Session: Free papers Session II - Diagnostics & Amblyopia

Refractive amblyopia risk factors and other eye care needs identified in a school-based vision program

Michael REPKA¹, Xinxing GUO¹, Medha KALLEM⁴, Andrew NGUYEN¹, Christina AMBROSINO¹, Daisy DAI³, Nick KOURGIALIS², Megan COLLINS¹

¹Wilmer Eye Institute, Johns Hopkins University, Baltimore, United States
²Helen Keller International, New York, United States
³Yale School of Medicine, New Haven, United States
⁴Emory University School of Medicine, Atlanta, United States

Introduction: School-based vision programs (SBVPs) can address pediatric eye health disparities by providing vision screenings, eye exams, and eyeglasses to underserved communities directly in schools. While many vision problems can be addressed within the school setting, SBVPs coordinate community referrals for the students with complex eye care needs. To allocate resources, SBVPs need understand the prevalence of refractive amblyopia risk factors (RARF) and other ocular pathology.

Methods: We conducted a retrospective analysis of Helen Keller International’s United States Vision Program data from 2016 – 2022. We included students from prekindergarten through grade 12 who received non-dilated eye exams following failed vision screenings. Outcomes included the number of students who failed vision screening, those having a RARF (anisometropia >1.25 diopters [D], hyperopia >4D, astigmatism >1.75D), those with myopia greater than 2D, those prescribed eyeglasses, and those referred to community providers for eye care beyond the scope of the SBVP.

Results: 103,184 of 285,283 (36%) students failed vision screening and received school-based eye exams. Among the 95,874 students with refraction data, mean age was 12±3 years; 46.4% were male. Three quarters of students (n=71,572) were prescribed eyeglasses. 32.6% (n=31,280) had a RARF; 11.5% (n=11,068) had anisometropia,1.7% (n=1,652) had hyperopia (>4D), and 25.7% (n=24,595) had astigmatism. 51.1% (n=48,988) had myopia (>2D). 17.4% (n=13,897) were referred for further care.

Conclusions: SBVPs address unmet vision needs in underserved communities, primarily myopia. One in 3 students who failed a school-based vision screening had at least one refractive amblyopia risk factor. A smaller proportion needed referral to a community provider. To effectively serve school aged children there needs to be a plan for referral of older children for management of amblyopia and other eye problems, often beyond the traditional timing.