Practices of a United States school-based vision program in referring children to community eye care

School-based vision programs (SBVPs) can increase children's access to eye care services, yet some children have needs beyond the scope of SBVPs and require referral to community providers. We describe the referral practices of a large United States SBVP.

A retrospective, cross-sectional analysis was conducted using data from pre-Kindergarten through grade 12 students (5-22 years of age) who underwent an SBVP eye examination after a failed vision screening. Data on student demographics, refractive error, and school-level indicators of socioeconomic disadvantage were extracted. The proportion of students referred to community eye care was assessed. Mixed-effects logistic regression models were implemented to understand associations between referral status and student-or school-level characteristics.

Of 97,107 students, 72,814 (75.0%) received eyeglasses and 13,884 (14.3%) were referred to community providers. Referrals were more common among younger students and those with greater school-level indicators of socioeconomic disadvantage. Compared with students with emmetropia, students with high hyperopia (OR = 7.21; 95% CI, 5.77-9.01) and high myopia (OR =3.70; 95% CI, 3.36-4.05) were more likely to be referred. Frequent referral reasons included refractive error (42.1%), amblyopia suspect (26.6%), and uncorrectable vision (26.1%). Nonreferred students were more likely to receive eyeglasses prescriptions (85.9% vs 9.4%).

SBVPs can address most uncorrected refractive error within the school setting, but a substantial proportion of students need further evaluation. Young students and those with high refractive error are more likely to require referral. SBVPs may benefit from developing resources and community networks to support students' referral completion.