Vision for Chicago: A Randomized Evaluation of a Strategy for Maximizing the Impact of Eyeglasses on Academic Performance for Children in Chicago

Background: Reading is a vital skill, key to school success, necessary for employment, and essential for functioning in everyday life. Many attempts to increase literacy have focused on schools, yet "out of school" factors have a substantial impact on student learning (Clabaugh, 2008). One non-instructional factor that may be part of school failure, in at least some students, is uncorrected vision. Approximately 20-25% of school-age children need eyeglasses (Ferebee, 2004), yet underserved and Black and Latino children are far less likely than middle class and white children to obtain and wear eyeglasses if they need them (Ganz et al., 2007; Heslin et al., 2006; Qiu et al., 2014; Ruderman, 2016; Zhang, Cotch, et al., 2012; Zhang, Elliott, et al., 2012). Unmet vision needs, prevalent among high-poverty populations, are particularly important to address because of the association between vision and learning (Glewwe et al., 2018; Hannum & Zhang, 2012; Ma et al., 2014; Neitzel et al., 2021; Slavin et al., 2018). One approach to solving the vision care access gap is providing school-based vision care. In these models, students who fail a vision screening receive follow-up care and eyeglasses onsite at the school. This is only a partial solution because students who are provided with appropriate vision care need to wear their eyeglasses regularly to benefit from them, and this is by no means assured (Alvi et al., 2015; Ethan et al., 2010; Kodjebacheva et al., 2014; Messer et al., 2012; Preslan & Novak, 1998). A comprehensive school-based model could not only provide access to care, but also build a system to ensure regular use of eyeglasses. Research Question: This article presents findings from a cluster randomized controlled trial on the effectiveness of program enhancements to a school-based vision program. The evaluation was designed to answer the following questions: (1) What are the one- and two-year impacts of Vision for Chicago (V4C) on the English language arts ("ELA") and mathematics achievement of children who are provided eyeglasses?; and (2) How do the effects of receiving eyeglasses on student achievement vary for students of different characteristics? Setting: A total of 80 schools from Chicago Public School (CPS), all of which participate in the Chicago Vision Exam Program (CVEP), were recruited (Table 1). CVEP works with optometric providers in the community to ensure that students have the option to receive an eye exam and eyeglasses if needed at no out-of-pocket cost. However, challenges exist that may prevent students from receiving the maximum benefit of these services, including rate of participation, available resources, and compliance. Participants: The study sample included students enrolled in study schools in school year (SY) 17-18 who had failed a vision screening in a year prior to school year 17-18. Characteristics of students included in the study were similar across the groups (Table 2). In addition, treatment and control students had acceptably similar pretest ELA and mathematics scores (Table 3). Intervention: V4C's mission is to increase utilization of CVEP and promote compliance with eyeglasses wear in CPS through educational and communication interventions. V4C aims to help ensure that students with suspected vision problems are receiving eye exams. The program also promotes awareness of eye health and works to streamline communication between families, school staff, and providers. Following the exam and provision of eyeglasses, V4C helps schools develop systems for teacher monitoring and encouragement of consistent eyeglass wear. Research Design: To evaluate the impact of V4C, we conducted a cluster-randomized trial. Schools were randomly assigned to be "intervention schools," where V4C was active, and "control schools" where the CVEP proceeded without additional support. Data Collection and Analysis: To estimate the impact of V4C on student achievement, we collected individual student demographic and achievement data from CPS for the 2016-17 through 2018-19 school years. The study examines the impact on the Northwest Evaluation Association's Measures of Academic Progress (MAP) in reading and mathematics, the Partnership for Assessment of Readiness for College and Careers test (PARCC) mathematics and English language arts test, and the Illinois Assessment of Readiness (IAR) English language arts and mathematics test. We used hierarchical linear modeling, where students were nested within the schools where they were enrolled for SY 17-18 (first year of the study). The treatment was a schoolwide intervention, and students' treatment status was determined by their school of enrollment. We also examined whether there were differential effects of V4C for students based on demographic characteristics and prior achievement using interaction terms between the V4C indicator and student-level covariates of interest. We used an intent-to-treat student sample, and students were included in the achievement sample even if they transferred to another school within CPS. Results: The 2-year impacts on MAP and IAR in both ELA and mathematics were not significant (Table 4). On the PARCC ELA outcome, there was a significant, positive impact of V4C for the 1-year results, with an effect size of +0.08 (p < 0.05, Table 5). Results on the 1-year impacts on MAP ELA assessment were positive (ES = +0.02), but not significant (p > 0.05). There were no significant impacts observed for mathematics on either MAP or PARCC. In addition to examining the impact for all students who received eyeglasses, we also explored whether impact varied by baseline achievement level, gender, English learner status, and special education status and no differential impacts were identified (Table 6). Conclusions: While significant educational effects of an intervention to improve eyeglass retention were found at 1 year, these were not observed at 2 years, highlighting the importance of ongoing maintenance efforts for school-based vision programs, similar to other studies of school-based vision programs (Neitzel et al., 2021). This demonstrates the need for further work to identify and implement strategies that can ensure students continue to wear and continue to benefit from prescription eyeglasses if needed. The findings of this study, if replicated, may provide support for stronger efforts to provide eyeglasses to students in order to improve achievement through enhancements to ensure participation and benefit from existing school-based care programs.