Vision

Untreated Vision Problems Compromise Learning

Being able to see well is key to success both in school and in life. Unfortunately, many children suffer from vision problems – problems ranging from common refractive errors that are typically correctable with eyeglasses (e.g., nearsightedness or farsightedness), to more serious problems that may require medication, surgery, or vision therapy (e.g., strabismus), to blindness. Although the vast majority of these problems can be effectively mitigated, low-income children and youth, as well as children and youth of color, are significantly more likely than their higher income, white peers to go without corrective vision treatment.(1)

Data on the prevalence of these problems in California is not regularly collected, but national data are helpful:

  • Some studies show that as many as 21.5% of children aged 6 to 11 and 24% of youth aged 12 to 17 have a vision problem.(2) Others have identified youth rates closer to 10%, with over 90% of the problems due to uncorrected refractive errors (nearsightedness or farsightedness).(3) Regardless of the exact percentage, it is clear that a significant number of children and youth are affected.
  • Low-income children and children with school difficulties are more likely than peers to have vision problems, a disparity partially attributable to higher rates of low birthweight and prematurity.(4)
  • Low-income youth and youth of color are both under-diagnosed and under-treated for vision problems.(5) Among children with special health care needs, black, Latino, and multi-racial children are two to three times more likely to have untreated vision problems than white children.(6)

Untreated vision problems adversely impact student learning. This occurs through both direct and indirect mechanisms, including by compromising sensory perception, hampering cognition and negatively affecting social-emotional development and connectedness to school.(7) According to the American Optometric Association, “symptoms of visual problems that threaten educational achievement include frequent eye rubbing or blinking, short attention span, avoidance of reading and other close activities, frequent headaches, covering of one eye, tilting the head to one side, holding reading materials close to the face, eyes turning in or out, seeing double, losing place when reading, and difficulty remembering what has been read.”(8)

School-Based Services Can Help Correct Vision Problems

Schools are natural locations for the provision of vision services. School-based screening programs, coupled with referrals and follow-up, can increase treatment rates. In addition, there is growing evidence of the effectiveness of providing providing professional optometric services on school campuses.(9)

  • 71% of states, including California, require school-based vision screening programs, as do 93% of school districts nationwide.(10) In California, parents must be notified of vision screening results.
  • A school-based screening program found problems in 3 out of every 100 children screened.(11)
  • An elementary school program found that when students were given school-based screenings, on-site professional services, two pairs of eyeglasses, and teacher encouragement they were significantly more likely to use eyeglasses (47% vs. 19%, among those in the intervention vs. control groups).(12)
  • A school-based demonstration project at the School Health Clinics of Santa Clara County in the San Jose Unified School District (SJUSD) found that rates of vision screenings that had follow-ups with specialists was higher in schools with full-time nurses (96%) than schools with only part-time nurses (67%).(13)

Resources for Practice

For tools that will help you start and run school asthma programs, see Vision Resources.

Citations

(1) Basch, C.E. (2010). Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap. Equity Matters: Research Review No. 6. Available at: http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web03082010.pdf.
(2) Ferebee, A. (2004). Childhood Vision: Public Challenges and Opportunities, A Policy Brief. The Center for Health and Health Care in Schools. Available at: http://www.google.com/search?client=safari&rls=en&q=ferebee+childhood+vision&ie=UTF-8&oe=UTF-8.
(3) As cited in Basch (2010): Vitale, S., Cotch, M.F., & Spreduto, R.D. (2006). Prevalence of Visual Impairment in the United States. Journal of the American Medical Association. 295: 2158-2163.
(4) Various studies, as cited in Basch (2010).
(5) As cited in Basch (2010): Ganz, M., Xuan, Z., & Hunter, D.G. (2006.) Prevalence and Correlates of Children’s Diagnosed Eye and Vision Conditions. Opthamology. 113(12): 2298-2306. Ganz, M., Xuan, Z., & Hunter, D.G. (2007). Patterns of Eye Care Use and Expenditures Among Children with Diagnosed Eye Conditions. Journal of the American Association for Pediatric Ophthalmology and Strabismus. 11(50: 480-487.
(6) As cited in Basch (2010): Heslin, K.C., Casey, R., Shaheen, M.A., Cardenas, F., & Baker, R.S. (2006). Racial and Ethnic Differences in Unmet Need for Vision Care Among Children with Special Health Care Needs. Archives of Ophthalmology. 124: 895-902.
(7) Basch, C.E. (2010). Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap. Equity Matters: Research Review No. 6. Available at: http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web03082010.pdf.
(8) As cited in Basch (2010): American Optometric Assocation. (n.d.). School-aged Vision: 6-18 Years of Age. Retrieved August 24, 2008, from http://www.aoa.org/x9451.xml.
(9) Various studies, as cited in Basch (2010).
(10) Basch, C.E. (2010). Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap. Equity Matters: Research Review No. 6. Available at: http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web03082010.pdf.
(11) Kemper, A.R., Helfrich, A., Talbot, J., & Patel, N. (October 4, 2011; epub). Outcomes of an Elementary School-Based Vision Screening Program in North Carolina. The Journal of School Nursing.
(12) As cited in Basch (2010): Ethan, D., Basch, C.E., Platt, R., Bogen, E., & Zybert, P. (2010). Implementing and Evaluating a School-Based Program to Improve Childhood Vision. Journal of School Health. 80: 340-345.
(13) Srivastava, A., Landau, M., and Rodriguez, E. (2015). School-based Vision and Hearing Screening: Highlights from a Nurse Demonstration Project.