Vision for the Future (March 6, 2025) • America's Optimistic Futurist

Posted by: Francis Koster Published: March 7, 2025

Vision for the Future (March 6, 2025)

Vision and Technology

Studies show that American children are vulnerable

to a disturbing global trend.

By 2050, half of the world’s population will be nearsighted.^1,2,3

In 2016, in a remarkable joint policy statement, the American Academy of Pediatrics (AAP), American Academy of Ophthalmology (AAO), and American Association for Pediatric Ophthalmology and Strabismus (AAPOS)—leading experts in pediatric vision—asserted that visual problems among school-age children lessen the ability to learn.^4,5 The most common eye disorders are “refractive errors” which many of us are familiar with—myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (uneven curvature of the eye surface).⁶ Without treatment, refractive errors not only impair academic performance; they can lead to permanent vision loss.⁷

To uncover such conditions, the groups recommended routine vision screenings from infancy through adolescence. Further, they endorsed the use of new, “instrument-based” technologies to detect the earliest visual disturbances. These digital tools, widely validated in lengthy trials, signified a “revolutionary” leap in the capacity to achieve healthy vision in children from all segments of American society.

Today, the AAO and others continue to support digital screenings,^8,9and the impetus for them has only grown. In some regions of the world, the AAO estimates 80-90 percent of teenagers and young adults are already myopic.¹⁰ American schoolchildren, too, are increasingly beset by refractive errors that remain uncorrected.¹¹ In 2024 an extensive survey of 51,000 caregivers across the U.S. revealed that nearly 47% of children aged 6 to 17 had not had a vision screening or exam within the last two years.¹²

Gobiquity Medical Health launches smartphone-based vision impairment photoscreener for kids

Although 41 states require vision screenings for K-12 children, only 6 mandate more than one screening before graduation.^13,14 In states such as North Carolina, where a caregiver must certify that a child has received a vision screening, a comprehensive follow-up exam is mandated when visual disturbances are found.¹⁵But enforcement of follow-up exams is tepid, and socioeconomic status is the most potent predictor of treatment.^16,17 For example, in November of this past year, researchers reviewed the outcomes of school-based vision programs in 410 schools across the U.S. In most of these schools, more than 87% of the student body qualified for free and reduced-price meals. The authors reported a median vision screening failure rate of 38.4 percent.¹⁸

The gap in eye care for children in low-income households underscores the conclusions of the joint missive issued nine years ago and echoed by many health professionals since then.¹⁹ Digital devices for screening vision—commercially-available, automated “photoscreeners” or “autorefractors”—provide a scalable means of delivering vision screenings, or streamlined eye exams, to all K-12 students.²⁰ And school-based vision programs afford the best opportunity for tracking scope of service and effectiveness.²¹ Photoscreeners offer the following advantages over traditional screening methods:

They are simple to implement--much like taking a photo with a smartphone;
Lay workers can be trained quickly;
Many are portable and inexpensive;
They are accurate, producing a high level of agreement with conventional screenings;
They are efficient, taking less than a minute to perform, so many children can be screened within a short period of time;
They require only brief cooperation from a child;
Software provides automated, instant results, estimating the amount of refractive error;^22,23
They enable both remote and caregiver monitoring.²⁴

As you plan for your community’s needs in 2025, consider the real-world accessibility of the following examples.

Apollo Infant Sight (AIS)²⁵ system captures the gaze of a child into an existing smartphone camera, measuring eye movements and features. Untrained users performed tests at home with a high degree of accuracy.
The Ma et al. Model²⁶ measures interpupillary distance, refractive error and alignment while a child holds the smartphone in front of his/her face. Integrated artificial intelligence algorithms provide automated expertise, enabling low-skilled workers to implement it easily.
The Kanna Photoscreener²⁷ pairs machine learning with an android smartphone, analyzing three facial images to construct a risk measure for major eye disorders.
GoCheck Kids Smartphone²⁸ offers an iPhone counterpart to android screeners, utilizing image-processing software to estimate the presence of visual disturbances. Its results can be transmitted remotely and manual detection can be employed to enhance sensitivity.

Let’s correct our vision of the future together.

Healthy Air, Healthy Water First

As a prominent pediatrician and podcast host, Dr. Christopher Magryta has long appreciated the relationship between environmental factors and public health. Recently, he interviewed Dr. Koster about the academic impact of poor air and water quality in schools. In this episode of Dr. M's Women and Children First, Dr. Koster discusses the medical science behind his motivation to protect K-12 students from harmful learning environments, as well as some readily implementable solutions for undesirable conditions.

Follow this link to listen to Dr. M's Women and Children First, featuring Dr. Francis P. Koster

The College of Optometrists' Guide to Your Child's Eyes