[Skip to Content]

Quiz

Optics and Refraction

Effect of a Randomized Interventional School-Based Vision Program on Academic Performance of Students in Grades 3 to 7A Cluster Randomized Clinical Trial

Educational Objective
To assess the effect of a school-based vision program on academic achievement among students in grades 3 to 7.

1 Credit CME

JAMA Ophthalmology

Published Online: September 9, 2021

Original Investigation

Article Information and Disclosures

Amanda J. Neitzel, PhD¹;

Betsy Wolf, PhD²;

Xinxing Guo, MD, PhD^3,4;

Ahmed F. Shakarchi, MBBS, MPH^3,4;

Nancy A. Madden, PhD¹;

Michael X. Repka, MD, MBA³;

David S. Friedman, MD, PhD, MPH⁵;

Megan E. Collins, MD, MPH^3,4,6

Author Affiliations

¹Center for Research and Reform in Education, Johns Hopkins University School of Education, Baltimore, Maryland
²Institute of Education Sciences, Department of Education, Washington, DC
³Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
⁴Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
⁵Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
⁶Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland

Read article on JAMA Network

Read Article Take Quiz

Key Points

Question How do school-based vision programs affect academic performance among students needing eyeglasses?

Findings This cluster randomized clinical trial found that a school-based vision program improved students’ reading scores over 1 year, especially girls, those in special education, and students in the lowest quartile at baseline. A sustained benefit was not observed over 2 years.

Meaning School-based vision programs may help children improve academic performace by providing eye examinations and eyeglasses.

Abstract

Importance Uncorrected refractive error in school-aged children may affect learning.

Objective To assess the effect of a school-based vision program on academic achievement among students in grades 3 to 7.

Design, Setting, and Participants This cluster randomized clinical trial was conducted in Baltimore City Public Schools during school years from 2016 to 2019 among 2304 students in grades 3 to 7 who received eye examinations and eyeglasses.

Intervention Participating schools were randomized 1:1:1 to receive eye examinations and eyeglasses during 1 of 3 school years (2016-2017, 2017-2018, and 2018-2019).

Main Outcomes and Measures The primary outcome was 1-year intervention impact, measured by effect size (ES), defined as the difference in score on an academic test (i-Ready or Partnership for Assessment of Readiness for College and Careers tests on reading and mathematics) between intervention and control groups measured in SD units, comparing cohort 1 (intervention) with cohorts 2 and 3 (control) at the end of program year 1 and comparing cohort 2 (intervention) with cohort 3 (control) at the end of program year 2. The secondary outcome was 2-year intervention impact, comparing ES in cohort 1 (intervention) with cohort 3 (control) at the end of program year 2. Hierarchical linear modeling was used to assess the impact of the intervention. Analysis was performed on an intention-to-treat basis.

Results Among the 2304 students included in the study, 1260 (54.7%) were girls, with a mean (SD) age of 9.4 (1.4) years. The analysis included 964 students (41 schools) in cohort 1, 775 students (41 schools) in cohort 2, and 565 students (38 schools) in cohort 3. There were 1789 Black students (77.6%), 388 Latinx students (16.8%), and 406 students in special education (17.6%). There was an overall 1-year positive impact (ES, 0.09; P = .02) as assessed by the i-Ready reading test during school year 2016-2017. Positive impact was also observed among female students (ES, 0.15; P < .001), those in special education (ES, 0.25; P < .001), and students who performed in the lowest quartile at baseline (ES, 0.28; P < .001) on i-Ready reading and among students in elementary grades on i-Ready mathematics (ES, 0.03; P < .001) during school year 2016-2017. The intervention did not show a sustained impact at 2 years or on Partnership for Assessment of Readiness for College and Careers testing.

Conclusions and Relevance Students in grades 3 to 7 who received eyeglasses through a school-based vision program achieved better reading scores. Students had improved academic achievement over 1 year; however, a sustained impact was not observed after 2 years.

Trial Registration The Registry of Efficacy and Effectiveness Studies Identifier: 1573.1v1

Take Quiz

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Accepted for Publication: July 19, 2021.

Published Online: September 9, 2021. doi:10.1001/jamaophthalmol.2021.3544

Corresponding Author: Megan E. Collins, MD, MPH, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287 (mcolli36@jhmi.edu).

Author Contributions: Drs Neitzel and Collins had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Neitzel, Wolf, Repka, Friedman, Collins.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Neitzel, Wolf, Guo, Shakarchi, Friedman, Collins.

Critical revision of the manuscript for important intellectual content: Neitzel, Wolf, Guo, Madden, Repka, Friedman, Collins.

Statistical analysis: Neitzel, Wolf, Shakarchi, Madden.

Obtained funding: Friedman, Collins.

Administrative, technical, or material support: Wolf, Repka, Collins.

Supervision: Neitzel, Wolf, Friedman, Collins.

Conflict of Interest Disclosures: Drs Neitzel, Wolf, and Collins reported receiving grants from Abell Foundation, Laura and John Arnold Foundation, and Hackerman Foundation during the conduct of the study. Dr Collins reported receiving personal fees from and previously serving as a consultant for Warby Parker, a company that manufactures the eyeglasses provided in the Baltimore vision program; this arrangement was reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. No other disclosures were reported.

Funding/Support: This study was funded by the Abell Foundation, Laura and John Arnold Foundation, and Hackerman Foundation.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: This article is intended to promote the exchange of ideas among researchers and policy makers; the views expressed in it are part of ongoing research and analysis and do not necessarily reflect the position of the US Department of Education.

Additional Contributions: We gratefully acknowledge the contributions of the following individuals from the Vision for Baltimore program: Letitia Dzirasa, MD, Mary Beth Haller JD, Francine Childs, BS, Joy Twesigye, MPP, MS, and Tempestt Little, MBA, Baltimore City Health Department; Sonya Santelises, EdD and Louise Fink, PhD, Baltimore City Public Schools; Ann Hollister, Damian Carroll, BFA, and Wade Brown, Vision To Learn; Hannah Reeve, BA, and Jesse Schultz Sneath, BS, Warby Parker; and Christine SySantos Levy, BA, Grace Galiani, BS, and Anne Currie, MS, Johns Hopkins University; they were not compensated for their contributions. In addition, we thankfully acknowledge our friend and colleague, Robert Slavin, PhD, who contributed to the design and conduct of the study, the interpretation of the data, and the review and approval of the manuscript; Bob died on April 24, 2021.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.