Amy Roan Moy, OD, FAAO, CPCO, FNAP, has spent her career immersed in community health optometry, and in that work, she’s seen a pattern that shouldn’t exist. Too many patients—children or adults—walk into an eye exam for the first time with preventable or treatable ocular conditions that have gone unaddressed simply because they lacked access to care.
“We often meet patients who are having their very first eye exam as an adult or as an older child,” says Dr. Moy, senior director of health center initiatives and optometric compliance and an associate professor of clinical optometry at the New England College of Optometry (NECO). She also serves as an attending optometrist at Martha Elliott Health Center at Boston Children’s Hospital. “And they come to us with ocular conditions that are preventable or treatable if they had just had earlier access to eye care.”
This disparity in access underscores the broader issue of visual health equity—the idea that all individuals, regardless of socioeconomic background, location, race, gender or disability, should have access to quality eye care that ensures positive visual health outcomes. But as Dr. Moy points out, the reality is far from that ideal.
BARRIERS TO CARE
Barriers to eye care aren’t always as simple as cost or insurance coverage, though those are major factors. Many people can’t afford to take time off work for an appointment or lack reliable transportation. Language barriers and health care literacy issues compound the problem, making even the prospect of seeking care feel insurmountable.
Even in urban areas where optometrists are seemingly abundant, disparities persist. “It’s easy to think that anyone can just walk into an eye clinic and access care, but that’s not always the case,” Dr. Moy says.
One of the most striking indicators of these disparities comes from data on community health centers. Of the 31.5 million patients seen in these centers nationwide, only 3% have access to eye care services. “And most of them are in Boston,” Dr. Moy says. “If you look at a map of where optometrists and ophthalmologists are in the U.S., there are these huge areas where people would have to drive for hours to get to eye care.”
VISUAL HEALTH EQUITY
Dr. Moy believes that visual health equity is about more than just access—it’s about understanding social determinants of health and recognizing that eye care does not exist in a vacuum. At NECO, she has made it a point to integrate discussions about culturally safe care into the curriculum, teaching students to see their patients as whole individuals rather than just a set of ocular conditions.
“We teach our students that they’re advocates for the patient,” she explains. “They’re not just saying, ‘I’m looking at your eyeball, and I’m done with you.’ They’re seeing them as a human person. And that takes into account social determinants of health.”
For practicing optometrists, Dr. Moy encourages them to think beyond their immediate patient base and consider the barriers that might prevent marginalized communities from seeking care. “Optometrists, besides seeing their own patients, can keep an eye out for marginalized communities and maybe reach out to them,” she says. “Think about what barriers there might be for those communities to come to their office, and if there are barriers, consider volunteering time or working with another community agency to help bridge that gap.”
She also sees an opportunity for policymakers to step in—particularly when it comes to children. “Children don’t vote, so they don’t have a voice,” she says. “But they’re the future workforce of our country. If they see well now, they’ll perform well in school, and they’ll have a better chance at performing well in school.”
WHAT HAPPENS AFTER THE VISION SCREENING?
At NECO, faculty and students conduct vision screenings in Boston public schools, and the numbers are staggering: About 38% of children screened fail. At another local health center in Lynn, Massachusetts, the failure rate is even higher—40%. “There’s something wrong,” Dr. Moy says. “We need to build structures and a workforce to hold the system accountable to ensuring good visual health for each child. Otherwise, they’ll slip through the cracks like they have been.”
Public awareness is another challenge. While organizations like NECO work to identify children with vision problems, many parents remain unaware of just how critical early and ongoing eye care is for their children. “We don’t tell the story as well as we could,” Dr. Moy admits. “If we told more stories about how 40% of the children being screened fail, more people would sit up and say, ‘Whoa, that’s a problem.’”
The impact of undiagnosed vision problems extends well beyond childhood. Vision changes over time, and without regular exams, many people unknowingly struggle with worsening eyesight for years. “Health equity is not just about early intervention—it’s about repeated access throughout life,” Dr. Moy says.
For visual health equity to be truly achieved, it will take efforts at multiple levels—from individual optometrists volunteering their time to policymakers ensuring that systemic barriers are addressed. But it starts with awareness that access to quality eye care isn’t a privilege, but a right.
Listen to Dr. Moy’s podcast on social determinants of health and culturally safe care.
