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Updated: Nov 17, 2025

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Analysis of vision screening failures in a school-based vision program (2016-19).

Rachel R Milante1, Xinxing Guo2, Amanda J Neitzel3

  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|February 18, 2021
PubMed
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One-third of students failed vision screenings in Baltimore City Public Schools. Current state-mandated screenings are inadequate for detecting vision issues in low-income communities.

Area of Science:

  • Ophthalmology
  • Public Health
  • Pediatrics

Background:

  • School-based vision screenings are crucial for early detection of visual impairments.
  • This study examined vision screening data from Baltimore City Public Schools, serving a predominantly low-income population.
  • Screenings were conducted across mandated (pre-K, K, 1st, 8th) and non-mandated (2nd-7th) grades.

Purpose of the Study:

  • To evaluate the effectiveness of current state-mandated vision screening protocols in identifying vision problems among students.
  • To compare vision screening failure rates between mandated and non-mandated school grades.
  • To analyze the prevalence and types of vision impairments detected in a large, urban, low-income student population.

Main Methods:

  • Vision screenings involving distance visual acuity, photoscreening, stereopsis, and cover testing were performed on 51,593 students (pre-K to 8th grade) from 2016-2019.

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  • Failure rates were analyzed by grade level and compared between mandated and non-mandated grades using logistic regression.
  • Visual acuity distributions were examined using individual student data.

    • Main Results:

    • Over 3 years, 34% (17,414) of students failed vision screenings, with failure rates ranging from 28% to 38% by grade.
    • Reduced visual acuity was the primary cause of failure (91%).
    • Significantly higher failure rates were observed in non-mandated grades (34.7%) compared to mandated grades (32.5%) (P < 0.001).

    Conclusions:

    • A substantial proportion of students, approximately one-third, failed vision screenings.
    • The findings indicate that current state-mandated vision screening schedules in Maryland are insufficient for comprehensive vision problem detection in underserved, low-income communities.
    • Expanded screening protocols may be necessary to ensure early identification and intervention for all students.