To address emerging children’s vision crisis due to COVID-19, AOA summit puts optometry in the lead

To boost optometry’s mobilization to support the urgent, post-pandemic eye health needs of children and families, the AOA Board of Trustees led an emergency summit featuring frontline doctors of optometry, industry leaders and key state and federal policymakers, putting essential optometric care in the national spotlight. The event marks the launch of an active campaign throughout 2021 aimed at getting children who have endured months of increased screen-time use to an AOA doctor of optometry for a needed comprehensive eye exam.

That was the concerned consensus of expert doctors of optometry at the virtual AOA Emergency Children’s Vision Summit on March 24. Hundreds of doctors, students and paraoptometrics attended the virtual event, a rich, multitiered conversation on the state of children’s eye health and vision as the nation emerges from the depths of the pandemic.

Further, panelists looked to discern the best pathway forward to ensure children have access to comprehensive eye care. The Children’s Vision Summit is the opening event for a yearlong dialogue, led by the AOA, focused on children’s eye care and vision health. The conversation continues at Virtual AOA on Capitol Hill, May 23-25, and the AOA School Readiness Summit, for the public and policymakers, in July.

“As we begin to emerge from the pandemic, it is critical for us to truly assess the potential impact the pandemic has had on the eye health of Americans—and especially children,” AOA President William T. Reynolds, O.D., said in opening the summit. “I know that all of us are concerned about the social, emotional, health and academic impact the pandemic has had on children. Social distancing requirements, loss of income with families and disruptions related to accessing health care all are recognized as impacting children’s overall well-being.

“Particularly concerning for optometry is that we recognize that many children may be increasingly experiencing digital eyestrain and other conditions brought on by the increased use of digital devices for online learning,” Dr. Reynolds says.

Doctors of optometry aren’t alone in their concern about the impact of the pandemic on the health of America’s children. Members of Congress are starting to hold hearings to gather information and assess needed policy changes and approaches, Dr. Reynolds noted.

Among the concerned is Kentucky Gov. Andy Beshear. Twenty years ago, Kentucky passed a first-in-the-nation law requiring children there receive  comprehensive eye exams prior to entering school.

Kentucky’s law has made a big difference to the state’s schoolchildren and remains one of his proudest achievements as an advocate in optometry, says Dr. Reynolds, who practices in Kentucky.

“This is a critical time for optometry to speak from our own experience to help guide policymakers as we work together to determine what we can all do to ensure the long-term health and prosperity of our younger generations,” Dr. Reynolds says.

Assessing the potential impact on children’s eye health

In the summit’s first panel facilitated by Michael Earley, O.D., associate dean of academic affairs at The Ohio State University College of Optometry, doctors of optometry talked about the extent of the issues among patients, from digital eyestrain to rising rates of myopia. 

E. Larry Jones, O.D., who practices in Washington state, reported a “huge increase” in his practice in asthenopia (eyestrain), eye aches, headaches, accommodative stress and convergence insufficiency.

A doctor of optometry in California, Jacqueline Theis, O.D., says she is seeing an increased number of patients with dry eye: “I’m seeing a lot of dry eye in the pediatric population and it just should not be there. Dry eye is a chronic condition and it doesn’t get better easily.”

If there is a “blessing in disguise,” Dr. Theis noted, it’s that parents are witnessing for the first time, due to virtual schooling, how their children are learning. With their children distracted and struggling to learn, parents are alarmed, she says.

“Usually education is multisensory and now that we are just computer-based, it’s heavily dependent on vision and auditory processing,” Dr. Theis  says.

Childhood poverty’s impact, intensified by the pandemic, was cited as a concern by Terri A. Gossard, O.D., M.S., who practices in Ohio and is a member of the AOA Board of Trustees. In America, there are nearly 11 million children living in poverty, Dr. Gossard says. Growing up poor can have wide-ranging, long-lasting repercussions, including a lack of access to health services such as eye care.

A decade ago, Dr. Gossard and the Ohio Optometric Association teamed up with other stakeholders to open a school-based vision health center in a public school. With schools closed due to COVID-19, students have lost access to eye care providers and vital vision services such as comprehensive eye exams, vision therapy and glasses.

“I don’t think schools are going to return to normal when this is all over,” says Dr. Gossard, whose undergraduate degree is in education. “I think there has been a permanent shift in teaching pedagogy and technology will play an ever-increasing role.

“As doctors of optometry, we need to think proactively about what this means for our children’s eyes and visual system,” she says.

