Search

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]

Objective: School-based vision programs (SBVPs) connect children to eyecare directly in schools with benefits for vision and academics. Whereas parental engagement is critical to SBVP success, research on parent perspectives is lacking. We report on parental suggestions about how to maximize the impact of SBVPs. Methods: Data were collected from 20 parent focus groups (90 participants) in Baltimore, MD and Chicago, IL. Focus groups were recorded, audio-transcribed, and coded using inductive thematic analysis. Results: Major themes of parental suggestions for maximizing SBVP impact were: (1) communication, (2) education, and (3) eyeglass resources. Flyers and phone calls were the most frequently suggested methods for communication. Parents requested education regarding screening outcome, instructions for eyeglass use, and eyecare recommendations. Parents also suggested eyeglass resources to assist in maintenance and multiple pairs of eyeglasses. Conclusions: This information provides a framework about what parents want to know about SBVPs and opportunities to strengthen program-parent engagement. This framework can support the mission of increasing early childhood vision screening and reducing vision loss in children and adolescents as set forth by Healthy People 2030. [ABSTRACT FROM AUTHOR]

Objective: School-based vision programs provide care directly in schools. Parental consent is typically required for student participation. In this paper, we examine school-level factors associated with consent form return. Methods: We included 123 schools served by a vision program in Baltimore, Maryland between the 2016-17 and 2018-19 school years. Multiple linear regression modeling was used to examine the associations between consent return rate and school type (elementary, elementary/middle or middle school), school size, student attendance, student mobility, percent of students in special education, poverty (percent eligible for free and reduced-price lunch), teacher qualifications, parent response rate to annual school climate survey, vision screening failure rate, and year of vision program participation (cohort). Results: The final model explained 26.2% of variability in consent return rate. Overall consent return rate was 57.8% (range 9.4%-100%). School size (β = -2.419, p < .01) and cohort (βCohort2 = 11.988, p < .01) were significantly associated with consent rate. Whereas poverty (β = 0.225, p < .10) and mobility (β = -0.647, p < .10) were relevant, they did not reach statistical significance. Conclusions: School-level factors are significantly associated with consent form return rates. School-based vision programs should consider additional measures to increase consent form return, especially in larger schools and schools with high rates of student mobility. [ABSTRACT FROM AUTHOR]

Vision screenings of a school-based program were conducted in state-mandated grades (pre-kindergarten [pre-K] or kindergarten [K], 1st and 8th grade), and nonmandated grades (2nd to 7th). During school years 2016-19, 51,593 pre-K to 8th grade students from 123 Baltimore City Public Schools underwent vision screenings, with 85% of the schools qualifying for Free and Reduced Price Meals. Assessments included distance visual acuity, Spot photoscreening, stereopsis, and cover testing. Screening failures were analyzed by grade using aggregate data. Failure rates for mandated and nonmandated grades were compared using a logistic regression model, and visual acuity distributions were analyzed using individual data. Over the 3-year period, 17,414 (34%) of students failed vision screening. Failure rates by grade ranged from 28% to 38%. Children in kindergarten and 3rd grade and higher were statistically more likely to fail screening than those in 1st grade. Reduced visual acuity was the most common reason for failure (91%). Failure rates were significantly higher in nonmandated grades than in state-mandated testing grades (34.7% vs 32.5% [ P < 0.001]). Mean visual acuity of all students who failed vision screening was 20/50 in the worse-seeing eye and was 20/40 in the better-seeing eye. One-third of students failed vision screening. High screening failure rates across all grades suggest that screening in select grade levels, as currently mandated in Maryland schools, is inadequate for detecting vision problems in the low-income communities served by this program.▪ [ABSTRACT FROM AUTHOR]