Myopia in children doubles every decade but pediatric eye exams aren't in most school screenings

Childhood myopia prevalence has risen from 25% to over 42% in the US since 1970, driven by increased screen time and reduced outdoor exposure, yet only 15 states require comprehensive eye exams (not just vision screenings) before kindergarten. School nurse screenings use a 20-foot Snellen chart that catches distance blur but misses astigmatism, convergence insufficiency, and early myopia progression — the exact conditions that cause a child to fall behind in reading and get misdiagnosed with ADHD or learning disabilities. By the time parents notice their child squinting, the myopia has often progressed 1-2 diopters beyond the point where intervention (atropine drops, ortho-K lenses) is most effective. This persists because school health budgets prioritize vaccinations and hearing screenings, and optometry lobbying has focused on adult insurance mandates rather than pediatric screening legislation.