A study recently published in Ophthalmic Epidemiology evaluated the impact of poverty on access to vision services by comparing the vision screening results of children who attended schools in western South Dakota with Title 1 or non-Title 1 designation.
What is Title 1?
Title 1 is the largest program of federal support for elementary and secondary education in the United States (U.S.) that distributes funds to schools that have at least a 40% student population from low-income households.
- Its intended purpose: Bridging the gaps between communities of varying socioeconomic statuses.
Interestingly: Earlier research has indicated that students who attended Title 1 schools were 2-3 times more likely to have unaddressed vision problems compared to their counterparts.
Give me some background.
Previous studies have demonstrated that children from lower socioeconomic statuses have an increased risk of having undiagnosed visual problems—which often correlates with uncorrected amblyopia risk factors.
- Consequently: Vision screening in children is essential to prevent vision-threatening conditions, such as amblyopia.
Of note: South Dakota remains one of eight states that lacks a formal childhood vision screening policy, despite the U.S. Preventive Services Task Force’s recommendation for vision screening to be performed at least once in all children aged 3-5 years to detect amblyopia or its risk factors.
Now talk about the study.
Investigators analyzed the data from KidsFIRST vision screenings—a free, statewide, and volunteer-led vision program—conducted with the SPOT photoscreener (Welch Allyn) performed in Rapid City Area elementary schools.
Students were referred for eye examinations based on the identification of the following problems:
- Anisometropia
- Anisocoria
- Astigmatism
- Myopia
- Hyperopia
- Gaze misalignment
- A combination of these
Findings?
Eye exam referrals have increased since 2012 (11.9% in 2012 vs. 19.7% in 2023), with a disproportionate increase in referrals from schools with Title 1 designation (25.2% in 2023) compared to non-Title 1 schools (11.9% in 2023, p < 0.001).
- Note: This may have been influenced by a switch in the consent process for vision screenings from paper forms to online.
A significantly higher prevalence of astigmatism referrals was also found in students from Title 1 schools (20.9%) compared to students from non-Title 1 schools (7.5%).
Anything else?
Although a higher percentage of students from Title 1 schools were reported to have received eye correction (24.4% vs. 16.6%), only a slightly higher percentage of students from Title 1 schools wore eye correction during screening (11.5% vs. 10.5%).
How can this problem be addressed?
The study authors recommended the implementation of “interventions to address vision problems identified through vision screening in the form of a free, community-based eye care clinic [that] will better allow for direct coordination of screening efforts and follow-up care from eye care professionals (ECPs), including dispensing of eye correction as necessary.”
Keep going…
They emphasized that while there was a screening rate of over 81% reported for all children receiving screenings since 2021, there is still a remaining 19% of children in this community who would receive screening if childhood vision screening was mandatory.
- In other words: These figures do not reflect the many communities across the state that may lack access to free vision screening services.
Limitations?
These included:
- A lack of information regarding follow-up with ECPs following vision referrals and results from follow-up exams
- Some students may have been identified as requiring correction when they in fact had an updated prescription at home—falsely elevating the referral rates
- The SPOT photoscreener has a reportedly low sensitivity for detecting hyperopia and strabismus, which are risk factors for amblyopia
Tie it all together for me.
These findings suggest that students at Title 1 schools have a higher rate of amblyopia risk factors.
In order to address this disparity, the study authors recommended statewide legislation mandating vision screening for children to identify and treat unaddressed visual problems, thereby reducing the risk of amblyopia in this vulnerable population.