Preparing Your Practice for Pint-Sized Patients

When it comes to children’s ocular health, we as eye care providers need to be poised and ready to address the growing need expected over the next several decades. Inconsistent school vision screening guidelines, as well as vague national recommendations, means that many children are potentially struggling with vision complications as they continue to slip through the cracks. Current projections anticipate the number of visually impaired children will increase by 26% by the year 2060, and nearly 70% of these children are expected to be visually impaired simply because they do not have the correct glasses prescription. As children spend more time on digital devices, especially in the current pandemic landscape of digital learning modalities, there has been shown to be a 1.25 times increased risk of developing myopia symptoms with each additional hour of digital device use. As optometrists, we need to understand these trends and be prepared to help educate parents and provide children with the ocular care they require.

Currently, all insurance plans through the Affordable Care Act include vision exam coverage, as well as all Medicaid plans, but often this vision insurance is underutilized simply because parents are not aware of its existence. One of the biggest hurdles we may face as optometrists when attempting to address children’s ocular health needs is simply getting young patients in the door.

Outreach efforts to inform parents and stress the importance of good ocular health can be beneficial both from a public health standpoint and a practice management stance. If parents are aware of the need to monitor children’s eyes and the increased risk of developing myopia due to our current lifestyles, they will be more likely to bring their child in for examinations.

When reaching out to parents, it can be useful to utilize traditional advertisement methods like Facebook ads or mailing campaigns to both current and potential patients. However, when considering efforts to specifically reach children, it can be helpful to also consider more direct appeals.

For example, contacting parent-teacher organizations, attending school fairs, and advertising at school sporting events may yield more direct results. On social media, contacting parenting groups or mom groups can also be a good way to educate parents of the need for healthy eyes in children. We should make it clear that good vision can have a dramatic impact on a child’s ability to participate in school, as well as influence other activities such as athletics and socialization. Many parents are well aware that their children are spending much more time on digital screens, but many parents may not realize what the full effect may be on their child’s vision. It can also be helpful to note that a child may not complain of poor vision. However, children with poor vision may struggle with schoolwork, demonstrate more behavioral issues, or avoid activities in which their eyesight limits them. In addition, mentioning that many children’s health insurance plans contain a provision for vision examinations can be enough to motivate some parents to schedule their child an eye examination.

Sometimes, the best way to inform parents is when they are actively sitting in your exam chair. I often have parents ask me when they should have their child’s vision tested, and it is times like these when it is helpful to know general recommendations. Currently, most sources agree that all children should have a basic vision evaluation by the age of 5 to screen for amblyopia and the associated risk factors. I educate parents about potential indications that a child may need an examination sooner, however, such as an eye turning inward or outward, the child bumping into things constantly or pulling objects in very close for examination, excessive squinting, or seemingly disinterested in the surrounding environment.

"As a child, you often don’t actually know your vision is blurry, and just assume everyone sees the same as you do."

Sometimes, I will even relate my own personal experience as a child who needed glasses at an early age but remained under the radar until my teens simply because I never complained. As a child, you often don’t actually know your vision is blurry, and just assume everyone sees the same as you do. For me and my parents, the realization moment didn’t occur until a coach pulled me aside during a pitching practice for fastpitch softball and asked why I wasn’t throwing the pitches the catcher was signaling. When I responded, “I just throw at the brown thing, I don’t know what you are talking about,” the coach recommended my parents go check my eyes. Turns out even a moderate myope like me was able to avoid detection for over a decade.

Many states recommend some form of vision screening, but these often only consist of a general test of visual acuity and often have very poor follow-up rates when a child fails a screening. It may be helpful to contact school nurses in your area and either offer your services to assist in vision screening efforts or provide your information as a potential eye care provider to be consulted when a child fails a school screening.

If you are going to dedicate efforts to recruiting children into your office, you should be prepared to handle the needs that come with this population. While you don’t necessarily need to be providing vision therapy or myopia management (although it could be argued these may be a potentially lucrative investment over the next several decades,) you should consider having kid-friendly testing material and child-sized eyeglass frames for those needing correction.

In practice media and print materials, include pictures of children with glasses to remind adults that your practice is equipped to handle pint-sized patients. If you aren’t able to provide a full line of children’s eyeglass frames or specialty infant frames, try to have at least a handful of smaller frames available or be able to direct parents to appropriate resources to obtain the necessary size frames. When in doubt, reach out to your frame reps and inquire whether they can offer any child-sized frames. Some reps may be willing to provide a catalog, so even if you aren’t able to carry all frames in office, you can have the option of ordering on-demand when a patient wants a frame.

Remind parents of the need for safety-grade materials and consider offering a “Kids Package” to help appeal to parents. Kids can be especially hard on glasses, so sometimes parents may appreciate having a package deal that bundles the price of the frame and safety-grade lenses together, as well as some form of a warranty replacement period in case the child breaks a frame.

Some practices may benefit from implementing some myopia control treatments. These may consist of traditional Ortho-K regimes, or perhaps newer therapies like Coopervision’s MiSight 1 day, which is the first FDA-approved soft contact lens to slow myopia progression in children. As myopia rates are projected to rise dramatically, many parents may specifically be looking for ways to address myopia development in their child. By being an early adopter of these treatment programs, your practice may have an established edge when the prevalence of myopia reaches its height.

At the end of the day, it would be a mistake to overlook the ocular health needs of children within the United States. There is currently a lack of common knowledge about the shifting visual demands of our modern lifestyles and the potential consequences for young, developing eyes. By educating the public about the need for regular ocular health monitoring in children, as well as the increased likelihood of needing a corrective prescription at this age, we can place our practices in a strong place to address this growing need and be well prepared to confront the rising trend.