Despite the spread of nearsightedness among U.S. schoolchildren, nearly 1 in 3 has not had a vision screening in at least two years, according to a new Education Week Research Center analysis of federal data, and research suggests several ways schools may help reduce children’s risk of bad eyesight.
Myopia, or nearsightedness, means that a person has good vision for close objects but difficulty seeing things farther away. The problem, caused when the eyeball grows too long from back to front, can in more severe cases mean that a student cannot see clearly even a foot in front of her face.
In 2017, the National Eye Institute, part of the National Institutes of Health, reported that nearly 42 percent of Americans are nearsighted, compared with only 25 percent in the 1970s. About 4 percent have severe, or “high” myopia, which can lead to blindness.
The problem is just as bad or worse in some other industrialized countries. Australia and Great Britain have seen similar increases in myopia. In China, India, and throughout industrialized Asia, the National Eye Institute reported that 80 percent to 90 percent of all high school graduates are nearsighted, and 20 percent have high myopia.
“The rate of children needing glasses is so much greater than I ever imagined,” said Carolyn Amberry, who is in her 17th year as a school nurse at Long Beach Unified schools in California. At Lincoln Elementary, one high-poverty school where Amberry worked, “I couldn’t believe at a school of 1,200 kids, I had more than 300 needing glasses.”
Natural Light Helps
Nearsightedness does run in families, but the spread of the vision problems has raised concerns among educators and researchers. Studies have pointed to both the rise of computer and mobile use and the reduction of recess in schools as potentially contributing to the problem.
“With technology nowadays, [students’] faces are always in a screen,” said Leila Bajarin, who coordinates vision screenings for students at Kalihi Waena Elementary in Hawaii. “I think that makes [eyesight] deteriorate a lot quicker at a young age.”
She’s not wrong, research says, but longitudinal studies suggest that reading and studying either on computers or in print—so-called “near work"—do not fully explain the rapidly rising rates of nearsightedness.
“There’s no question that the [electronic] devices and students starting to use them so early contributes to the earlier onset of myopia we’re seeing,” said optometrist Amanda Hikin, “but a lot of the kids we are seeing are [in poverty] and may not have as much access to some of those things. But still we see quite a lot of myopia and astigmatism.”
Instead, researchers including Donald Mutti, an optometry professor at Ohio State University in Columbus, have found what children do inside is less important a predictor of myopia than the time children spend outside. Young children’s eyes grow quickly in infancy and toddlerhood, but that growth slows during the school years. If instead, the eye continues to lengthen at its early pace, light coming through the lens will not focus correctly, creating myopia. Mutti and other researchers have suggested exposure to natural light in the elementary years helps to trigger the slower pace of growth—so being outside less during and after school also may boost the risk of nearsightedness.
Spotting Vision Problems
The American Association for Pediatric Ophthalmology and Strabismus recommends children have their vision checked at least every other year after age 5, but states differ widely in whether and how often students are screened. In Connecticut and New Jersey, for example, just over 23 percent of children younger than 18 have not had a vision check in the past two years; in Idaho and Nevada, that share is more than 40 percent, according to the research center analysis of data from the National Survey of Children’s Health, an ongoing federal study of children in more than 364,000 households across the country. Children in poverty also were more likely than their wealthier peers to go two years or more without screening, the analysis showed.
At Kalihi Waena Elementary, Bajarin recalled one child, who was among the more than 32 percent of schoolchildren in Hawaii who hadn’t had their eyes tested in two years. The 5th grader’s teachers noticed she had trouble seeing two years ago—"She was moved up [in the classroom], but even at the front of the class, there is information up on all walls” that she couldn’t see, Bajarin said—but for two years, her father argued he didn’t have time to take his daughter for an eye exam. “Thankfully, we convinced him before she aged out of our school.”
The 5th grader ultimately got an exam and free glasses during a screening event by Vision to Learn, a nonprofit that works with schools in 12 states to identify and correct vision problems among students in poverty. In the group’s first screening of about 200 of Kalihi Waena’s 480 P-5 students, 75 students needed glasses, including several older elementary students.
“It helped a lot, behaviorally, in the classroom with a lot of the kids,” said Bajarin, the school’s parent-community networking coordinator. “Some of [the students], they won’t speak up, because they don’t know that they have an actual vision problem. When they can see better, they don’t feel so insecure and that they have to act up, ... and getting glasses, it was something for them that boosted their confidence because they could take ownership of it.”
Nationwide, 70 percent of the children for whom Vision to Learn provides glasses had never had their vision corrected before, and another 20 percent have outdated prescriptions, according to Damian Carroll, the group’s national director.
“When the children finally get to the eye exam and are told they needed glasses, it is often just such a shock,” Carroll said. “The kid doesn’t realize there’s a problem because it’s the way the world has always looked, and it’s just not something parents first think of when the child is struggling in school.”
Long Beach’s Amberry agreed; on her own, she said, she was only able to get follow-up exams and glasses for 50 percent to 70 percent of students who failed their initial vision screenings before the school began working with nonprofits to provide on-campus exams and fittings.
Hikin, the optometrist, said Vision to Learn and other groups that work with schools also increasingly are moving away from testing vision using the traditional letter-and-shape eye charts (which were the focus of the national survey), and toward using auto-refractors, handheld machines that gauge vision by measuring how light changes as it enters a person’s eye. That sort of testing can be done on less verbal and younger children.
Mary Beth Thurston, a school nurse at Long Beach Unified, said her district also works with the local Lion’s Club to get 3- and 4-year-olds in its preschool programs tested for glasses. Last year, she said about eight out of the 200 students tested ended up needing new glasses. Next year, the district will try to pair students’ medical physicals and vision screenings, to encourage more families to get their children tested.
Screening and getting glasses to students, while important, is only a start, Amberry said. Lincoln Elementary in Long Beach made a photo gallery of students wearing their glasses to boost their confidence and held popsicle parties for those who wore their glasses regularly, both to encourage students to wear them and to report quickly if they were lost or broken. Reading teachers also began referring struggling students for vision screenings earlier, at the same time they tried academic interventions.
Other studies suggest getting children outside more can lower their risk of developing vision problems. Mutti of OSU found that for children of nearsighted parents, about 20 percent of those who spent at least 14 hours a week outside developed nearsightedness, compared to 60 percent of children with the same genetic risk who spent less time outdoors. Similarly, large randomized-controlled studies in Australia and China found primary schoolchildren who got more than 40 minutes a day of outdoor activities were more than 20 percent less likely to develop nearsightedness. But getting outside more did not necessarily slow the progression of myopia in students who had already developed deteriorating vision.
In a separate 2017 study in China, a team of researchers from that country as well as from Australia, the United Kingdom, and the United States tested a so-called “bright classroom,” built with wall-sized clear and light-diffusing glass and intended to provide more access to natural light while reducing glare or distractions from outside the classroom. The study found over the course of a year, light from the blue-green part of the spectrum—which has been associated with lower risk of nearsightedness—was significantly higher in the prototype classroom than traditional classrooms, and a group of 230 students and teachers testing the room reported it was more comfortable for reading than a typical classroom.
However, the yearlong pilot was too short to tell whether students who used the bright classroom actually became less likely to develop myopia than those in regular classrooms.
A version of this article appeared in the May 30, 2018 edition of Education Week as A Growing Vision Problem Is Hidden in Plain Sight