Foreseeing The Early Signs of Poor Pediatric Eye Health

Aug 23, 2023

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Before he could even speak, Andre Tillery’s mother questioned her son’s visual acuity through a host of concerning signs at his extremely young age.

Initially dismissed by doctors who failed to properly diagnose his symptoms, it was his third visit to an eye doctor before Tillery was directed to emergency eye surgery to correct the condition impeding his vision. Although rare in children, Tillery’s story mirrors a common experience for juveniles with pediatric eye problems and the severe issues that can prevail when met with the common barriers standing between their access to proper vision health care.

According to the National Institutes of Health (NIH), congenital pathological conditions, which are most often genetically determined, cannot be prevented. Thus, screening for eye diseases in infants and young children is extremely important to prevent worsening issues. Tillery’s parents quickly learned that his visual impairment came at a cost from hereditary conditions.

“I had cataracts, which is a very rare case because you usually don’t develop cataracts until you are much older. It was two things that concerned my mother. My eyes were closer to a gray color, and I also kept sitting close to the television,” Tillery explained.

“[Initially], my mother took me to an eye clinic but they said they didn’t see anything, but one of her girlfriends kept stressing to her that something about my vision wasn’t right, and to take me somewhere else. She eventually took me to a full-service hospital where they did a full inspection and found that I had cataracts.”

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Tillery, a local optician, has seen his share of eye conditions among adults and children across the District. However, he added that he has only seen severe visual deficits in a handful of kids, as his case of juvenile cataracts at such a young age is quite a rare condition.

When examining the heart of the matter in pediatric visual disparities, a lack of access to visual health care is often the greatest barrier in preventing children from receiving an informed diagnosis at the most opportune time to identify, and correct their illness before it is too late.

Dr. Janine Smith-Marshall, a Howard University Hospital pediatric ophthalmologist, shared insight into the dangers of pediatric eye diseases that often bear heavier consequences when left undetected.

“Fortunately there isn’t a lot of racial inequality in terms of eye diseases. What we do see is a lot of disparity in access to healthcare. Typically, pediatric ophthalmologists work very closely with pediatrician family practitioners who will do screenings with children’s annual exams,” Smith-Marshall told The Informer.

She said most children begin getting their eyes checked around 3 years old, using a photo screener, which will help determine whether patients are at risk. However, lack of access to pediatric ophthalmologists and screeners can present challenges for many young people.

“If a patient doesn’t have access to continuity of care in their medical home, then patients can easily be overlooked,” Smith-Marshall explained.

The pediatric ophthalmologist explained that certain visual issues like amblyopia or lazy eye, for example, have a critical time limit for the patient’s most optimal chance of treating the defect.

Smith-Marshall shared that when you catch someone early enough, typically between 3 to 6 years old, and they are compliant with treatment, there is almost a 100% success rate in being able to correct the eye. However, if that child is not seen until they are closer to 9 or 10 years of age, the chance of being able to clear that vision deficiency decreases to less than 10%, making it extremely important to ensure good access to care and primary care options early on.

School health screening programs and early exams with their pediatricians serve as critical preventative steps in identifying these issues, as worst-case scenarios can result in blindness over time. Inspired to lessen the gap between underserved children and much-needed access to vision health care, the Prevention of Blindness Society of Metropolitan Washington is pounding the pavement across the District to bring eye care services to children who may lack the resources, or even age requirements to visit an eye doctor within reach.

“We go into schools in the District that are in underserved areas. We bring a volunteer doctor, and they give exams. We bring all the equipment so that it can be set up in a school’s library, nurses’ office [or space of their choice]. We bring an optician and a selection of glasses and the kids get to choose two pairs of glasses for themselves,” said Caren Forsten, CEO of the Prevention of Blindness Society of Metropolitan Washington. “We are all trying to make sure that children in underserved communities can get the care they need.”

It is not just money that serves as the greatest barrier for young kids, but it is difficult to find doctors who will see children under a certain age. Forsten explained that similar to food desserts, there are pediatric eye care desserts in the District community, leaving parents to have to navigate much of that process on their own. The organization maintains a list of doctors who accept Medicaid and will see children of various ages.

Luckily for Tillery and his family, who once experienced the eager hunt for a doctor that would give him the proper attention he needed, he was able to land the vision care that would eventually correct his cataracts before it became a permanent fixture in his life.

“Age tends to be a significant barrier for children and vision care. I think [most doctors] just assume that young kids are not going to need anything, but you can’t say that because just like in my case, you don’t [always] know, and that can be a problem,” Tillery said.