March 4, 2026. Avery Kerwin.
The 8-year-old knew she was struggling to see.
“My teachers say I squint a lot,” Becca said as I checked her vision during a free pediatric screening event near her school in Winston-Salem in North Carolina.
The second grader’s mom sat next to us and shared the challenges she was facing as she struggled to help her daughter.
“We’ve been trying to get an appointment, but there wasn’t one available for three months,” she said
As part of my North Carolina Schweitzer Fellowship, I organize free vision screenings for uninsured children. Parents often tell us how surprised they are to learn how poor their child’s vision is — and how much of a difference a simple pair of glasses can make, both in boosting school performance and in making children more comfortable. The value of a basic vision screening that includes ordering glasses is a reminder that when the system works, solutions can be straightforward.
But a harsher truth has become clear: screenings alone are not enough. Even when children have health insurance that includes vision care, many do not get the care they need.
Medicaid covers routine eye exams and corrective eyeglasses for children under 21. Yet in a study in low-income schools in Toronto, Nishimura and colleagues found that about one-third of kindergarteners who failed vision screenings never completed the recommended eye exam, and nearly half of those who received glasses were no longer wearing them by second grade because the glasses were lost, broken, or never replaced. This research illustrates how fragile follow-up care can be even when screening and free glasses are offered. Through conversations with local pediatric ophthalmologists, we’ve learned why. In a telephone survey of eye care practices in Michigan, Kemper and colleagues found that although most were willing to see children, only about two-thirds accepted Medicaid, suggesting that many families with public insurance struggle to find a provider for follow-up care. Among clinics that do accept Medicaid, some limit the number of low-income children they see daily, creating long waitlists. Others accept Medicaid for exams but don’t dispense glasses onsite, forcing families to navigate a confusing system to help children get glasses. For parents facing limited transportation options, unpredictable work schedules or language barriers, this added step often becomes a dead end.
The consequences are real. Without corrective lenses, kids fall behind in reading because they can’t see the board clearly. They avoid sports because they can’t track a ball. They miss social cues because they can’t read expressions. In a clinical trial in Baltimore, Neitzel and colleagues found that giving students glasses through a school-based program led to significant gains in reading scores within a year. The evidence is clear: vision matters for how children learn, interact, and function.
This disconnect between coverage, diagnosis, and actual care is what I call the “vision gap” — a form of preventable visual impairment that affects educational progress and well-being.
We can close this gap with concrete changes:
Ensure on-site optical access. Any practice accepting Medicaid should offer glasses at their clinics or partner with a reliable optical provider. No child should leave with a prescription that their families can’t easily fill.
Eliminate patient caps. Clinics accepting Medicaid shouldn’t restrict the number of children they see through quotas that create months-long delays. Accepting Medicaid should mean providing consistent access.
Invest in mobile and school-based programs. Bringing exams and glasses directly into schools removes logistical barriers families face. The Baltimore trial showed this model works.
Adjust Medicaid reimbursement. Clinicians need fair reimbursement to make full-service vision care financially feasible.
Expand education. Families deserve clear information about how better vision boosts academic performance. Schools and clinics should provide simple, multilingual resources so parents understand why regular eye care matters.
Vision is basic to a child’s ability to function. A pair of glasses doesn’t fix every challenge, but it helps remove one major barrier. For a child like Becca, seeing clearly isn’t theoretical. It’s the difference between participating fully in school or constantly working around a problem that should’ve been fixed long before.
Health insurance coverage without access amounts to no coverage at all. Every diagnosis must lead to care children can actually receive. Medicaid may promise vision benefits on paper, but for too many children, the world remains blurry. We have the tools to bring it into focus—we just need the will to make sure every family can access them.
Avery Kerwin
Wake Forest University School of Medicine Class of 2027
Project SEE Clinic Co-Director
2025-26 NC Schweitzer Fellow
The opinions expressed are the author’s own.