Optometrists historically have thought about AC/A in terms of the ratio between accommodation and convergence responses. In the days when optometrists paid significant attention to these issues, there was considerable debate as to whether the AC/A was modifiable through vision therapy. There’s a new ACA that optometrists seem to be paying much more attention to: the Affordable Care Act, also known as ObamaCare. This ACA has engendered a fair amount of controversy, along with snags in implementation. One of the more significant components of the ACA from our point of view is coverage for annual comprehensive eye examinations for children as an Essential Health Benefit. Beginning January 1, 2014, comprehensive pediatric vision is one of ten essential benefits authorized by the ACA as required for all health plans sold in state-basedhealth insurance marketplaces (exchanges) and many plans outside the marketplaces. The National Commission on Vision & Health has an informative background information sheet about this. Predictably, because the American Optometric Association was in favor of annual comprehensive eye exams for children, MD organizations opposed it. “Screenings are good enough” they argued.
Consider this: when an MD examines a child on a routine basis, as might be the case through ACA, there is a high probability that nothing of significance will be found. That is because the prevalence of eye disease requiring treatment in the pediatric population in very small. Screenings designed to detect significant refractive abnormalities, amblyopia, and strabismus suffice because those are the only conditions other than disease that require treatment. To see significant numbers of children who are normal clogs the schedule of pediatric ophthalmologists who are already busy enough panning for surgical gold. It is not “cost effective”. Having a screening system that helps do some of the panning for them is an essential part of the pediatric ophthalmologist’s business model. Direct access to optometrists for examination through the family’s medical plan puts a crimp in the feeder pipeline from pediatrician to pediatric ophthalmologist. Parents are now more likely to proceed directly toward comprehensive examinations based on their independent research. Frankly I suspect that many pediatric offices and school nurses will be relieved to give up the vision screening process if implementation of the ACA pediatric examination runs smoothly. The American Optometric Association has produced a nice fact sheet explaining why Health Reform Offers Better Children’s Vision Care in the U.S.