Are we contributing to the pediatric eye care desert?

Editor’s Note: The thoughts and opinions expressed are those of the author and do not necessarily represent the opinions of this publication.

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A recent JAMA Ophthalmology paper¹ suggests that there are pediatric eye care "deserts" in the US, which has sparked conversation across the optometry and ophthalmology professions. Several doctors have been quick to point out that the authors’ methodology is flawed (i.e., their sole criteria for identifying a pediatric practice relied on four public databases.) These included the American Academy of Optometry and the American Optometric Association doctor finders, where they used filters for binocular vision, perception; and pediatric optometry, infant assessments.

The reality is that a significant number of practices provide vital pediatric services every day. Re-analyzing the data to include “family practices” would likely amount to nearly 30,000 optometric locations alone—orders of magnitude higher than the 586 pediatric optometrists reported.

Yet perhaps there’s a deeper discrepancy at play. It’s one that’s not explicitly described in this paper, but which is being further exposed through the subsequent conversation. Optometrists should be asking
themselves a hard question: “Should I be considered as practicing pediatric primary care optometry if I’m not offering myopia control and management?”

Considering the widespread data on the myopia epidemic, access to interventions (including an FDA-approved contact lens for slowing myopia progression in children), and abundant science and clinical education, I’d say the answer is no. Looking the other way and hoping that a professional colleague is taking up the charge is only allowing the sands of a childhood myopia desert to spread.

Let’s step back to the practice definition for a moment. Most of the time when I ask colleagues what’s the youngest age they’ll see in a “family practice,” they will say age four. Four-year-olds are remarkable. They can speak in complete sentences, answer simple questions, and have back-and-forth conversations. They can follow multi-step commands and identify colors, shapes, numbers, and letters during an eye exam. Their cognitive skills are developing quickly. They are naturally inquisitive and curious. Children this age have emerging fine motor skills as well. They can use scissors, manage pens and pencils mostly independently, and use eating utensils. They can draw a person with at least three body parts—even eyes! Emotionally, they are likely to comfort others who are hurt or sad and like to be helpful.² We may not give four-year-olds credit for how capable and amazing they are!

For certain, there’s an important place for pediatric specialists—we need and want these colleagues in our midst, given their additional didactic and clinical training. However, leaving myopia management only to them is akin to leaving glaucoma and macular degeneration to only ocular disease-trained doctors or contact lenses only to contact lens-trained colleagues. Myopia management is primary care just like these other conditions.

Pediatric specialists cannot and should not shoulder the myopia burden alone. The data on the treatment gap—which the optometry and ophthalmology professions have the clear ability and even
obligation to close—is staggering. There are nearly 300 children ages five to 17 with myopia for each optometrist and ophthalmologist in the U.S.³ For those ages zero to 17 who wear contact lenses, 87% are in a single vision design—a device that lets their myopia get worse.⁴

Three years ago, the World Council of Optometry declared myopia management standard of care. US optometrists and ophthalmologists are among the most well-educated and well-resourced clinicians on the planet. We should be leading this charge in every town, village, and city across the country, making sure kids have the gift of being able to interact with others and learn through clear and comfortable vision.

At the end of the day, it is our duty to educate the public about the need for eye exams at an early age. And like other progressive eye diseases, once myopia is identified, we can’t allow it to continue unchecked. Parents have the right to know the best options for their children, and are relying on us as the experts.

So contrary to the JAMA Ophthalmology papers, optometrists are very well distributed across virtually all US counties, including rural and lower socioeconomic ones. They are highly trained to take care of the
whole family, from preschoolers to seniors.

Still, the amount of untreated myopia is alarming. It’s baffling that tens of thousands of optometrists are not treating or not consistently treating this disease—and as a result, 19 million children in the US alone are going without the standard of care. I don’t know any other eye disease that we casually let grow worse, especially one who’s deleterious effects will be felt for generations.

Kyle Klute, OD, FAAO, received his optometry degree from Illinois College of Optometry in Chicago and then completed additional training at a Veteran’s Medical Center in Battle Creek, Mich. He is the founder of Good Life Eyecare in Omaha, Neb. And Glenwood, Iowa, a consultant for Eyecode Education, and the editor of the Journal of Medical Optometry. kdklute@gmail.com

As eye health providers in whom our communities have placed their full trust, we have been given and accepted incredible responsibility. Myopia control is primary eye care. If we can’t rally behind that and move more quickly to provide treatment in our own offices, we may have to be more accepting that those JAMA Ophthalmology contentions may be more valid than we’d like.

References:

1. Siegler NE, Walsh HL, Cavuoto KM. Access to Pediatric Eye Care by Practitioner Type, Geographic Distribution, and US Population Demographics. JAMA Ophthalmol. 2024 Apr 11:e240612. doi:10.1001/jamaophthalmol.2024.0612.

2. Wisner W. 4-Year-Old Child Development Milestones. VeryWell Family. March 15, 2022. Accessed April 26, 2024. https://www.verywellfamily.com/4-year-old-developmental-milestones-2764713

3. Fortin P, Kwan J. The Myopia Management Opportunity in the United States Using the 2020 Census. ARVO, Denver, Colorado. May 2022.

4. Kwan J et al. Current trends in pediatric eye examinations and contact lens prescribing in the US. Global Specialty. Lens Symposium, Las Vegas, Nevada. January 2024.