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

Medha Kallem; Xinxing Guo; Xi Dai; Christina Ambrosino; Andrew Nguyen; David S Friedman; Michael X Repka; Nick Kourgialis; Megan Collins

doi:10.1016/j.ophtha.2024.11.012

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

Ophthalmology. 2024 Nov 12:S0161-6420(24)00719-X. doi: 10.1016/j.ophtha.2024.11.012. Online ahead of print.

Authors

Medha Kallem¹, Xinxing Guo², Xi Dai³, Christina Ambrosino⁴, Andrew Nguyen⁵, David S Friedman⁶, Michael X Repka⁷, Nick Kourgialis⁸, Megan Collins⁹

Affiliations

¹ Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: mcolli36@jhmi.edu.
² Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Yale University, Department of Ophthalmology.
⁴ Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine.
⁵ Johns Hopkins University School of Medicine.
⁶ Massachusetts Eye and Ear Infirmary, Glaucoma Center of Excellence, Boston, MA, USA.
⁷ Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁸ Helen Keller International, New York, NY, USA.
⁹ Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: mcolli36@jhmi.edu.

PMID: 39542178
DOI: 10.1016/j.ophtha.2024.11.012

Abstract

Objective: School-based vision programs (SBVPs) deliver vision care services directly to students at school, helping address disparities in access to pediatric vision care. We aim 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 fewer than 60% of total grade levels served by the SBVP were excluded, resulting in a sample of 410 schools.

Methods: Vision screening and eye exam data were extracted from Helen Keller International's United States Vision Program dataset from 2016 through 2022. Individual student data were aggregated to characterize each school's SBVP outcomes and 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). Descriptive statistics summarized SBVP outcomes. Fractional regression models were utilized to understand associations between SBVP outcomes and school characteristics.

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

Results: We evaluated 151 (36.8%) elementary, 155 (37.8%) middle, and 104 (25.4%) high schools, with a median FARM% of 87.4% and a plurality of Hispanic students in 61.0% of schools. Overall 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 multivariate analysis, each 10% increase in FARM% was associated with a 2.6% (95% confidence interval [CI]: 1.54-3.65), 1.8% (CI: 0.87-2.74), and 0.86% (CI: 0.36-1.36) increase in screening failure, eyeglasses prescription, and referral rates, respectively.

Conclusions: There is significant vision care demand among public schools, especially those with student populations from lower socioeconomic backgrounds. SBVPs are important in bridging the gap in pediatric vision care access in such populations. Our findings demonstrated opportunities to allocate program staffing and equipment resources according to schools' anticipated needs, thus maximizing SBVPs' impact in delivering pediatric vision care.