After more than a year of significantly increased screen time and disrupted vision testing for many students, new research shows how learning could improve if schools help students identify and swiftly correct developing vision problems.
A new randomized clinical trial of a vision screening and eyeglasses program at the Baltimore City public schools finds providing rapid eye exams and glasses, in addition to standard vision screenings, uncovered significantly more vision problems and improved reading performance for participating students over three years.
Nearly 7 percent of U.S. children under 18 have a diagnosed vision problem, according to federal data. But school closures and social distancing in the last year have disrupted routine campus-based vision screenings in many districts. Even before the pandemic began, nearly a third of children had not had a vision screening in the last two years. (The American Academy of Pediatrics and the American Academy of Ophthalmologists recommend children get an eye exam every two years if they have never been diagnosed with a vision problem, and annually if they require vision correction.)
“Providing a child who can’t see clearly [with] a pair of glasses is a very simple and straightforward intervention, but there are multiple layers to that process happening, and there are a lot of equity issues that make it less likely to happen in a more-disadvantaged community,” said Megan Collins, a pediatric ophthalmologist and assistant professor at the Wilmer Eye Institute at Johns Hopkins School of Medicine in Baltimore, who co-authored the study published this month in the Journal of Ophthalmology.
Around 40 states require some sort of vision screening in K-12, but prior studies have found low-income students and students of color are disproportionately less likely to have regular vision screenings and correction than higher-income and white students.
She noted that a third of the mostly low-income students screened with the Baltimore program ended up needing an exam and vision correction. The district serves more than 75,000 students, about 76 percent of whom are Black and 14 percent are Hispanic. Nearly 60 percent of the district’s students are low-income.
“Historically kids who failed a vision screening before this program existed may never have gotten to an eye doctor,” Collins said. “Anecdotally, we know for a lot of these kids, it was their first pair of glasses.”
Maryland only requires students to receive vision screenings at kindergarten, grades 1 and 8, or the first year a student enters school. The state does not require schools to follow up with students who fail the screening to make sure they get a full eye exam or vision correction. The Vision for Baltimore initiative provided a full vision screening to every student in grades 3 to 7, every three years. Students who failed the screening were also given full eye exams and glasses if needed at no cost to their families.
Because only a third of schools in the district participated in any given year, researchers from Johns Hopkins University compared the performance of more than 2,300 students in grades 3 to 7 in schools who received eye exams and glasses in each school year from 2016 to 2019 to those whose school did not participate in the program that year.
After a year, they found students who received the exams and glasses performed better on the i-Ready, the Partnership for Assessment of Readiness for College and Careers test in reading. The overall gains in reading were .09 of a standard deviation, or enough to move a student scoring at the 50th percentile up to the 54th percentile. Students who saw the biggest improvements were those who initially performed in the lowest 25 percent of readers and those with disabilities who each saw improvements of .25 of a standard deviation or more. Female students improved by a slightly smaller amount. All the participating students also improved to a lesser extent on the math tests, but only in elementary school.
Collins said the findings suggest schools should provide more follow-up for children who fail regular vision screenings, to ensure they actually get support to correct vision problems.
“A vision screening ... is done usually by a technician or a school nurse, sometimes a teacher,” Collins said. “It’s not diagnostic; it’s not done by an optometrist or an ophthalmologist. If a kid is referred to an eye exam, it’s usually done by an optometrist or an ophthalmologist; it is a medical exam that helps ascertain whether or not somebody needs new glasses or has any other types of problems with their eyes.”
Students did not maintain the improvement in reading two years after receiving glasses, however. The study did not look at why the effect faded, and it is not clear how many children in the control group got eye exams on their own after two years. Amanda Neitzel, the deputy director of evidence research at the Johns Hopkins Center for Research and Reform in Education, and researcher at the university’s Center for School-Based Health Solutions also noted that over time, students’ prescriptions may have changed, or they may not have worn corrective lenses consistently after the first year. While the Baltimore program did replace glasses that were lost in the first year, she said students need ongoing vision supports.
“I would want to emphasize that this is not just, you know, one more thing for your school nurse to check off,” Neitzel said. “This is something that’s actually going to require the buy-in and engagement of your entire school staff to make it happen.”
Disruptions, screen time may add to vision concerns
The findings come as many students return to in-person learning after more than a year of some or mostly virtual schooling, significantly more screen time overall, and potentially fewer outside activities, all of which experts say could increase the likelihood that vision problems could develop.
While evidence is mixed about how much screen time may contribute to vision problems among children, international and U.S. research has found rates of myopia, or nearsightedness, have risen dramatically for students in the United States and other industrialized countries.
Researchers found similarly rising rates of nearsightedness among Baltimore students, Collins said.
“As kids got into subsequently higher grades, we’re seeing more myopia ... and I would suspect that trend would become even more amplified given the current pandemic ... when we have lots of kids who could have had 12 to 18 months learning virtually,” she added. “These vision screenings at schools can help detect problems that may seem asymptomatic, because students are not always going to say, ‘I can’t see the board,’ they’re just going to walk close to the board or just try to compensate.”
“I think these trends are going to continue, and it’s going to be more important as we move forward to think about vision partnerships with the community to make sure that [vision-impaired students] get everything that they need,” Collins said.
