Posted by: Janet Hughes | August 31, 2008

Cost-effective method?

j0283679“Mandated eye exams not a cost-effective method to protect sight” headlined the Chicago Tribune’s Voice of the People on August 26, 2008. The next day, the Chicago Suntimes headlined my Letter to the Editor, “With new law, kids need not go without eye care.”

I’m shocked the Illinois Association of Ophthalmology (IAO) does not support required eye exams for children starting school. In their letter, the IAO applauds the Tribune for last week’s editorial, “We do not need another nanny-state mandate.”

The IAO states, “forcing every kindergartner in Illinois to obtain a comprehensive eye exam is not a cost-effective method to protect their sight.”

An eye exam is not a cost-effective method to protect a child’s sight? Illinois mandates health and dental exams three times during a child’s schooling to protect a child’s body and teeth. How could one eye exam, before a child starts learning to read and write, be wasteful for a child’s sight? Academic learning is estimated to be 80% visual.

The IAO favors “a less costly approach in which family physicians and pediatricians, who already provide school physical exams, would also conduct a careful vision and eye health examination.”

j0336542Ha! The “careful vision and eye health examination” supported by the IAO is really a vision screening. Don’t be fooled. Do you know vision screening does not diagnose vision problems? Only an examination by an eye doctor can.

Two of my children passed vision screenings with undetected vision problems by the school and pediatrician. I learned the “cost-effective method” doesn’t work.

As a parent, I want what’s best for our kids—an eye exam by an eye doctor. All parents, schools, and doctors should want the same.

What do you think of the IAO’s position?

Copyright (c) 2008 Vision First Foundation. All rights reserved.


  1. In my “personal opinion,” the Illinois Association of Ophthalmology cannot be for anything optometry supports…it’s politics pure and simple…and the IAO wants the children of Illinois to suffer for it….even one of their own (an OMD)…I believe it was Dr. Romano, editor of the journal Binoc Vis & Strab Quarterly, noted that Ophthalmology was on the losing side of this issue….comprehensive examinations for our children are vital….it is appropriate…it is cost effective (when you consider the cost of a single child with amblyopia for example)…it is also time for both ophthalmology and the pediatricians to get on the right side of this law.

    I could argue that well baby exams are not cost effective…but I doubt pediatricians would stop doing well baby exams…I could argue that back to school check ups are not cost effective…but I doubt pediatricians would stop doing them….the IAO and the pediatrician associations need to change their views…..they sound like they want to stop their patients from receiving the best care possible…stop thinking about yourself….start thinking about the welfare of your patients…support this law….have your patients get full eye examinations today!

    Go to Mainos Memos Blog for the latest kids and vision research….go to COVD for info on learning related vision problems…

    Contact me at if you have any questions…

    Dominick M. Maino, OD, MEd, FAAO, FCOVD-A

  2. Loved your comments, Dr. Maino! You’re so right…it’s about time the ophthalmologists and pediatricians get on the right side of the law.

    The more their argument is exposed, the weaker it gets.

    Vision First will continue to pour sand on this fire. Soon it will fizzle out. 🙂

  3. Dr. Maino and Janet,

    Hope your blogs are well read.

    My only comment at the moment is how can a pediatrician claim they will check children’s vision? How, with what, and with what training? They have about the same training and skills to do dental examinations…almost nothing. That is why they refer patients to the child’s dentist. Some do refer out for an optometric examination, but most just check acuity, some eye pathology, and they’re done unless they refer to an OMD.

    Hate to say it…that is why so many children remain one-eyed all of their life, not to mention so many other binocular anomalies missed.

    The other is the negative statements by AAPOS. Why are they worried about the primary eye examination by an optometrist? Are they not the secondary specialists, the one optometry refers to for medical and surgical needs for the child’s eyes? Why are they trying to do optometry without going to an optometry college?

    This whole issue, starting out with untrained vision school screeners, and then MDs, pediatricians, ophthalmologists who are not optometrically educated and then trying to control the system, is the cause of the problem and the brain-washing of the public and mostly the parents up until now.

