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Purpose: To investigate the relationship between neighbourhood disadvantage and vision screening failure rates., Methods: 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., Results: 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)., Conclusions: 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.

Competing Interests: M.E.C. was a paid consultant to Warby Parker at the time study was conducted. M.E.C. is also a Member of Board of Directors at Warby Parker Foundation. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.

Purpose: To explore stakeholders' perceptions of a school-based vision programme (SBVP)., Methods: We conducted 20 focus groups with 105 parents and teachers at schools in Baltimore, MD, that participated in a SBVP. Facilitators used a semi-structured interview guide to discuss participants' perceptions of the SBVP. Focus groups were audio-recorded, transcribed, and coded using inductive thematic analysis., Results: Participant perceptions fell into three categories: benefits of school-based eye care, limitations of school-based eye care, and observation of impact. The majority of participants had positive comments about the programme; benefits included convenience (location, time, and cost), the comprehensive nature of the programme, the quality of the eyeglasses and ability to receive replacements, and a positive screening/exam experience. Limitations of programme impact were related to communication and organisation, the time to receive the glasses, missed instructional time, and uncertainty about screenings. Observations of impact included academic and classroom improvements, as well as visual and other health improvements., Conclusion: Parents and teachers reported mostly positive perceptions regarding the SBVP. Their appreciation for the convenience underscores that location, cost, time, and comprehensive services are crucial aspects for implementing a successful programme. To maximize impact, programs must also implement robust communication campaigns that integrate into the schools' workflow to help parents and teachers stay engaged in the process from start to finish.

Objective: There are unmet needs for refractive correction in the pediatric population, especially in high-poverty communities. We reported the impact of refractive correction on vision outcomes over a 2-year follow-up in the Baltimore Reading and Eye Disease Study., Design: Prospective, school-based cohort study., Participants: Students of second and third grades who were prescribed glasses during baseline assessment., Methods: We conducted baseline eye exams in 12 Baltimore public schools during the fall of school year 2014-15 with follow-up visits in the spring of school year 2014-15 (first follow-up) and school year 2015-16 (second follow-up). Visual acuity (VA) was measured at distance and near with correction. Refractive status was determined based on the eye with the larger refractive error and categorized as myopia, hyperopia, and astigmatism., Main Outcome Measures: VA in better-seeing and worse-seeing eye at first and second follow-up, and acuity improvement from baseline., Results: In the 206 students (84% African American) who completed the first follow-up, both distance (from 0.14 ± 0.20 to 0.05 ± 0.10 logMAR) and near presenting VA (from 0.08 ± 0.16 to 0.03 ± 0.06 logMAR) improved from the baseline assessment; children with more severe hyperopia showed improvement in near VA by 0.05 ± 0.16 logMAR. Children who were prescribed glasses through a school-based research study had improved vision, which was sustained into the following school year., Conclusions: Many second and third graders in Baltimore Schools needed refractive correction and benefited from provision of glasses with sustained vision improvement over the 2-year observation., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: We describe the Baltimore Reading and Eye Disease Study, report baseline ocular findings, and explore the feasibility of eye examinations in the school setting., Design: Prospective, school-based cohort study., Participants: Students in second and third grades., Methods: Baseline eye examinations, including near and distance presenting visual acuity (VA), stereopsis, ocular alignment, dilated retinal examination, and cycloplegic refraction, were performed in 12 Baltimore public schools during the 2014-15 school year., Main Outcome Measures: Presenting VA, prevalence of refractive error, and other ocular findings., Results: Among the 1054 eligible students, 321 participated. There were 271 (84.4%) African American and 186 (57.9%) female students; mean age was 7.9 ± 0.8 years. Cycloplegia was achieved in 308. The mean presenting distance and near VA was 0.1 ± 0.2 logMAR (range -0.1 to 1.5) and 0.1 ± 0.2 logMAR (range 0.0-1.6) in the better-seeing eye, respectively. The most common ocular findings were +1.00 diopter (D) or greater hyperopia (34.7%), -0.50 D or greater myopia (29.5%), 1.00 D or greater astigmatism (23.4%), and convergence insufficiency (7.2%). Thirty-seven (11.5%) children needed referral to an eye care provider; 10% of students required glasses full-time., Conclusions: Whereas the majority of second and third grade students in this study have good VA and minimal refractive error, 1 in 9 have an ocular finding necessitating further evaluation. It was feasible to conduct cycloplegic eye examinations in the school setting., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Abstract: In an effort to address health care disparities in pediatric eye care, school-based vision programs have been established. These programs, while not universally available, have been established at individual schools or across school districts in at least 20 states in the United States (US). They play a critical role for students who are not accessing eye care, especially in disadvantaged communities. In the US, school-based vision programs often provide vision screenings, eye exams, and eyeglasses directly in the school setting. The rationale for involving schools in vision care delivery is the recognition of the inter-relatedness between health and education, including how poor vision can impact learning. Vision for Baltimore is a citywide school-based vision program that provides vision care for all Baltimore City Public Schools elementary and middle school students (age range 4 to 16 years). The goal of this paper is to summarize lessons learned from our work on clinical outcomes from screenings and eye exams, the academic impact of Vision for Baltimore, and qualitative work about consent challenges and stakeholder engagement. While school-based vision programs may vary in operations, we hope the lessons learned through our work may help demonstrate the transformative impact on vision and learning, as well as the importance of addressing stakeholder needs to maximize impact and ensure program sustainability., Competing Interests: A product used in the study described in this publication was manufactured by Warby Parker. Dr. Collins was a paid consultant to Warby Parker at the time study was conducted. Dr. Collins is also a Member of Board of Directors at Warby Parker Foundation. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies., (Copyright © 2022 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)

Purpose: To assess the patterns and predictors of glasses wear in a 2-year school-based study., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2019 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)