

In addition, it is crucial to remember that emmetropic patients might have a neutral refractive error while still experiencing around 0.1mm of axial length advancement per year.

Recently published evidence suggests that the maximal axial length slowing experienced by a myope treated with a multifocal soft contact lens may be similar to that seen by an emmetrope in some cases.

As a result, it is unlikely that we will be able to completely halt axial length growth in children who are still growing. In addition, it is vital to remember that these are averages, which means that certain patients will progress more rapidly than the average myope.

What can we do with this information to determine the effectiveness of myopia management treatments? Efficacy is determined by observing that individuals progress less than the mean value for their age and race after undergoing a particular treatment.

While this is not a perfect sign of effectiveness, it does provide us with some foundation for determining whether a treatment is helpful, and we will most likely continue to rely on this type of data until studies that speak to the effectiveness of treatments in individual patients are conducted.

We discuss with families the potential benefits of combination therapy after at least one year of treatment. Nonetheless, it is up to the parents, after they have been educated, to decide whether or not to change the course of therapy.