    One ophthalmologist said it all, “I am in favor of the mandate to have children’s vision examined, but please do not send me those kids.”
    Dr. Floyd Mizener

  4. Regarding the cost effectiveness of eye exams, that reasoning just doesn’t make sense. What other doctor can you see personally for 20-30 minutes and only be charged 50-60 dollars? Typical MD fees could be $75-90 for about 3-4 contact time to tell the parent their child has a runny nose and that’s not a financial burden!!!

    Also, why is the mandate for the dental eval not a waste? We read with our eyes, not with our teeth!!!

  5. For 34 years, since my son passed the “vision screening,” I have not understood why people who proclaim that children are our priority, we must give children the best, etc., have been against assuring that children start school with the most important learning tool…proper vision.

    As far as cost, what is the cost to the child with an undetected vision problem?

    According to the current IDPH Vision Screening Manual, Chapter 1, “Impaired vision in children can seriously impede learning and contributes to the development of emotional and behavioral problems. Nationally, the percentage of eye defects among all school children is between 20 and 25%. It is doubtful if any other handicapping condition so drastically affects such a large segment of the school population. Early discovery and treatment can prevent or at least alleviate many of these problems.”

    What is the cost to the tax-payers? Tax-payers cost when a child is having difficulties in school.

    What does it cost to evaluate and service a student who is having difficulties in school due to undetected vision problems?

    The teacher observes and keeps records.

    A meeting of professionals is called.

    An intervention plan is developed and implemented.

    Then there will be observation and record keeping for about a month.

    Another meeting to evaluate. Interventions are developed by the team.

    More meetings.

    A meeting to evaluate the Response To Interventions (RTI). They may develop some additional interventions.



    New plan of interventions or referred for a case study.

    A psychologist observes and tests the student.

    More meetings.

    An Individual Education Plan (IEP) is developed and implemented. The student may receive additional services such as resource, speech therapy, occupational therapy, possibly an aid, and the purchase of additional items to assist the student.

    At least yearly (annual review), there is a meeting to discuss progress and to develop a new IEP.

    Every three years there is a complete evaluation with tests, observations, the psychologist, the classroom teacher, any other professionals dealing with the student and a meeting with the parent.

    In addition, the teacher is taken from class time. There is an additional cost for a substitute and precious time lost for the students. All of these steps cost money, when it could be an undetected vision problem.

    Which do you think is more costly?

  6. Good point, Dr. Poswilko, about reading with our eyes and not our teeth. I don’t remember all this hoopla when the dental law went into effect. And that’s required three times–kindergarten, second, and sixth grade! Ugh…

    I hope Vision First can put an end to this nonsense. 🙂

  7. I just read your post, Nora…I love the way you explain the high cost of IEPs. You are so right…all those meetings cost time and money.

    I also think it’s awful that speech therapy, physical therapy, occupational therapy, even psychotherapy is offered to children yet vision therapy isn’t included.

    It’s time children’s vision is brought into the 21st century. 🙂

  8. My daughter, now 5, got glasses when she was 15 months old, and that was thanks to our being tipped off to some problems due to a lazy eye. Had that lazy eye not manifested, who knows how much longer she’d have gone without the proper eyecare? My wife and I receive very interested comments regularly from people asking about how we knew she needed glasses…there is clearly a lack of awareness among well-educated, well-meaning parents, so I agree with you, Janet, that it’s only common sense that there be a mandatory eye exam before schooling starts, especially in light of, and in comparison to, all the other requirements.

  9. Every parent wants what is best for their child. If there is a vision problem, the sooner it is detected, the better.

  10. As always, the IAO makes a vaild point which we all need to consider. Oh yes, I can see their logic now, why waste a whole $50.00 on our little ones just to make certain that they have good visual and ocular health? Just think, that same $50.00 will buy alot of Halloween candy, which by the way, is coming up very soon, so when those same kids show up at the dentist office for their examinations, moms and dads can spend even more $ to have those cavities filled. After all, why waste a state mandated dental exam!

    And as far as having kids’ eyes examined by the Pediatric Family Physician, aren’t these the same folks, who along with the testers in school, who caught just so many ocular and visual abnormalities in the past? This IAO position is simply a stroke of genius. The Pediatric Family Physician can simply hand over the vision screening, whoops, I meant to say testing; to yet another untrained ancillary medical support staff person, who can further demonstrate their complete ineptitude with someone else’s kid’s eyes.

