California’s children are living without vision care, and the problem is getting worse

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When Kekoa Gittens was 3 years old, his kindergarten teacher told his mother that he had a problem. He couldn’t sit still. He did not participate. When other children learned the alphabet, he did not pay attention.

Over the next year, problems in Kekoa’s classroom worsened. His mother, Sonia Gittens, took him to a pediatrician, who referred him to an eye doctor.

The doctor looked at the back of Kekoa’s eyes and diagnosed her with myopic degeneration, a dramatic form of nearsightedness.

“The children are too young. They don’t know how to express their feelings and say, ‘Teacher, I can’t see,'” said Sonia Gittens, who lives in the Marin County town of Corte Madera.

Now, Kekoa is a successful high school student, but too many kids don’t get their eyes tested until they’re far behind in school.

Vision problems, especially nearsightedness, are becoming more common among American children. According to 2019 federal survey data, approximately 1 in 4 school-age children, or 25%, wear glasses or contacts, and that percentage increases as children grow older.

In California, too few medical children like Kekoa receive eye exams, and the problem is worsening. Between 2022 and 2024, only 16% of Medi-Cal school-age children visited an eye doctor for their first or ongoing vision test or glasses, according to a report commissioned by the California Optometric Association. This is down from 19% eight years ago. The report, based on two years of Medi-Cal data, suggests the state is moving in the wrong direction, even though eye problems are becoming more prevalent among children.

Medi-Cal provides insurance to low-income and disabled Californians.

“When I look at children, I’m always surprised that every day they’re not getting the care they need,” said Ida Chan, a pediatric optometrist and associate dean at Western University of Health Sciences in Pomona.

Kekoa Gittens wore glasses when she was young. Photo courtesy of Sonia Gittens.

The trends identified in the report are alarming, Chung said. At her clinic, where about half of the children receive Medi-Cal, children with congenital vision loss typically arrive for the first time after first grade. This shows Chung that many children don’t have access to adequate eye care.

Children may receive basic vision tests at school or from their pediatrician, but some eye problems still go unnoticed. “It’s something I had before my child was born,” Chong said.

Vision tests are down across the state.

Colusa County, a rural area north of Sacramento, saw the sharpest decline in pediatric eye doctor appointments in the state, from 20% in 2015-16 to just under 2% in 2022-24.

The report shows that vision care performance in nearly every county (47 of 58) is worse than in the past, with some counties like Colusa showing marked declines.

Most of the severe declines occurred in rural areas, but declines were also seen in urban areas such as San Francisco and Los Angeles. Only seven counties saw an improvement in the rate of children receiving vision tests and glasses. Four counties were excluded from comparisons in the report because their numbers were too small.

“The underperformance here is so widespread that we really need to do something,” said the report’s author, David Maxwell Jolly, a health care consultant and former head of the Department of Health Services, which oversees Medi-Cal. “These numbers are much lower than what we would expect if we were successful in detecting children with treatable conditions.”

A Department of Health Services spokesperson said in an email that the state could not confirm the accuracy of external reports, noting that tracking vision services can be difficult because “not all encounters are recorded in a single, comprehensive data set.”

For example, most initial vision screenings are performed in the pediatrician’s office during a well-child visit. This includes eye and hearing screenings, as well as vaccinations and developmental checks. About half of children on Medi-Cal receive well-child visits, according to state data.

Still, experts say the low numbers speak to the reality. If children were ensured that they received follow-up care from their initial exam, overall vision testing and glasses uptake would be closer to 25-30%, consistent with the known prevalence of vision problems in children, rather than the 16% reported by the Optometric Association.

Maxwell-Jolly said his analysis was based on internal private sector reports that track vision services.

The state’s latest Preventive Services Report, which assesses how well Medi-Cal is providing preventive care to children, shows that comprehensive eye exam uptake among children and youth ages 6 to 21 is similar to the Optometric Association’s analysis of 17%.

Contra Costa County had the third largest decline in children’s eye care in the state. A spokesperson for Contra Costa Health Plan said medical health plans are not required by the state to track vision benefits and it will take time to understand the data. But the state tracks vision services internally, according to the Department of Health Services.

The bill, sponsored by the Optometric Association and authored by Rep. Patrick Ahrens, a Democrat from Cupertino, aims to require states to establish quality measures of vision benefits and publicly report performance data. The purpose of this law is to track where children do not have adequate access to vision services and ensure that Medi-Cal providers are improving their services.

