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Original Investigation
September 9, 2021

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

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
JAMA Ophthalmol. 2021;139(10):1104-1114. doi:10.1001/jamaophthalmol.2021.3544
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.


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

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