    Yet, ophthalmology has made a valid point. Why waste that kind of money only once in a child’s educational experience? The IAO has certainly made the case for 2 or 3 more wasteful spending forays along the road to a child’s higher education. Now lets see, that could mount up to a whole $150.00, maybe more, for a professional eye examination, and heaven forbid, additional $ for some corrective eyewear, if necessary.

    I know only too well that the IAO can’t be saying that this is not their patient target population; that would be impossible to believe.

    This IAO response has been paid for by the parents of children who have been ill served by this kind of thinking in the past. Hopefully, more kids will get better served because of this new law. Oh yes, I forgot to mention, I was once one of those kids!

  11. Janet…

    My personal thanks to you for all of your hard work and all those involved with the Vision First Foundation. You certainly got it right in response to the Tribune article and I want to commend you for your comments.

    As chief sponsor of the bill, I personally know the challenges that we faced regarding this legislation and it was your determination that made it happen.


  12. and thank YOU, Senator Demuzio, for your dedication and commitment to this cause. I know it wasn’t easy turning SB 641 into Illinois law. Your willingness to support what’s best for the children makes you an outstanding senator.

    May you be an inspiration to other legislators seeking the eye exam law across the country! 🙂

  13. Hello Janet,

    … failing all through school has haunted me all my life… no one picked up on my vision problem .. not the teachers not my parents. I remember not being able to find my classrooms because I could not see the numbers on the doors… so I would hide in the girls bathrooms ( they were easy to find ) until the next class. it was a nightmare for me. Because the teachers became frustrated with me they would make me sit in the rear of the room .. ( out of sight ..out of mind) thats how it felt. At the end of class, we were told to copy our assignments from the Blackboard… I could not see the assignments on the blackboard… so I copied nothing. I was ignored .. the teachers NEVER bothered with me. I failed miserably.

    I have learned more on my computer..thank goodness to Spell Check …. then I did in school. I just know a few things … emails… internet … nothing complicated… I could never do office work on my computer … my daughter has taught me a lot … her name is Barbara. She was a high honor student in high school as were my 2 sons .. I named my daughter after a girl in my class who was a A+ student and she was very popular… so I named my daughter after her .. in hopes SHE would be smart.

    I would be honored to be your friend Janet .

    As you can see I have not written any Petitions … writing is very difficult for me. And my reading abilitys are very limited…and slow. I do not know much about punctuation so I add alot of these … … ….

    Thank you Janet,
    Dolores / Blu (from Care2)

    In response to… (IAO)…Not Cost -effective ?
    What did it cost me to live a life of being uneducated..and a failure ALL through school..Sometimes I dream of what I could have been (I wanted to be a scientist) had I had my eyes examined early.My eyes were so bad …I thought everyone was like me … I was a child …what did I know.?
    You tell me IAO…
    …you tell me.

  14. And I am honored to be your friend, too!

    Thank you, Dolores, for sharing your trials of living with an undetected vision problem. I felt your pain. I wish I could give you a great big hug right now…

    May you be comforted in knowing your struggles were not in vain. God is going to turn those scars into stars. Your story is going to help a lot of children and people.

    I am more determined than ever, Blu, to continue fighting for what’s best and right…

    Thanks for making a difference in my life!

  15. Thank you to the Doctors, to Janet and to all the other people who have made responses about eye vision examinations being done before children begin kindergarten. I was one of those children who did not get an eye examination and it was not until it was brought to my parents attention that I had a proper eye examination carried out by a proper Opthamologist and eye specialist that my problem was detected and dealt with. I have been wearing spectacles since I was a very young child. I got taunted and laughed at by other children, but at least I could see better. I will never have perfect sight because I was born with cataracts and I have high levels of astygmatism but I can see. I beg your shcools to do something about this – for the sake of the children!

  16. Oh Judy…thanks for sharing your story with us. My heart goes out to you. Kids who wear glasses should never be teased! I am so sorry you struggled with your vision problem for so many years, alone.

    Your story shows me there is a great need for education regarding children’s vision. Thank you, for making a difference in my life! You’re no longer alone, Judy. You inspire me to keep fighting for what’s best for the kids. God bless you, dear friend…

  17. Love your comments on this one.

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