Statement of Need
A call to action to improve children’s vision and eye health in the United States
Introduction to Children’s Vision and Eye Health (from Children’s Vision and Eye Health: A Snapshot of Current National Issues 2nd Edition)
There are many success stories of children who have received treatment for visual disorders. However, for too many children, such disorders are often not identified and thus not treated early. These children may fall behind in school, exhibit behavioral disorders in the classroom, and lag in reaching developmental milestones. Everyone has a role in the early identification of children’s vision disorders—parents, pediatricians and primary care providers, preschool program providers, school nurses, and teachers, among others.
Vision has a critical role in children’s physical, cognitive, and social development. Up to one in 17 young children and one in five preschoolage children enrolled in Head Start has an undiagnosed vision disorder. Without early detection and treatment, uncorrected vision disorders can impair child development, interfere with learning, and even lead to permanent vision loss. Moreover, visual functioning is a strong predictor of academic performance in schoolage children, and vision disorders in childhood may continue to affect health and well-being through adulthood.
Vision is a global concern. According to the World Health Organization (WHO), 2.2 billion people have vision impairment, with 1 billion estimated to be being children. The majority of children have uncorrected refractive error (URE). Blindness resulting from URE and other causes have been diagnosed in 1.4 million children. Researchers estimate that in 2015, there were 174,000 preschool-age children in the U.S. with a visual impairment, with conditions including uncorrected refractive error amblyopia, and other eye diseases. Blindness in childhood is particularly concerning, as many disorders leading to impairment are preventable. One of the greatest concerns is that vision loss will impact a child’s quality of life, affecting financial, social, and employment opportunities over his or her lifespan.
The economic costs of children’s vision disorders are significant, amounting to $10 billion yearly in the U.S. Typically, families shoulder 45% of these costs. This estimate accounts for the costs of medical care, vision aids and devices, caregivers, special education, federal assistance programs, vision screening programs, and quality of life losses, and does not take into account any limitations in future employment or social opportunities.
On the global level, several notable organizations have identified the need for comprehensive wellness and addressed the social determinants impacting health. The United Nations has developed Sustainable Development Goals (SDG) to address the health needs of the global population.15 The third SDG, often referred to as Universal Health, focuses on good health and wellness for all. Although eye health falls under this heading, vision and eye health also impact other SDGs. For example, SDG Goals 1 and 4—poverty and quality education, respectively—are both directly impacted by visual ability. Numerous researchers have shown that vision disorders, if not identified and addressed in a timely fashion, can compromise a child’s academic success. Poverty also restricts access to quality eye services, and children with disabilities have a higher prevalence of vision and eye health disorders.
The WHO reports that “vision, the most dominant of our senses, is vital at every turn of our lives yet it is overlooked worldwide and often untreated.” In 2018, the G20 Development Working Group called for “investing in early childhood [ages 0–8 years] development,” which includes reducing the cycle of poverty and inequality. Development is defined as the “continuous acquisition of skills and abilities across the domains of cognition, language, motor, social and emotional development.” As vision is vital to each of these developmental areas, the NCCVEH advocates for eye health as a part of this important initiative. We must recognize the paramount importance of vision within the current contexts of comprehensive health and the social determinants of health.
In the U.S., vision care for children (including eye health education, screenings, care coordination, eye care, and treatment) is addressed in a variety of venues, including primary care offices, public health clinics, schools, childcare facilities, eye care provider offices, and community health program settings. Early detection, diagnosis, and treatment of a vision disorder is critical to a child’s long-term vision health, and vision screenings serve a useful role in identifying children in need of eye care and promote further evaluation by a professional. Many children in the U.S. do not receive timely vision screenings or access to professional eye care, and wide variation exists among the laws and regulations related to vision and eye health.
The purpose of this report is to provide facts and strategies to help readers facilitate change on a state and local level in order to eradicate blindness and visual impairment. This document brings together information on the scope of vision disorders in children, national and state-level policies, and efforts to build comprehensive systems to promote children’s vision and eye health. Research is continuously providing new knowledge on risk factors, better access to needed services, and estimates of the prevalence of vision disorders among U.S. children.
