When Kekoa Gittens was 3, his preschool teacher told his mother he was a problem. He couldn’t sit still. He didn’t participate. When other kids learned the alphabet, he didn’t pay attention.
The next year, Kekoa’s classroom problems worsened. His mother, Sonia Gittens, took him to his 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 are too little. They don’t know how to express themselves and say ‘I cannot see it, teacher,’” said Sonia Gittens, who lives in the Marin County town of Corte Madera.
Today, Kekoa is a successful high schooler, but too many kids don’t get their eyes checked until they’re far behind in school.
Vision problems, particularly nearsightedness, have grown more common among American children. Roughly one in four school-age kids, or 25%, wear glasses or contacts, a proportion that increases as kids get older, according to 2019 federal survey data.
In California too few children on Medi-Cal like Kekoa are getting their eyes checked, and the problem is growing worse. Just 16% of school-age kids on Medi-Cal saw an eye doctor between 2022 and 2024 for first-time eye exams, continuing vision check ups or glasses, according to a 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 that the state is moving in the wrong direction even as eye problems become more prevalent among kids.
Medi-Cal provides insurance for low-income Californians and those with disabilities.
“Every day when I see these children it is always a surprise to me that the kids are not getting the care they need,” said Ida Chung, a pediatric optometrist and an associate dean at Western University of Health Sciences in Pomona.
The trend indicated in the report is alarming, Chung said. In her clinic, where about half of children are on Medi-Cal, it’s common for kids with congenital vision problems to visit for the first time when they’re in first grade or later. That indicates to Chung that many kids don’t have enough access to eye care.
Though kids might be getting 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 decrease statewide
Colusa County, a rural farming region north of Sacramento, saw the sharpest drop in kids’ eye doctor appointments in the state from 20% between 2015-16 to just under 2% between 2022-24.
Nearly all counties — 47 out of 58 — performed worse on vision care than they did in the past, the report shows, with some, like Colusa, declining significantly.
Most of the severe declines happened in rural areas, although urban counties like San Francisco and Los Angeles also saw decreases. Only seven counties improved the rate 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 care consultant who authored the report and the former director of the Department of Health Care Services, which oversees Medi-Cal. “These numbers are way lower than what you would expect to be seeing if we’re doing a good job of detecting kids with treatable conditions.”
A spokesperson for the Department of Health Care Services said in an email the state could not confirm the accuracy of an external report, noting that vision services can be difficult to track because “not all encounters are captured in a single, comprehensive dataset.”
For example, many initial vision screenings take place in the pediatrician’s office during well-child visits, which include eye and hearing screenings as well as immunizations and developmental checks. State data shows about half of kids with Medi-Cal receive well-child visits.
Still, experts say the low numbers tell a real story: if children were reliably getting follow-up care from initial screenings, the share who get comprehensive eye exams and glasses would be closer to 25-30% — in line with the known prevalence of vision problems among kids — rather than the 16% found in the optometric association’s report.
Maxwell-Jolly said the analysis he conducted replicated an internal, unpublished department report tracking vision services between 2015 and 2016. His analysis, based on data obtained through a public records act request, updated the results for more recent years.
The state’s most recent Preventive Services Report, which measures how well Medi-Cal delivers preventive care to children, shows the rate of comprehensive eye exams for children and young adults ages 6-21 is similar to the optometric association’s analysis at 17%.
Contra Costa County experienced the third largest decline in children’s eye care in the state. A spokesperson for Contra Costa Health Plan said Medi-Cal health plans are not required by the state to track vision benefits and that it would take time to understand the data. The state, however, does track vision services internally, according to the health care services department.
A bill sponsored by the optometric association and authored by Assemblymember Patrick Ahrens, a Democrat from Cupertino, aims to require the state to establish vision benefit quality measures and report performance data publicly. The goal of the legislation is to track where kids do not have enough access to vision services and to ensure that Medi-Cal providers are improving services.
Rural challenges
Amy Turnipseed, chief strategy and government affairs officer for Partnership HealthPlan of California, said rural parts of the state struggle to find enough providers. The nonprofit health insurer provides Medi-Cal for 24 northern counties, including Colusa and Modoc.
In Modoc County, which borders Oregon and Nevada, one optometrist serves a 90-mile radius. Partnership has worked closely with that optometrist to ensure they continue accepting Medi-Cal patients, Turnipseed said.
“In rural counties with lower populations, losing even one provider can exponentially impact the access to services to families,” Turnipseed said. “In the past few years we’ve seen vision providers reduce or limit their Medi-Cal, which makes it harder for families to see providers.”
Modoc is one of just seven counties where more children have received vision care in recent years, according to the report.
Providers frequently cite low reimbursement rates from the state as a reason for not accepting Medi-Cal patients. The California Optometric Association estimates only about 10% of its members accept Medi-Cal. The reimbursement rate for a comprehensive eye exam is about $47, said Kristine Shultz, association executive director.
“Our reimbursement rates haven’t increased in 25 years. Imagine getting paid what you were paid 25 years ago,” Shultz said.
Schools check kids’ vision, but follow-up is spotty
State law requires schools to periodically check kids’ vision starting in kindergarten. Those screenings are a good bellwether for if a child is struggling to see in class, said Chung with Western University. The problem is getting the kids who fail 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 screening, meaning they likely have a vision problem. But based on conversations with school nurses, Chung said only about 7% of those children then go to an eye doctor and come back to school with glasses.
Chung, who chairs the children’s vision committee for the California Optometric Association, said colleagues who work with school districts around the state report similar experiences.
“If a high number of those children are not getting the follow up care, we may just be fooling ourselves and checking a box,” Chung said. “We’re in compliance with the law in California but are we really helping the children?”
For some families, the answer is no. That’s what happened to Kekoa when he was 3. 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 would he be able to read an eye chart, she reasoned. It wasn’t until his problems got worse that Gittens took Kekoa to an eye doctor.
Now, at 15, Kekoa wears contacts and likes athletics. He needs to see to compete in capoeira martial arts competitions and surf on the weekends, his mother said.
Many parents lack the resources to take their kids to the doctor, or simply wait. Notes from school nurses flagging that a child failed a vision screening may also get lost in a backpack on the way home, educators say. The California Department of Education does not track the results of school vision screenings.
Vision To Learn, a nonprofit, created a mobile eye clinic to help bridge the gap between kids failing school vision screenings and getting glasses. The group brings an optometrist to campus, meaning kids that need an eye exam can get one the same day and go home having gotten a prescription and ordered glasses.
Damian Carroll, chief of staff and national director, said Vision to Learn’s numbers tell a similar story to Chung’s. About one-third of students screened are unable to read the eye chart, but very few of those kids have adequate glasses.
In the California schools where the program operates, around 70% of kids who have been prescribed glasses did not own a pair. Another 20% had glasses with outdated prescriptions, according to internal data, Carroll said.
And that gap can drastically affect learning outcomes or behavior in school.
“First and second graders who try on glasses the first time are blown away because they just thought that’s how the world looked,” Carroll said. “They can see the leaves on the trees and the math on the board, and it’s shocking to them.”
For the record: This story has been updated to reflect that Maxwell-Jolly’s study replicated the methodology of an earlier one by the Department of Health Care Services, but did not republish department findings.
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 price they can afford. Visit www.chcf.org to learn more.