Article Date: 2/1/2013

Reaching the Pediatric Patient

Reaching the Pediatric Patient

Meet children’s visioncare needs by making this underserved patient population a priority in your practice.


With the inclusion of well vision exams for children younger than age 18 in the Affordable Care Act (ACA), there is the potential for significant growth in the pediatric market.

The ACA does develop an interest in pediatrics and proposes to include children’s well vision care. With insurance exchanges being set up in many states, some states will go with a federal exchange. The intent is to provide a place where those who are currently uninsured can go to purchase medical insurance. A required benefit of these plans is a children’s eye exam, not just a screening. The estimate is that there will be 10 million children who will receive vision coverage who do not currently fall under any medical insurance plan, according to the AOA.

When I began my practice in 1979 there were 64.1 million children younger than age 18. In 2012 that total rose to 76 million. Projections for 2020 are for that age group to grow to 81 million.1

We are all familiar with the growth of the baby boomer population and their increasing visioncare needs, but it appears that children are also an underserved patient population.

Birth to age 3

Becoming involved with InfantSee is the easiest way to begin, with a minimal investment in additional equipment. The AOA has all the information you need to provide and promote this valuable service to your patients and those in your community. There are brochures, training and a kit available for purchase (


Treating pediatric patients, such as the child above, 3, who has a history of amblyopia and strabismus, can grow your practice.

Talking about infants with parents, soon-to-be parents and grandparents creates awareness that you are the specialist when it comes to children’s vision. Today, I am seeing those infants I saw two or three years ago for their kindergarten exams — a base of new patients.

Ages 3 to 5

If parents have older toddlers, then I recommend an initial exam at age 3, not just a screening. We are looking for amblyopic patients in the 3- to 5-year-old population.

Amblyopia is present in 2% to 4% of the population, which would equate to roughly 3.24 million children in 2020, given current projections.2 The relative number of glaucoma patients is nearly the same. Examples of the costs involved with this population include the purchase of hand-held equipment and automated projectors that show cartoons.

You and your staff are even more critically important. Patience and a sense of humor are your best tools, as well as a willingness to get down to the patient’s level (even if it is sometimes the floor).

School-aged children

The next level of pediatric care in which you can develop a niche is the school-aged patient. Two areas of growth would be myopia control and vision therapy for convergence insufficiency, both of which are areas of parental concern.

No parent likes to be told that their child’s prescription is getting worse every year. Research is ongoing on the efficacy of orthokeratology in the management of myopia. More recent research is based on peripheral retinal focus and the use of dual focus soft contact lenses to manage myopia.

There are ample avenues of information beyond the scope of this article that can be pursued to make you an expert in treating children who have progressive myopia, such as the American Academy of Optometry ( and the Orthokeratology Academy of America (

Providing vision therapy in your office is also an untapped area of growth for a pediatric practice. While all of us would find fitting contact lenses on young patients a fairly easy transition, providing office vision therapy is a larger commitment. Fortunately, there are computerized home vision therapy programs available to begin offering a treatment plan for those issues. You can use that as a base to expand to an office-based program.


Historically, methods employed to market and create a pediatric practice involve contacting schools and parent-teacher organizations and attending health screening fairs among other traditional avenues of creating awareness in your community. These are methods I worked on when I began my practice.

One effective method was sending a report to every patient’s teacher. Initially I kept a list of all these teachers manually but the advent of computer programs to handle address lists made it much easier to manage. Now, I send a mass mailing to all the teachers every fall thanking them for their referrals and sharing new information about their child’s vision demands or a new piece of equipment I had purchased for the office to evaluate their student’s vision.

A variation on this would be contacting the teachers by e-mail. Ask for permission to communicate by via e-mail to individual students, and acquire a list of email addresses for an e-mail blast to all of the teachers, or to a specific school district or specific school. The possibilities for this type of communication are only limited by your creativity.

The benefit is the personalization possible and the fact that there is no cost involved, as there once was with the cost of the letters and postage. I would caution you on the individual e-mails: There are strict rules on secure information that can be transmitted. For case-sensitive information, find a way to meet the teachers personally or at least have a phone conversation.


Pediatric vision care is the growth market that bookends the baby boomer market at the other end of the demographic spectrum. Developing a pediatric visioncare niche is one specialty area in which no other vision care provider can offer what we do.

Referrals from colleagues, parents and teachers grow your practice, expanding your patient base beyond what you have from standard vision plans. OM

1. Federal Interagency Forum on Child and Family Statistics. Child population: Number of children (in millions) age 0-17 in the United States by age, 1950-2011 and projected 2012-2050. Available at: Accessed January 29, 2013.

2. Friedman DS, Repka MX, Katz J, et al. Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months the Baltimore Pediatric Eye Disease Study Ophthalmology. 2009 Nov;116 (11):2128-34.

images Dr. French practices in Orland Park, Ill., and emphasizes pediatric optometry and vision therapy. She has lectured extensively to parent and teacher groups about the importance of children’s vision and its relationship to schoolwork. E-mail her at, or send comments to

Optometric Management, Issue: February 2013, page(s): 35 - 37