Vision Needs of Children Who Failed School-based Vision Screening with and without Eyeglasses

ABSTRACT

Purpose

To compare the vision needs of children wearing and not wearing eyeglasses who failed school-based vision screening.

Methods

Students aged 4 to 16 years in 41 Baltimore City schools were screened using distance visual acuity (VA) and photoscreening. Students failing screening underwent school-based non-cycloplegic examination. We compared students who were wearing eyeglasses at failed screening with those not wearing eyeglasses with respect to age, sex, right-eye refractive error, right-eye presenting, and best-corrected VA (BCVA).

Results

A total of 2176 students failed screening and completed the examination; 94 (4.3%) failed while wearing eyeglasses. Students wearing eyeglasses were older (mean age 10.2 vs 8.8 years, p < .001). Myopia (72.3% vs 46.0%, p < .001), severe myopia, ≥6.00 spherical equivalent diopters (D) (9.6% vs 1.8%, p < .001), astigmatism (66.4% vs 50.8%, p = .004), and severe astigmatism, ≥3.00 D of cylinder (14.9% vs 7.0%, p = .008) were more common in students wearing eyeglasses. The prescription rate was higher for students wearing eyeglasses at failed screening compared with those not (95.7% vs 80.4%, p < .001). About 4% of the children in both groups required referral to community providers for non-refractive pathology, such as strabismus or amblyopia (p = .6).

Conclusion

Children who fail vision screening while wearing eyeglasses nearly always needed an updated prescription and had more severe refractive errors than those not wearing eyeglasses. However, the community referral rate was the same for both groups. School-based programs can support children currently wearing eyeglasses that may be incorrect or outdated.

KEYWORDS:

• Eyeglasses
• pediatric vision needs
• refractive error
• school-based vision care
• vision screening

Acknowledgments

We are deeply grateful to the Vision for Baltimore team for their work. This program and this research would not be possible without their dedication and support. We would particularly like to acknowledge the following colleagues for their efforts to support this research:

Baltimore City Health Department: Mary Beth Haller, Francine Childs, Joy Twesigye, and Tempestt Little

Baltimore City Public Schools: Louise Fink

Warby Parker: Hannah Reeve, Jesse Schultz Sneath

Vision To Learn: Ann Hollister, Wade Brown, Damian Carroll

Johns Hopkins University: Christine SySantos Levy, Grace Galiani, Anne Curry

Conflicts of interest

The corresponding author, MEC, previously served as a consultant for Warby Parker, a company that manufactures the eyeglasses provided in the Baltimore vision program. This arrangement was reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. There are no other conflicts of interest among authors. All authors participated fully in the research.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Abell Foundation, the Arnold Foundation, and the Knights Templar Eye Foundation.