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When Kekoa Gittens was 3 years old, his preschool teacher told his mother that he was a problem. He could not sit still. He did not participate. When the other kids were learning the alphabet, he didn’t pay attention.
The following year, Kekoa’s problems in the classroom worsened. His mother, Sonya Gittens, took him to the pediatrician, who referred the boy to an eye doctor.
That doctor looked at the back of Kekoa’s eyes and diagnosed him with myopic degeneration, a dramatic form of nearsightedness.
“They’re too young. They don’t know how to express themselves and they say, ‘I can’t see it, teacher,'” said Sonia Gittens, who lives in the town of Corte Madera in Marin County.
Today, Kekoa is a successful high school student, but too many kids don’t get their eyes checked until they’re behind in school.
Vision problems, especially nearsightedness, have become more common among American children. roughly one in four school-aged childrenor 25%, wear glasses or contact lenses, a percentage that increases as children age, according to data from a 2019 federal survey.
In California, too few Medi-Cal kids like Kekoa are getting eye exams, and the problem is getting worse. Only 16 percent of school-age children in Medi-Cal visited an eye doctor between 2022 and 2024 for first eye exams, follow-up vision exams or glasses, according to report commissioned by the California Optometric Association. That’s down from 19% eight years earlier. The report, based on two years of Medi-Cal data, suggests the state is moving in the wrong direction even as eye problems are becoming more common among children.
Medi-Cal provides insurance for low-income and disabled Californians.
“Every day when I see these kids, it’s always a surprise to me that the kids aren’t getting the care they need,” said Ida Chung, a pediatric optometrist and associate dean at Western University Health Sciences in Pomona.
The trend outlined in the report is alarming, Chung said. At her clinic, where about half the children are on Medi-Cal, it’s common for children with congenital vision problems to visit for the first time when they’re in first grade or later. This shows Chung that many children do not have sufficient access to eye care.
Although children may receive basic vision screenings at school or from a pediatrician, some eye problems are still overlooked. “It’s something the child had before they were born,” Chung said.
Eye exams are down across the country
Colusa County, a rural agricultural region north of Sacramento, saw the steepest decline in pediatric eye doctor appointments in the state, from 20 percent between 2015-16 to just under 2 percent between 2022-24.
Nearly all counties — 47 out of 58 — fared worse in vision care than in the past, the report showed, with some, like Colusa, seeing significant declines.
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Most of the major declines were in rural areas, although urban counties such as San Francisco and Los Angeles also saw declines. Only seven counties improved the percentage of children receiving eye exams or glasses. Four counties were excluded for comparison in the report because the numbers were too small.
"The decline in performance here is so widespread that something really needs to happen," said David Maxwell-Jolly, a health consultant who authored the report and former director of the Department of Health Services, which oversees Medi-Cal. "These numbers are much lower than what you would expect to see if we were doing a good job of finding children with treatable conditions."
A spokesperson for the Department of Health said in an email that the state cannot confirm the accuracy of an outside report, noting that vision services can be difficult to track because "not all encounters are captured in a single, comprehensive data set."
For example, many initial vision screenings are done in the pediatrician's office during well-child visits, which include eye and hearing exams, as well as immunizations and developmental screenings. State data shows that about half of children with Medi-Cal receive well-child visits.
Still, experts say the low numbers tell a true story: If children reliably receive follow-up care from initial screenings, the proportion of those receiving comprehensive eye exams and glasses would be closer to 25-30% — consistent with the known prevalence of vision problems among children — instead of the 16% found in the Optometric Association report.
Maxwell-Jolly said the analysis he performed was based on an internal, unpublished department report tracking vision services.
The state is the newest Preventive Services Reportwhich measures how well Medi-Cal provides preventive care to children, shows that the rate of comprehensive eye exams for children and youth ages 6-21 is similar to the Optometric Association's analysis of 17%.
