Rx for Reading Gaps: Screen All Students Early for Vision Problems

Some of the most academically vulnerable students are also more likely to have basic vision problems that have been overlooked, new research finds.

The study in the Journal of the American Medical Association-Ophthalmology finds that, across more than 30,000 school-age students, low-income, English-learner, and racial minority students all had a higher risk of being identified with vision problems—if they were screened at all—but they also were less likely than other students to get corrective care.

The results come amid rapidly rising rates of nearsightedness worldwide. More than 40 percent of U.S. adults now have myopia, or nearsightedness, according to the most recent estimates, a 66 percent jump in the past 30 years. Fully half of people worldwide are expected to be nearsighted by 2050, with nearly 1 in 10 expected to develop a severe myopia that can lead to blindness. The rise in vision problems have been attributed to an array of factors, from increased screentime to fewer outdoor activities that require focusing at different distances.

The vision disorders must be identified and corrected in childhood to prevent students’ eyesight from degrading, and research suggests early vision correction can help struggling readers.

But it has been difficult to get a clear picture of vision problems among U.S. children and adolescents due to uneven vision screening. A team of researchers led by Isdin Oke, an ophthalmology researcher at Boston Children’s Hospital and Harvard Medical School, analyzed the vision data from more than 30,000 children ages 6 to 17.

Sixty-two percent of these students (just under 18,500) had received a vision screening in the last two years, either at school or through a pediatrician. Of those, about 28 percent were referred for a full eye exam—and nearly all of those referred ultimately began treatment for vision problems.

But students’ access to screening and later care varied significantly, by family income, race, and ethnicity.

The study found 43 percent of students living below the federal poverty line had not received a recent vision screening, compared to 34 percent of those in the wealthiest fifth of students. Similarly, 63 percent of white students had a recent vision screening, 3 percentage points higher than the rate for Black or Hispanic students and 10 percentage points higher than for Asian students. Similar patterns were found among students identified with vision problems who actually received corrective glasses or other treatments.

Likewise, children who did not speak English at home were 9 percentage points less likely to get screened for eye problems than those from families who primarily spoke English.

“At each stage along the care pathway, children from historically marginalized racial and ethnic groups, low-income households, and non–English language speakers experience worse outcomes,” Oke and his colleagues concluded.

Interplay of academics and eyesight

More than 40 states require at least some vision screening in schools, but not all meet the guidelines of the American Academy of Pediatrics and the American Academy of Ophthalmologists, which advise eye exams every two years for children who have never been diagnosed with a vision problem, and annually for those who need vision correction.

Visual demands change as students progress through school. While students are learning to read and identify numbers in early elementary school, visual instruction involves larger print sizes and shorter, widely spaced words in high-contrast colors. In upper elementary and secondary, students must focus for extended periods of time on longer, smaller-printed texts.

At least one study of low-income students in the lowest quarter of reading performance on state tests found that those who received regular eye exams and glasses improved their reading performance by roughly 9 percentile points, or a quarter of a standard deviation, on the i-Ready, the Partnership for Assessment of Readiness for College and Careers test in reading.