In a California classroom today, a teacher writes a mathematical equation on the white board. Later, you will show the assignment instructions on the display screen before asking the students to read at their desks.
This is mainly how learning works. An estimated 80% of what children learn is presented visually. And there is a direct connection between visionary health and school performance – a connection that becomes apparent when children arrive in preschool.
Yet California has been falling behind in providing much-needed eye care to more than half of the state’s children, who are helped by Medi-Cal, the state’s version of Medicaid.
A recent report released by the California Optometric Association found just 16% of Medi-Cal children receive basic eye care – meaning 5 out of 6 don’t. In 47 of California’s 58 counties, the percentage of children receiving eye care has decreased over the past seven years.
More children than ever before are at risk of being abandoned due to poor and uncorrected vision. For many, distant objects appear dim, and children cannot absorb what they cannot see. For others, it takes more effort to maintain a clear view of the page in front of them, causing fatigue and discomfort.
There are two things that cause this problem. First, we are dealing with an epidemic of myopia, or nearsightedness. Its prevalence has nearly doubled in the US over the past 30 years. By 2050 it is expected to affect half of the world’s population.
A 2018 study in Southern California found that 41.9% of teens, ages 5 to 19, were myopic. Environmental factors are believed to be at play – an abundance of activities around work, screen time in childhood and a minimum of time spent outdoors.
Second, and equally troubling, California faces a problem with access to vision care. Reimbursement rates for Medi-Cal are so low that providing them costs more than what providers pay.
California reimbursement for new patient eye exams and repeats is only $47 – the third lowest in the nation and less than half of the national Medicaid average. The rate has not risen in 25 years.
The results are predictable: 10% of California eye doctors have been forced out of the Medi-Cal program in the past two years, and 90% of patients report having difficulty finding a Medi-Cal provider.
Although this means that children who need glasses do not get them, and thus are at risk of falling behind in school, the health consequences are more pronounced.
Severe myopia increases the risk of serious eye disease; but early treatment of myopia can delay its progression. And a comprehensive eye exam can detect signs of diabetes and other serious diseases, leading to referrals for treatment.
The recommended eye care schedule for children is less frequent: once at 6 months of age, at 3 years of age, before entering first grade and every year or two thereafter.
This simple, inexpensive intervention can yield lifelong benefits. However, California has been ignoring this important health care.
Medi-Cal is clearly under increasing pressure. At the national level, the cuts made last year will reduce Medicaid funding by $1 trillion over the next decade and could result in nearly 12 million people losing health coverage.
That makes it even more important that Medi-Cal remains an important pillar of California’s safety net.
But in the area of pediatric eye care, Medi-Cal is not doing its essential work; not when only 1 in 6 eligible children receive a basic eye exam in a two-year period.
We must not let children fall behind because of vision problems that can be easily identified and remedied in an accessible way.
Dr. Brian Park is president of the California Optometric Association. Ted Lempert is the president of Children Now. They wrote this piece for CalMatters.