Given the importance of vision in early childhood development, the NCCVEH will continue to advocate for appropriate vision and eye health services to help all children reach their full potential. Much work remains to build awareness of the significance of vision disorders and ensure that every state initiates a comprehensive system to promote vision and eye health. This report is intended as a tool to engage readers in supporting our efforts.
Actions Needed NOW to Preserve Children’s Vision Health
Attention to vision and eye health in young children is critical to long-term vision outcomes. Unfortunately, many children do not receive timely vision screenings or eye care. Public health activities- including work by the NCCVEH to improve surveillance, vision screening, and access to eye care, and encourage state and local efforts to provide screening within the community- are critical steps for improving children’s vision and eye health in the United States.
What can you do? Take action now to:
Identify gaps in the delivery of vision services, gaps in data collection, and gaps in state performance measures;
Clarify confusion or lack of understanding of existing state laws, mandates, and protocols to align vision screening guidelines in your state;
–Establish a support system for your improved vision health approach which may include hiring new program staff or establishing a technical advisory body.
The NCCVEH convened a National Expert Panel comprised of leading professionals in ophthalmology, optometry, pediatrics, public health, and related fields to establish recommendations on how to improve the public health infrastructure supporting the early detection of children’s vision problems.
Establishing Consistency and Accountability for Children’s Vision
Vision and eye health in children younger than age 6 years is a national priority (Healthy People 2020; Office of the Inspector General, 2010).
Early identification of vision problems and eye diseases, including amblyopia, strabismus, and high refractive errors [hyperopia, myopia, astigmatism, and anisometropia], is critical for optimal treatment. Thus, children’s vision and eye health must be elevated in importance in the medical home and in public health and community settings.
Little consistency, however, exists among children’s vision health stakeholders for screening procedures, frequency, referral criteria, and follow-up methods. The lack of standards for surveillance of children’s vision and eye health in the United States is yet another public health challenge.
The National Center for Children’s Vision and Eye Health at Prevent Blindness (NCCVEH) is an effort funded in part by HRSA- Maternal and Child Health Bureau to improve these public health challenges, as well as the system that supports children’s vision and eye health in the United States.
NCCVEH is responding to the need for an improved system to support children’s vision and eye health by empowering key stakeholder groups to use:
1) Evidence-based vision screening practices and improved follow-up to eye care to help ensure early detection and treatment;
2) Integrated health data systems to track vision and eye health and improved surveillance;
3) State- and national-level performance measures to track program accountability and direct limited program resources.
Key Stakeholders in Children’s Vision and Eye Health
- Public health leaders;
- Vision and eye health care providers (Ophthalmology and Optometry);
- Primary care providers/medical home;
- Early childhood educators;
- Early care and education agencies;
- Families;
- Community organizations;
- Insurance providers;
- Legislators;
- State agency coordinators;
- Funders.
About the National Center for Children’s Vision and Eye Health
The mission of the National Center for Children’s Vision and Eye Health at Prevent Blindness (NCCVEH) is to improve the systems that address children’s vision and eye health. To accomplish this mission, the NCCVEH is developing a coordinated public health infrastructure to promote and ensure a comprehensive, multi-tiered continuum of vision care for young children. This coordinated approach to vision health for children leads to a uniform implementation of successful screening programs, increased follow-up to eye care, improved surveillance, and stakeholder engagement.
The NCCVEH celebrated it’s 10th anniversary in 2019:
National Center for Children’s Vision and Eye Health 10th Anniversary
Recommendations for a Comprehensive Vision Screening System
Recommendations from the National Expert Panel to the NCCVEH include:
- All children aged 36 to <72 months should be screened annually (best practice) or at least once (acceptable minimum standard) during the interval between their third and sixth birthdays.
- Vision screening requires training and certification of screening personnel with recertification of personnel completed every 3 to 5 years.
- Vision screening programs must plan for acquisition of sufficient and appropriate space, as well as obtaining and maintaining equipment and supplies.
