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To investigate the relationship between neighbourhood disadvantage and vision screening failure rates. This analysis uses aggregate data from pre-kindergarten to eighth grade schools participating in a school-based vision programme in Baltimore, Maryland, from 2016 to 2019. Data on number of students screened and number of students who failed vision screening per grade level were recorded for each school. The Area Deprivation Index (ADI) was obtained for each school using the school's ZIP+4 code. The association between vision screening failure rates by grade and school ADI was analysed using negative binomial regression models, adjusted for grade level and accounting for clustering by school. Nine hundred seventy-two grades across 117 schools were included in this analysis. Median national ADI percentile across the sample was 71 [interquartile range (IQR): 48–85] (100 = most deprived). The median grade-level screening failure rate across the entire sample was 33% [IQR: 26–41%]. School ADI was not associated with vision screening failure rate (incidence rate ratio (IRR) = 1.01 per 10 percentage point increase in ADI, 95% CI: 0.99, 1.03, p = 0.217). In this study, there was no association between vision screening failure rates and school ADI. With one in three students failing screening in a high poverty public school district, these findings suggest a high need for vision services across schools in all neighbourhoods. Future work should investigate the impact of students' home ADI and socioeconomic status on vision screening outcomes. [ABSTRACT FROM AUTHOR]

To report refractive error findings in Baltimore City schoolchildren who failed school-based vision screenings. In this cross-sectional analysis, students pre-kindergarten through 8th grade who failed screenings during school years 2016–2019 received an eye examination, including non-cycloplegic autorefraction and visual acuity (VA) measurements. Refractive error was identified when there was at least: −0.50 diopter (D) spherical equivalent (SE) myopia, +0.50D SE hyperopia, 1.00D astigmatism, or 1.00D anisometropia in either eye. Generalized estimating equation models were used to identify factors associated with clinically significant refractive error, defined as decreased VA and more severe refractive error. Of 7520 students who failed screening, 6627 (88%) were analyzed. Clinically significant refractive error and any refractive error were found in 2352 (35.5%) and 5952 (89.8%) students, respectively. Mild myopia (45%, −0.50 D to <-3.00 D SE) and low astigmatism (47%, 1.00 D to <3.00 D cylinder) were the most prevalent types of refractive error. Proportions of students with myopia increased with higher grade levels (Ptrend<0.001). Myopia and astigmatism were more common in black and Latinx. Risk factors for clinically significant refractive error included higher grades (odds ratios [OR] ranged from 1.30 to 2.19 compared with 1st grade, P <.05) and Latinx ethnicity (OR = 1.31, 95%CI: 1.08–1.59). A Baltimore school-based vision program identified a substantial number of students with refractive error in a high-poverty urban community. Over 1/3 students who failed vision screening had clinically significant refractive error, with black and Latinx students at higher risk of having myopia and astigmatism. [ABSTRACT FROM AUTHOR]

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]