Vision screening outcomes and follow-up intervals among socioeconomically disadvantaged students from a school-based vision program.

Abstract

To evaluate rates of vision screening failure, eye exam completion, eyeglass prescribing, and follow-up recommendations from a school-based vision program (SBVP). Retrospective cross-sectional analysis. Pre-kindergarten through 5^th grade students (ages 4-13) who underwent school-based screening in Fort Worth, Texas in 2022-2024. Students who failed screening were offered school-based eye exams. Parent-reported demographics and school-level economic disadvantage (Free and Reduced-Price Meals; FARM%) were extracted. Mixed-effects logistic regression evaluated associations of grade, gender, race, ethnicity, eyeglass wear at screening, and FARM% for screening failure, eye exam after failure, and eyeglass prescription among exam completers. Associations between ocular diagnoses and follow-up interval, categorized as <6 months or ≥6 months, were tested using chi-square or Fisher's exact tests. Rates of screening failure, eye exam completion, eyeglass prescription, and follow-up interval. Among 41,236 students screened across 81 schools (median FARM%: 93.9%), 64.0% were Hispanic. Overall, 8,682 (21.1%) failed screening; 3,873 (44.6%) completed an eye exam. Hispanic and Black students had higher odds of screening failure (OR 1.35, 95% CI 1.25-1.46; 1.36, 95% CI 1.25-1.48, respectively) compared to non-Hispanic and non-Black students, respectively. After screening failure, Hispanic students had higher odds of completing an eye exam (OR 1.27, 95% CI 1.08-1.48), whereas Black students had lower odds (OR 0.82, 95% CI 0.69-0.97). Students with greater school-level economic disadvantage had higher odds of screening failure (OR 1.17 per 10% FARM increase, 95% CI 1.14-1.21) and completing an exam after failure (OR 1.24 per 10% increase, 95% CI 1.13-1.38). Among 3,767 students examined, 14.2% were recommended follow-up <6 months. Earlier follow-up was more common among those with amblyopia/amblyopia suspect (68.9% vs 6.6%) and strabismus (64.1% vs 13.3%) compared to those without (both p<0.001). In a predominantly Hispanic, economically disadvantaged district, this SBVP identified substantial unmet vision needs with disparities in screening failure and eye exam completion. Earlier follow-up recommendations were more common for high-risk diagnoses. Future work should focus on understanding whether students successfully connect to follow-up care after referral and developing guidelines to support children with ongoing eye care needs beyond SBVPs.