School-Based Vision Program Linked to Improved Student Academic Performance

Megan E. Collins, MD, MPH

Due to substantial issues of uncorrected visual impairment from refractive error in school-age children, school-based vision programs (SBVPs) may offer opportunities to improve access to care, particularly in high-poverty neighborhoods.

As a result, a recent study aimed to assess the impact of a citywide SBVP Vision for Baltimore’s school-based vision services, including provision of eyeglasses, student achievement in English language arts and mathematics.

Investigators, led by Megan E. Collins, MD, MPH, Wilmer Eye Institute, Johns Hopkins University School of Medicine, observed students who received eyeglasses through an SBVP achieved better reading scores, with improved academic achievement over 1 year but no sustained impact after 2 years.

Methods

The team performed a cluster randomized clinical trial conducted in Baltimore City Public Schools during school years from 2016 - 2019. It included 127 schools in the study, after exclusion of 24 schools for lack of eligibility.

Each school was stratified and randomized with a 1:1:1 ratio into 3 study cohorts using block randomization. They noted cohorts 1, 2, and 3 received Vision for Baltimore interventions during 1 of 3 school years, including 2016 - 2017, 2017 - 2018, and 2018 - 2019.

The Vision for Baltimore services included vision screening, eye examinations, and eyeglasses, with screenings conducted for all students. Those who failed the screening test were provided a 2-sided consent form offering an eye examination and research participation.

For outcome measurements, investigators used reading and mathematics scores from the i-Ready test and the Partnership for Assessment of Readiness for College and Careers (PARCC) test. Demographic data was obtained from Baltimore City Public Schools.

Investigators noted program effect size (ES) was defined as the difference in score on a particular academic test between intervention and control groups.

The primary study outcome included the 1-year intervention impact, measured by ES, to compare cohort 1 (intervention group) with cohorts 2 and 3 (control) at the end of the 2017 - 2018 program year. In addition, they compared cohort 2 (intervention) with cohort 3 (control).

Further, secondary outcomes included the 2-year intervention impact, measured by comparing cohort 1 (intervention) with cohort 3 (control) at the end of the 2017 - 2018 program year.

Results

After randomization, a total of 42 schools were collected in cohort 1 and cohort 2 and 43 schools were included in cohort 3.

Data show the analytic sample included 2304 students, with 54.7% female (n = 1260) and a mean age of 9.4 years. Patients were mostly Black (n = 1789, 77.6%), followed by White (n = 432, 18.8%) and Latinx (n = 388, 16.8%). Also, 406 students (17.6%) in special education were included.

Further, the team observed an overall 1-year positive impact on the i-Ready reading score (ES, 0.09; P = .02) during the 2016 - 2017 school year.

Similarly, a positive impact on i-Ready reading scores was seen during the 2017 - 2018 school year (ES, 0.12; P = .09) and PARCC test scores during the 2016 - 2017 (ES, 0.04, P = .31) and the 2017 - 2018 school year (ES, 0.04, P = .59).

At 2 years, data show a positive intervention impact on i-Ready reading scores (ES 0.08, P = .23) and mathematics scores (ES, 0.08, P = .20), but were not considered statistically significant.

Furthermore, the team observed a positive impact among female students (ES 0.15, P <.001) and those in special education (ES 0.25, P <.001) on i-Ready reading.

In addition, a positive impact was seen among students in elementary grades on i-Ready mathematics (ES 0.03, P <.001) during the 2016 - 2017 school year. However, the intervention did not show a sustained impact at 2 years or on PARCC testing.

Conclusion

The study concluded the benefit of SBVP at 1 year was not sustained after 2 years, noting students may wear eyeglasses less over time or refractive correction may not be sufficient enough.

“Collectively, these findings underscore that for SBVPs to maximize impact, they must not only provide eyeglasses but also ensure mechanisms for monitoring wear, replacement, and connection to community eye care clinicians for long-term care,” investigators wrote.

The study, “Effect of a Randomized Interventional School-Based Vision Program on Academic Performance of Students in Grades 3 to 7,” was published online in JAMA Ophthalmology.