Associations between School-Based Vision Program Outcomes and School Characteristics in 410 Schools.

Abstract

Purpose: School-based vision programs (SBVPs) deliver care to students at school, addressing disparities in access to pediatric vision care. We aimed to evaluate the associations between SBVP outcomes and school-level characteristics.

Design: Retrospective cross-sectional data analysis.

Participants: Public schools with at least 50 SBVP-enrolled students 5 to 22 years old with complete demographic data. Schools with less than 60% of total grade levels served by the SBVP were excluded, creating a sample of 410 schools.

Methods: Vision screening and eye examination data were extracted from 2016-2022 Helen Keller International's United States Vision Program dataset. Individual student data were aggregated to characterize each school's SBVP outcomes and were analyzed with schools' publicly available socioeconomic and demographic data (student body race and ethnicity composition, proportion of students qualifying for free and reduced-price meals [FARM], and proportion of English language learners). Fractional regression models were used to understand associations between SBVP outcomes and school characteristics.

Main outcome measures: SBVP outcomes were rates of vision screening failure, prescriptions for eyeglasses, and community eye care referral among each school's SBVP-enrolled students.

Results: We evaluated 151 elementary schools (36.8%), 155 middle schools (37.8%), and 104 high schools (25.4%), with a median proportion of students qualifying for FARM of 87.4% and a plurality of Hispanic students in 61.0% of schools. Median rates of vision screening failure, eyeglasses prescription, and referral were 38.4%, 25.2%, and 5.4%, respectively. High schools were associated with increased screening failure and eyeglasses prescription rates and a decrease in referral rate compared with elementary schools. In multivariable analysis, each 10% increase in proportion of students qualifying for FARM was associated with a 2.6% (95% confidence interval [CI]: 1.54%-3.65%), 1.8% (95% CI, 0.87%-2.74%), and 0.86% (95% CI, 0.36%-1.36%) increase in screening failure, prescriptions for eyeglasses, and referral rates, respectively.

Conclusions: Significant vision care demand exists among public schools, especially those with students from lower socioeconomic backgrounds. School-based vision programs are important in improving pediatric vision care access. Our findings demonstrated opportunities to allocate personnel and equipment resources according to schools' anticipated needs, thus maximizing SBVPs' impact.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.