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Vision Screening Outcomes and Follow-Up Intervals among Socioeconomically Disadvantaged Students from a School-Based
YuQing Xu1, Xinxing Guo2, Kendall D Stout3
1Division of Pediatric Ophthalmology and Adult Strabismus, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Purpose:
To evaluate rates of vision screening failure, eye examination completion, eyeglass prescribing, and follow-up recommendations from a school-based vision program (SBVP).
Design:
Retrospective cross-sectional analysis.
Participants:
Prekindergarten through fifth-grade students (aged 4-13 years) who underwent school-based screening in Fort Worth, Texas, from 2022 to 2024.
Methods:
Students who failed screening were offered school-based eye examinations. Parent-reported demographics and school-level economic disadvantage (free or reduced-price meals [FARMs]%) were extracted. Mixed-effects logistic regression evaluated associations of grade, sex, race, ethnicity, eyeglass wear at screening, and FARMs% for screening failure, eye examination after failure, and eyeglass prescription among examination completers. Associations between ocular diagnoses and follow-up intervals, categorized as <6 or ≥6 months, were tested using χ2 or Fisher exact tests.
Main Outcome Measures:
Rates of screening failure, eye examination completion, eyeglass prescription, and follow-up interval.
Results:
Among 41236 students screened across 81 schools (median FARMs%: 93.9%), 64.0% were Hispanic. Overall, 8682 (21.1%) failed screening and 3873 (44.6%) completed an eye examination. Hispanic and Black students had higher odds of screening failure (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.25-1.46; OR, 1.36; 95% CI, 1.25-1.48) compared with non-Hispanic and non-Black students, respectively. After screening failure, Hispanic students had higher odds of completing an eye examination (OR, 1.27; 95% CI, 1.08-1.48), whereas Black students had lower odds (OR, 0.82; 95% CI, 0.69-0.97). Students with greater school-level economic disadvantage had higher odds of screening failure (OR, 1.17 per 10% FARMs increase; 95% CI, 1.14-1.21) and completing an examination after failure (OR, 1.24 per 10% increase; 95% CI, 1.13-1.38). Among 3767 students examined, 14.2% were recommended for follow-up <6 months. Earlier follow-up was more common among those with amblyopia or amblyopia suspects (68.9% vs. 6.6%) and strabismus (64.1% vs. 13.3%) compared with those without either diagnosis (both P < 0.001).
Conclusions:
In a predominantly Hispanic, economically disadvantaged district, this SBVP identified substantial unmet vision needs with disparities in screening failure and eye examination completion. Earlier follow-up recommendations were more common for high-risk diagnoses. Future work should focus on understanding whether students connect to follow-up care and developing guidelines to support children with ongoing eye care needs.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
