For about a third of school-aged children, the world looks blurry but vision care in childhood goes beyond who can get glasses in kindergarten.
Poor eyesight can go unnoticed for years and affect the basics of well-being, from the ability to socialize to literacy, mental health and future income.
"From a lifelong perspective, if you don't have adequate vision care, (you are) less likely to go to college, less likely to do well in K-12, less likely to have sustainable work, less likely to have health insurance, less likely to have housing, and are more likely to have a shorter lifespan and worse health outcomes," said Swapna Reddy, assistant dean and professor at Arizona State University's College of Health Solutions.
While many children face vision challenges, less than half have access to regular eyesight checks. Routine checkups are even lower for children 5 years old and younger, and vision screening for pre-kindergarteners in Arizona is below the national average.
Cecil Swyers, director of a volunteer-powered EyeCare4Kids initiative that works with low-income families, recalled how one of the first children they evaluated put on glasses for the first time: "He went outside and said, 'I've never seen leaves before' ... Can you imagine being the mother of that child?"
Helping parents seeking eye care for their children was one main goal of a study co-authored by Reddy, while the other was assessing Medicaid's "network adequacy."
"What do those words even mean? There's a network of providers that are supposed to be providing health care for, let's say, AHCCCS patients or even under private insurance coverage, Reddy said. "Is that network adequate to meet those needs?"
The research revealed gaps in pediatric eye care services, especially for children insured by AHCCCS, Arizona's Medicaid program, and those living in rural parts of the state.
"Just because you have a health insurance card, if that health insurance card is not giving you access to the care that you need when you need it in a way that is accessible, affordable to you, then that card is not worth a whole lot," Reddy said.
Three-quarters of eye care practices in Arizona do not see children covered by Medicaid, shrinking the pool even further when serving children under 5.
They also found that wait times are shorter for urban areas compared to rural, while counties like Navajo, Greenless and La Paz have few to no providers.
Neha LaCorte is an optometrist and owner of Advanced Vision and Achievement Center in Phoenix and works as a neuro-optometrist at Banner Concussion Center.
LaCorte had a 13-year-old patient from Prescott whose severe nearsightedness in one eye caused her headaches. The patient couldn't receive the same care in Prescott.
"They still had to pay out of pocket to find somebody to see their kids. So, Medicaid didn't serve them well in that scenario," LaCorte said.
While LaCorte treats patients with Medicaid at Banner Health, she said she can't do so in her private practice due to low reimbursement rates for vision therapy.
Until 2019, Arizona was one of the eight states in the U.S. that did not mandate vision screenings in school. Former Gov. Doug Ducey signed into law the School Vision Screening Requirements in 2019, but it did not take effect until 2024. The law requires schools to provide vision screenings when a student first starts attending a school. Routine screenings are also mandatory for third and seventh graders.
Rizwana Biviji, an assistant professor at ASU's College of Health Solutions and the study's co-author, called the new mandates "a very good first step" but acknowledged that more needs to be done, such as ensuring providers accept AHCCCS, bilingual services, mobile clinics in rural areas, telehealth and mail order options for glasses and education.
"Education is very important," Biviji said. "If there are any signs that the child is squinting or if the child is trying hard to read, then what is the first part of the point of intervention?"