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Approximately 25% of school-aged children in the United States have vision abnormalities, most commonly refractive error that can be corrected with spectacles. Limited follow-up adherence after failed school-based vision screening led to an increase in school-based eye care programs that provide screening, eye examinations, and spectacle prescription at the school. These programs address the access barrier and often provide the first point of contact between children and eye care. Nevertheless, several lower prevalence conditions, such as amblyopia, strabismus, and glaucoma, cannot be adequately treated in the school setting, and some require frequent and long-term follow-up, necessitating referral to eye care providers in the community. We conducted a literature review and identified 10 programs that provided school-based screening, examinations, and spectacle prescription and reviewed their referral rates, criteria, mechanisms, adherence, ocular findings at referral, and long-term care plans. Most programs referred 1% to 5% of screened children. Most communicated with parents or guardians through referral letters and used various strategies to incentivize adherence. Referral adherence was 20-50% in the four programs that reported these data. School-based eye care programs rarely referred children for long-term follow-up care needs, such as updating spectacle prescriptions annually. [ABSTRACT FROM AUTHOR]

We report visual acuity improvement and refractive profiles in children prescribed glasses by a school-based vision program (SBVP) in Baltimore, Maryland. In this cross-sectional analysis, pre-kindergarten through 8th grade students who failed vision screening underwent an eye examination. Students prescribed glasses are included. Visual acuity improvement was the difference between presenting and best-corrected visual acuity based on noncycloplegic manifest refraction. Clinically significant refractive error (CSRE) was defined as ≥0.75 D myopia, ≥2.00 D hyperopia without strabismus, ≥1.00 D hyperopia with esodeviation, or ≥1.50 D astigmatism AND presenting visual acuity ≤20/40 or ≥2-line interocular difference with the better-seeing eye ≤20/30. Characteristics associated with greater visual acuity improvement were explored. Of the 4,972 students, mean age was 9.4 ± 2.7 years; 77% were black, and 18% were Hispanic. Myopia, hyperopia, astigmatism, and CSRE were found in 65%, 24%, 60%, and 46% students, respectively. In the better-seeing eyes, 70% gained ≥2 lines. Of students with CSRE, improvement of at least 5 lines in the worse-seeing eye increased from 30.9% in pre-kindergarten and kindergarten to 77.3% in 7th and 8th grade (P trend < 0.001). Students with CSRE had a higher rate of gaining at least 2 lines' improvement in their worse-seeing eyes compared with those without (98.7% vs 80.6%). Older students as well as black and Hispanic students were more likely to have improvement of at least 2 lines. Most students prescribed glasses from our SBVP had clinically significant visual deficits corrected.▪ [ABSTRACT FROM AUTHOR]

We present the prevalence and severity of refractive error among students participating in a school-based vision screening and eye exam program in Baltimore. Based on autorefraction results from 2,219/2,273 students (98%), 1,201 (54%) had myopia (spherical equivalent [SE] <= -0.5 D), 657 (30%) had hyperopia (SE >= +0.5 D), 1,341 (60%) had astigmatism (cyl >= +1D), and 682 (30.8%) had anisometropia (>=1 D). [Extracted from the article]

Vision screenings aim to identify students with possible vision problems. As part of a Baltimore school-based vision care program, screenings were conducted for all students, including those in state-mandated grades and nonmandated grades (2-7), in 82 schools. From 2016-18, 32650 pre-K to 8th grade students from Baltimore schools underwent vision screenings (distance acuity, Spot photoscreener, stereopsis, and alignment) by Health Department staff. [Extracted from the article]

To assess the patterns and predictors of glasses wear in a 2-year school-based study. Second and third graders underwent an eye examination at school. Two pairs of glasses were provided if they met prescribing criteria. Replacements were provided as needed. Students received follow-up examinations and completed survey questionnaires during the same and the following academic year. Of the 197 students prescribed glasses who completed year 1 follow-up, 172 (87%), were observed to still be wearing glasses. However, less than two-thirds of students reported wearing glasses as prescribed (eg full-time if prescribed full-time). Most students, 175 (89%), reported being happy with their glasses and 135 (69%) reported improvement in vision. Thirty-nine students (20%) reported being teased about their glasses. Replacement glasses were required by 136 students (66%). Refractive error was not associated with likelihood of requiring replacement. Being observed wearing glasses correlated with parent (OR = 4.2; 95% CI, 1.2-15.0) and teacher reminders (OR = 6.4; 95% CI, 1.5-28.4) in year 2. Most children continued to wear glasses during follow-up, yet not always as prescribed. A substantial proportion of students required replacements, underscoring the importance of school-based programs developing mechanisms to monitor eyeglasses usage and mechanisms to replace lost or broken pairs. [ABSTRACT FROM AUTHOR]

To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences. Cross-sectional, retrospective study. Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye. Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least –0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models. Differences between noncycloplegic and cycloplegic autorefraction measurements. The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18–1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18–1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10–1.36) and those with hyperopia (OR range, 4.20–13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild–moderate–high myopia or moderate–high hyperopia. Three quarters of school-aged individuals had < 1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children. [ABSTRACT FROM AUTHOR]