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To compare the vision needs of children wearing and not wearing eyeglasses who failed school-based vision screening. Students aged 4 to 16 years in 41 Baltimore City schools were screened using distance visual acuity (VA) and photoscreening. Students failing screening underwent school-based non-cycloplegic examination. We compared students who were wearing eyeglasses at failed screening with those not wearing eyeglasses with respect to age, sex, right-eye refractive error, right-eye presenting, and best-corrected VA (BCVA). A total of 2176 students failed screening and completed the examination; 94 (4.3%) failed while wearing eyeglasses. Students wearing eyeglasses were older (mean age 10.2 vs 8.8 years, p <.001). Myopia (72.3% vs 46.0%, p <.001), severe myopia, ≥6.00 spherical equivalent diopters (D) (9.6% vs 1.8%, p <.001), astigmatism (66.4% vs 50.8%, p =.004), and severe astigmatism, ≥3.00 D of cylinder (14.9% vs 7.0%, p =.008) were more common in students wearing eyeglasses. The prescription rate was higher for students wearing eyeglasses at failed screening compared with those not (95.7% vs 80.4%, p <.001). About 4% of the children in both groups required referral to community providers for non-refractive pathology, such as strabismus or amblyopia (p =.6). Children who fail vision screening while wearing eyeglasses nearly always needed an updated prescription and had more severe refractive errors than those not wearing eyeglasses. However, the community referral rate was the same for both groups. School-based programs can support children currently wearing eyeglasses that may be incorrect or outdated. [ABSTRACT FROM AUTHOR]