Over One Third of Students Failed Recent School-based Vision Screening Program

The demand for eyeglasses prescrip­tion updates was high among children who failed a school-based vision screening with their habitual correction, but the majority did not wear their eyewear. Click image to enlarge. School-based vision programs improve children’s access to vision care in underserved areas, but little is known about the composition of Rx status among kids identified as needing new or updated glasses. In a recent study, researchers aimed to describe the baseline eyeglasses-wearing status and the need for new and updated eyeglasses prescriptions for these students. They found that the need for eyeglasses is high across the board, with an increase among higher grade levels, but the majority aren’t wearing them, even if they have them. The findings were reported in Optometry and Vision Science. This cross-sectional analysis examined retrospective data of 285,285 students in the Northeastern US, spanning all grades from pre-kindergarten to grade 12, who received a school-based eye exam after a failed vision screening . More than one third (38.8%) of students failed the vision screening test. Of the 97,069 students who met the inclusion criteria for vision impairment, 75% were prescribed eyeglasses as part of the program. The need for eyeglasses was notable across all age groups, especially among higher grade levels (9th through 12th grades) and those with more severe refractive error. This may be due to states having vision screening mandates that emphasize early elementary school grades, along with many school-based vision programs operating in elementary and middle schools. The authors suggest expanding the vision programs to high school grades, given their high unmet need for refractive services, as well as the academic impact of eyeglasses. Most students who failed a vision screening while wearing eyeglasses needed a prescription update. This aligns with a prior smaller report in a Balti­more school-based vision program, which found that over 95% of students who failed a school-based vision program vision screening while wearing eyeglasses need an updated prescription. In con­trast to the high prescription rate among the current wearers, 63% of students who had not previously worn eyeglasses were prescribed eyeglasses. “This finding may reflect the fact that a subset of children, including students with emmetropia and non-wearers, may inevitably receive false positive results from a vision screening,” the authors wrote in their Optometry and Vision Science paper. They noted they did not have data to assess the sensitivity or specificity of the vision screening. Among current wearers, students with at least 6D myopia and at least 3D astigmatism had the greatest likelihood of spherical equivalent and cylindrical prescription change, respectively. Prescription changes of at least 0.50 spherical equivalent were common, with more than three-quarters of students having myopia. A meta-analysis examining myopia in urban, school-age children suggested that children with myopia experience an annual myopic progression of -0.55D to -0.82D spherical equivalent. “From the perspective of a school-based vision program and in line with the American Academy of Ophthalmology guidelines, myopic children may require more frequent prescription updates and, in some cases, may be referred to community providers to consider interventions for managing myopia progression,” the authors explained in their OVS article. Nearly one-third of students who were prescribed eye­glasses did not have their habitual correction for vision screening with them at school. Notably, this group had worse presenting visual acuity compared with those currently wearing eyeglasses or those who did not report wearing them. “While we do not know the reason for these stu­dents not wearing their eyeglasses, it underscores the need to support not only access to eyeglasses but also encouragement from teachers and parents to enhance compliance and mecha­nisms to replace lost and broken frames,” the researchers wrote. They suggest that school-based vision programs should include access to eye­glasses, replacements and information about wear and care, as providing eyeglasses alone may not be sufficient to ensure regular and consistent use. “Collectively, these findings underscore the need for increased access to longitudinal pediatric eye care services in the community, including robust referral networks for school-based vision programs,” the authors concluded.   Click here for the journal source.  Ambrosino CM, Collins ME, Nguyen A. Need for eyeglasses and prescription updates in students receiving a school-based eye exam. Optom Vis Sci. April 22, 2025. [Epub ahead of print].