Rural challenges

Amy Turnipseed, chief strategy and government affairs officer at California Partnership Health Plan, said rural areas of the state are struggling to find enough health care providers. The nonprofit health insurance company provides Medi-Cal to 24 northern counties, including Colusa and Modoc.

In Modoc County, bordering Oregon and Nevada, one optometrist practices within a 90-mile radius. Turnipseed said the partnership is working closely with its optometrists to ensure they can continue to accept Medi-Cal patients.

“In rural counties with small populations, the loss of even one provider can have a sharp impact on families’ access to services,” Turnipseed said. “In recent years, we have seen vision health care providers reduce or limit Medi-Cal, making it difficult for families to see a provider.”

An assortment of glasses at the Vision to Learn mobile optometry clinic at Esther Lindstrom Elementary School in Lakewood on March 20, 2026. CalMatters Photography by Ariana Drehsler

Modoc is one of just seven counties where more children are receiving vision care in recent years, according to the report.

Health care providers often cite low state reimbursement rates as a reason for not accepting Medi-Cal patients. The California Optometric Association estimates that only about 10% of its members accept Medi-Cal. The reimbursement fee for a comprehensive eye exam is about $47, said Kristin Schultz, executive director of the association.

“Our reimbursement rates haven’t increased in 25 years. Imagine receiving what you were paid 25 years ago,” Schultz said.

Schools check children’s vision, but follow-up is inadequate

State law requires schools to regularly test children’s vision starting in kindergarten. Western University’s Chong said such screenings are a good clue if a child has trouble seeing during class. The problem is taking children who fail the test to an eye doctor.

Chong operates an academic optometry clinic in collaboration with local schools in Pomona. Up to 35% of students fail the screening each year. This means that students are more likely to have vision problems. However, based on conversations with school nurses, Chong said only about 7% of children who subsequently go to the eye doctor and return to school with glasses.

Chong, who chairs the California Optometric Association’s Children’s Vision Committee, said his colleagues in school districts across the state have reported similar experiences.

“If many of these children are not receiving follow-up care, we may be fooling ourselves and checking a box,” Chong says. “We comply with California law, but are we really helping children?”

Kekoa Gittens is now 15 years old and wears contacts. Photo courtesy of Sonia Gittens.

For some families, the answer is no. That happened when Kekoa was three years old. The school tested his eyes and said he may have vision problems. But her mother, Gittens, waited. Her son was still learning numbers and letters. How could he read the eye chart, she reasoned? Gittens took Kekoa to an eye doctor when her symptoms worsened.

Kekoa, now 15, wears contacts and likes track and field. According to his mother, he needs his eyesight to compete in capoeira martial arts competitions and surf on weekends.

beginning: Dr. Kiyana Kavusi shows text on the monitor during 11-year-old Noah Mattison’s vision test. last: Optician Maya Ortega looks into the eyes of 6-year-old Italia Martin before choosing new glasses at the Vision to Learn mobile optometry clinic at Esther Lindstrom Elementary School in Lakewood on March 20, 2026. Photographed by Ariana Dresler for California Matters.

Many parents don’t have the resources to take their child to the doctor or just wait. Educators say a note from the school nurse informing children that a child has failed a vision test can also end up in a backpack on the way home. The California Department of Education does not track school vision test results.

Vision To Learn, a nonprofit organization, has created a mobile eye clinic to help kids bridge the gap between failing their school vision exam and getting glasses. The group brings an optometrist to campus, so kids who need a vision test can get it done the same day, get a prescription, order glasses and go home.

Chief of staff and national director Damien Carroll said Vision to Learn’s numbers told a similar story to Chong’s. Approximately one-third of students tested are unable to read an eye chart, but few have suitable glasses.

In the California schools where this program was implemented, approximately 70% of the children prescribed glasses did not have glasses. Carroll said internal data shows an additional 20% were wearing glasses with an outdated prescription.

And that gap can have a significant impact on learning outcomes and behavior at school.

“First and second graders are surprised when they put on glasses for the first time because that’s how they thought the world looked,” Carroll said. “They can see the leaves on the tree and the calculations on the board, and it’s shocking to them.”

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Supported by the California Healthcare Foundation (CHCF). The foundation works to ensure people have access to the care they need, when they need it, at an affordable price. For more information, please visit www.chcf.org.