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How ACA can help improve pediatric eye care


Optometrists have the opportunity to improve eye care for all children thanks to the pediatric essential eyecare benefit in the Affordable Care Act (ACA), says Glen Steele, OD, FCOVD, FAAO, and Heather McBryar, OD, FCOVD.

Atlanta-Optometrists have the opportunity to improve eye care for all children thanks to the pediatric essential eyecare benefit in the Affordable Care Act (ACA), says Glen Steele, OD, FCOVD, FAAO, and Heather McBryar, OD, FCOVD.

One of the first steps of helping the pediatric population is spreading awareness not just among parents but also among other eyecare and healthcare professionals and community partners, such as teachers, childcare providers, education providers, churches, and nonprofit organizations. It is important that a child see an eyecare professional early and often in order to detect any visual or ocular concerns before they affect the child’s quality of life.


Pediatrician vision screenings

One of the common misconceptions working against eyecare professionals is that the pediatrician’s screening is an adequate exam for a child. Dr. Steele says even ODs assume that the pediatricians are catching vision disorders, but they’re still missing them due to time constraints.

Related: Examining pediatric eyes

“Pediatricians are facing the same kind of squeeze we are,” he says. “What’s the nature of the eye exam that they do now? Not much. And I’m not bashing pediatricians. I’m saying they’re taking this limited knowledge they have and applying it to all kids.”

Dr. Steele says pediatricians are testing children of different ages-a 3-year-old child and a 9-year-old child, for example-in the same manner. However, the expectations for a toddler vs. an elementary-age child are different, yet the screenings in a pediatrician’s office remain the same. Also, more and more children are using digital devices in school, but they are not being tested at near.

“They don’t put vision as a part of their thinking process, so this is a wonderful opportunity for us because the pediatricians are going to know about the Affordable Care Act. We can use that to our advantage,” says Dr. Steele.

These screenings often do not lead to a diagnosis or treatment and do not test processes needed for the classroom. That is why connecting with pediatricians on this subject is so important. Dr. McBryar says the essential eyecare benefit will most benefit ODs when they educate the other people in a child’s life to help get those children in need into an optometry office as soon as possible. 

“Like Dr. Steele said, they’re feeling the squeeze too, so they’re going to be looking to those other professions who can help them out,” she says.

Next: The importance of parent education


The importance of parent education

Parents need to understand that a comprehensive eye exam tests more than visual acuity.

“I can’t tell you how often I hear, ‘But this doctor says his vision is fine,’ as if the only thing to vision is 20/20,” says Dr. McBryar.

She says that she is going take a thorough history, check binocular function, refraction, and ocular health, of course, but the most important part of that exam will be parent education.

Related: Share this pediatric vision checklist with your patients

“Even if we aren’t finding something wrong, it’s important that they’re coming back to us on a routine basis so that we can monitor for any changes that might occur,” says Dr. McBryar.

There are a few physical symptoms parents should aware of that may signal a problem:

• Headaches

• Double vision

• Blurry vision

• Eye strain/pain

• Motion/car sickness

And if there is something wrong, then parent educationbecomes even more important because the parents will need to understand thediagnosis and comply with any treatment plans.

Next: Reaching out to healthcare and community partners


Reaching out to healthcare and community partners

Outside of a child’s family, other gatekeepers can be your allies in protecting a child’s vision and ocular health.

Teachers, school employees, and educational psychologists need to understand the role a vision problem can play on a child’s school performance. Educators also need to know what kinds of problems to look outfor, so they can raise the alarm if need be.

One in six children are two or more grade levels behind. Dr. McBryar says that 60 percent of children with learning disabilities have some kind of undiagnosed vision problem.  

Related: 3 tips to navigate the allergy discussion with kids

Sometimes teachers notice things that the parents don’t see-or don’t want to see. Make sure your patients’ teachers (and parents) are on the look out for these signs of vision problems in and outside the classroom:

• Losing place when reading

• Poor reading comprehension

• Letter and number reversal

• Poor spelling ability

• Difficulty learning letters and numbers (This is even more common because the demand has increased for kindergarten students, who are expected to read at this level.)

“For a lot of these kids who show up in my office, they’ve had educational testing, and the school system comes back and says that they’re fine-well, what’s the problem? We’re in a unique position because a lot of the time it is an underlying vision problem,” says Dr. McBryar. “We can provide the documentation to show what’s going on to get that child the right accommodations that she needs.”

If you treat infant and pediatric patients, reach out to other optometrists in your area who don’t and inform them of the services you can provide for their patients. Other partners may include ophthalmologists, vision specialists in schools, vocational rehabilitation experts, and assistive technology centers. 

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