Practicing in New York City, Andrea Thau, O.D., says her office is now seeing in children the same symptoms they once saw only in adults. “Accommodative issues, binocular issues and dry eyes,” says Dr. Thau, noting the serious consequences for vision development in children. “This is really an important point for all of us, because we are poised to be the ones to help the parents understand the importance of ongoing, comprehensive eye care for all children.”

Katherine Weise, O.D., a professor of optometry at the University of Alabama at Birmingham School of Optometry, pointed out a consequence of children’s comparatively inactive lifestyle due to COVID-19. Between 2002 and 2015, Dr. Weise noted there was a rise in Type 2 diabetes in young people 20 years and younger.

“We need to get kids active again, whether it’s individually or as team sports resume,” she says. “Youth sports can help us reduce the number of kids with type 2 diabetes who go on to become adults with type 2 diabetes.”

Pathway forward

Moderated by the chair of the AOA’s Industry Relations Committee, Jerry Neidigh, O.D., doctors of optometry in the second panel discussed the barriers to patients accessing eye care and how to break through them.

Among the solutions were:

• Developing cross-professional relations between health care providers, educators, school nurses and others.
• Beginning conversations with parents, and even their grandparents, early and often.
• Educating legislators, their staffs and policymakers on the value of comprehensive eye exams.
• Talking up the upside of comprehensive eye exams in the context of overall health vs. the deficiencies of screening.
• Setting up family-friendly hours in a practice.
• Educating and engaging paraoptometrics to support doctors of optometry in children’s eye health and vision care, says Erlinda Rodriguez, CPO, chair of the Paraoptometric Resource Center.

Erin McCleary, O.D., who practices in Connecticut, says doctors of optometry should, for instance, meet children’s influencers “on their turf.”

“Preschool visits have been a great opportunity to see children,” Dr. McCleary says. “To go directly into the school and see these young children and get them excited about eye care. Send home resources to the parents directly.”

To engage other health care providers, Dr. McCleary also sends consultative letters. Every letter, she says, is an opportunity to educate a pediatrician about the importance of comprehensive eye exams.

“If you are a doctor who sees young children, write a letter to the pediatrician every time you see (the child),” Dr. McCleary says. “It comes down to making yourself the expert in eye care in their eyes and how easy is that because we are.”

Jennifer Smith Zolman, O.D., called InfantSEE ^® the “golden ticket” to educating parents about their children’s eye care. InfantSEE is a program managed by Optometry Cares ^®—The AOA Foundation. The program provides no-cost eye assessments for infants 6-12 month by InfantSEE doctors.

“Once you have these new parents in your office, this is your opportunity to educate them about the importance of a yearly eye exam,” says Dr. Zolman, who chairs the AOA InfantSEE^® and Children’s Vision Committee.

“The goal is to start early with parents so that the yearly comprehensive eye exam becomes the norm in their children’s life,” she adds.

Messaging also is key in advocacy on behalf of children to legislators and policymakers, says Lori L. Grover, O.D., Ph.D., a member of the AOA Board of Trustees.

“Part of that (message) is that evidence-based, contemporary, optometric care is recognized as high-value, available health care,” Dr. Grover says. “It’s safe, it’s timely, it’s effective, it’s efficient, it’s equitable and it’s patient-centered. However, it’s not yet fully realized.

“We also, as part of our message, want to stress that healthy, functional vision is essential to a child’s overall health and development and increased uptake of comprehensive eye care is the acknowledged approach to achieving that goal,” she says

Doctors of optometry have the expertise and resources to address children’s vision issues in their practices today.

For instance, they can expand the usual questions doctors ask during a history of their patients to include inquiries about children’s educational environments in 2020 or their time spent on social media and gaming, says Hilary Hawthorne, O.D., who practices in California. “Asking these kinds of questions will build a better way to assess children’s vision,” Dr. Hawthorne says.

Says Joshua Watt, O.D. who practices in Colorado: “Tracking skills, stereovision, distance and near cover tests or even a basic symptom check list are all important pieces that can be used to help evaluate these kids and determine if these are issues we need to be dealing with.”

Valuable members-only resources

The AOA has recognized children’s eye care and vision health as a serious and growing public health concern with implications for the nation’s children. To support doctors of optometry and raise public awareness, the AOA provides numerous resources including the AOA’s Children’s Vision toolkit.

The Children’s Vision Summit was supported by AOA Visionary Supporters Johnson & Johnson Vision and Essilor of America and Executive Supporter CooperVision.