Millions of children in the United States are without access to vision screenings and eyecare, yet there is no established program dedicated to the early detection of vision problems in children.
To address this gap, the Early Detection of Vision Impairments for Children (EDVI) Act of 2025 (H.R. 2527) was proposed to be the first federal program focused on expanding access to pediatric eyecare. The EDVI Act aims to increase access to vision screenings and referrals to eyecare providers, with a long-term goal of improving visual and educational outcomes.1
Why early detection matters in pediatric vision
According to the American Optometric Association, 1 in 5 preschoolers have vision problems, and 1 in 4 school-aged children need corrective lenses.2 While beneficial, school screenings miss up to 75% of vision problems, and only 38% of public school children receive follow-up care after their screening.2
Children with vision issues do not always complain of symptoms because they are unaware their vision is abnormal, or they may have one good eye masking the symptoms of their blurry eye. Meanwhile, they’re at risk for permanent vision loss in one or both eyes without early intervention. It is critical for parents, guardians, teachers, and physicians to be educated on the importance of routine eye exams, even if a child is asymptomatic.
Comprehensive eye exams and vision correction are also important for academic success.3 Children may experience symptoms such as blurry vision, headaches, eyestrain, double vision, or loss of place while doing their schoolwork. Even behaviors such as avoidance, inattention, or frustration during schoolwork may actually be due to treatable visual symptoms.
Key vision conditions targeted
Amblyopia and strabismus
Early intervention is especially important to prevent amblyopia, which occurs in one or both eyes as a result of abnormal visual development due to high refractive error, strabismus, or visual deprivation (ex., congenital cataracts).
Studies show that the “critical period” for visual development occurs from birth to around age 8, but the visual system is the most neuroplastic from birth to age 3.4 This is the most sensitive period of development, so it is important to examine children even before they start school. Full-time glasses wear at a young age can prevent the development of refractive amblyopia.
Strabismic and deprivational amblyopia usually have more severe levels of vision loss, and can be prevented with early detection and treatment. As age increases, the visual prognosis decreases even once treatment is initiated. A variety of treatments may be needed including surgery, glasses, and/or vision therapy.
In addition to blurry vision, patients with amblyopia often have accommodative, vergence, and oculomotor deficits.5 Prevention of amblyopia can also decrease these associated conditions and maximize academic and social success in children.
Looking for tips on discussing amblyopia with patients? Check out How to Talk to Patients and Parents about Amblyopia!
Refractive error
Non-amblyogenic myopia, hyperopia, and astigmatism also need to be treated early with glasses or contact lenses to ensure children can see clearly at all distances. With the increasing rates of myopia and the treatment options we now have available to slow myopia progression, early detection of myopia is ideal.6
Myopic patients should be referred to the appropriate providers for treatment options, including Stellest lenses, MiSight contact lenses, orthokeratology contact lenses, and/or atropine eye drops. Many parents and patients are not aware of the ocular health risks of high myopia, and increasing screenings and referrals can also help spread awareness of these risks.
Ocular pathology
While less common, there are many other vision conditions where early detection is important. For example, children with progressive vision loss, such as those with retinitis pigmentosa, can maximize their success by learning adaptation techniques prior to losing their vision.
EDVI Act funding and program structure
The primary funding of the EDVI Act would be provided by the Health Resources and Services Administration (HRSA). Grants would be given to states, communities, and tribes, to implement coordinated pediatric vision care systems, including screenings, referrals, and follow-up care.1
States and communities would then use these grants to create vision care networks in schools, early learning centers, and community health centers. This allows for flexibility at the state level based on the particular needs of that community. HRSA would set national guidelines and reporting requirements.1
Additional funding was also requested to develop federal evidence-based guidelines and best practices to improve consistency amongst providers between states. The EDVI Act especially aims to improve access to services and reduce disparities in vision and ocular health in rural and underserved communities.1
Strengthening the continuum of care
Coordinating continuity of care can be difficult in the current vision-care system. For example, a child may receive glasses from a school screening, but then not receive appropriate follow-up care to ensure proper correction, improvement in vision, adherence to glasses wear, and initiation of any additional treatment needed.
The EDVI Act aims to improve continuity of care by following nationally guided follow-up protocols and creating more accessible referral networks.1
Role of optometrists in EDVI implementation
The majority of school screenings are performed by the school nurses, though optometrists do occasionally participate in school screenings. However, optometrists are critical for follow-up care and in implementing successful referral networks in the community. Pediatric optometrists specifically will be vital in improving collaboration with schools, pediatricians, and public health programs.
Looking to get involved in pediatric vision screening? Take a look at Partnering with Pediatricians to Improve Myopia Outcomes!
Broader impact and advocacy
There are significant geographic and socioeconomic disparities in pediatric eyecare.7 There is a lack of public awareness on the importance of pediatric eye exams, as well as a lack of providers in rural and low-income areas.
The EDVI Act aims to help the communities in need of services by increasing access to care and providing the necessary funding to do so.1 Supporting and increasing awareness for this bill is a great opportunity for optometrists to advocate for policy advancement in their field.
Where the bill stands and how you can help
The bill remains in the early stages of the federal legislative process. It is currently being held in the House Committee on Energy and Commerce awaiting review and voting, before being sent to the House floor.1
Currently, there is no sponsor to take the lead on this bill in the Senate, and it is still awaiting a Senate companion bill. Other vision programs, such as the CDC’s Vision Health Initiative, have experienced budget cuts from the federal government,8 which is not promising for the momentum of the EDVI Act.
As an optometrist, how can you help move this bill along?
- Support Prevent Blindness, a volunteer organization devoted to preserving vision, in their advocacy for the EDVI act. Their website has a lot of valuable information on how to help support the EDVI Act and other vision initiatives.
- A “Dear Colleague” letter is circulating in the House to gain co-sponsors and momentum. Send a message to your congressional member and ask them to cosponsor the EDVI Act. Go to https://advocacy.preventblindness.org/edvi-act for more information and for a link to take action.
- Encourage the congressional members in your area to join the Congressional Vision Caucus (CVC). The CVC is a bipartisan group of congressional members dedicated to highlighting a national conversation around policies related to vision loss, blindness, impairments, and disabilities.