Contra Costa County experienced the third largest decline in children's eye care in the state. A spokesman for Contra Costa Health Plan said Medi-Cal health plans are not required by the state to track vision benefits and that it will take time to understand the data. However, the state tracks vision services internally, according to the Department of Health Services.
A bill sponsored by the Optometric Association and authored by Assemblyman Patrick Ahrens, D-Cupertino, aims to require the state to establish vision quality measures and publicly report performance data. The purpose of the legislation is to track where children lack sufficient access to vision services and to ensure that Medi-Cal providers improve services.
Rural challenges
Amy Turnipseed, chief strategy and government affairs officer for Partnership HealthPlan of California, said rural parts of the state are struggling to find enough providers. The nonprofit health insurer provides Medi-Cal to 24 northern counties, including Colusa and Modoc.
In Modoc County, which borders Oregon and Nevada, one optometrist serves a 90-mile radius. The Partnership is working closely with that optometrist to ensure they continue to accept Medi-Cal patients, Turnipseed said.
"In rural areas with smaller populations, the loss of even one provider can exponentially affect access to services for families," Turnipseed said. "Over the past few years, we've seen vision providers reduce or limit their Medi-Cal, making it harder for families to connect with providers."
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Modoc is one of only seven counties where more children have received vision care in recent years, according to the report.
Suppliers often quote low recovery rates by the state as a reason for not accepting Medi-Cal patients. The California Optometric Association estimates that only about 10 percent of its members accept Medi-Cal. The reimbursement rate for a comprehensive eye exam is about $47, said Christine Schultz, the association's executive director.
"Our recovery rates haven't increased in 25 years. Imagine being paid what you were paid 25 years ago," Schultz said.
Schools screen children's vision, but follow-up is spotty
State law requires schools to periodically test children's eyesight starting in kindergarten. These projections are a good example if a child is struggling to see in class, said Western University's Chung. The problem is getting the kids who didn't pass the screening to an eye doctor.
Chung runs an academic optometry clinic that works with local schools in Pomona. Each year, up to 35% of students fail the test, meaning they probably have a vision problem. But based on conversations with school nurses, Chung said only about 7 percent of those kids then see an eye doctor and return to school with glasses.
Chung, who chairs the California Optometric Association's Children's Vision Committee, said colleagues who work with school districts around the state report similar experiences.
"If a large number of these children are not receiving follow-up care, we may just be fooling ourselves and checking the box," Chung said. "We follow the law in California, but are we really helping the kids?"
For some families, the answer is no. This happened to Kekoa when he was 3 years old. The school checked his eyes and said he might have vision problems, but his mother, Gittens, waited. Her son was still learning his numbers and letters. How could he read an eye chart, she reasoned. It wasn't until his problems worsened that Gittens took Kekoa to an eye doctor.
Now 15, Kekoa wears women's shoes and enjoys athletics. He should compete in capoeira martial arts competitions and surf on the weekends, his mother said.
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Many parents do not have the means to take their children to the doctor or simply wait. Notes from school nurses noting a child failed an eye exam can also get lost in a backpack on the way home, educators say. The California Department of Education does not track school vision screening results.
Vision To Learn, a non-profit organization, created a mobile eye clinic to help bridge the gap between children who fail vision screenings at school and those who receive glasses. The group brings an optometrist to campus, meaning kids who need an eye exam can get it the same day and go home after getting a prescription and ordering glasses.
Damien Carroll, chief of staff and national director, said Vision to Learn's numbers tell a similar story to Chung's. About a third of the pupils tested could not read the eye chart, but very few of these children had suitable glasses.
In California schools where the program operates, about 70 percent of children prescribed glasses do not own a pair. Another 20 percent had glasses with outdated prescriptions, according to internal data, Carroll said.
And that gap can dramatically affect academic performance or behavior at school.
"First and second graders who are trying on glasses for the first time are amazed because they just thought this was what the world looked like," Carroll said. "They can see the leaves on the trees and the math on the board, and it's shocking to them."
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.
This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.