Through our children's eyes--the public health impact of the vision screening requirements for Indiana school children

Background: The vision screening of preschool and school children is a widely accepted procedure to detect vision problems that can interfere with learning. The Indiana General Assembly requires the annual vision screening with the Modified Clinical Technique (MCT) of all children upon their enrollment in either kindergarten or the first grade, with the exception of schools that apply for and receive waivers to conduct only a distance Snellen chart screening.

Methods: In association with the Indiana State Department of Health, the Indiana University School of Optometry conducted an analysis of statewide school screening data on 36,967 grade 1 children from 139 of the 294 Indiana school corporations that submitted data for the 2000-2001 school year to examine differences in referral rate by screening method, the socioeconomic status of children screened, and academic performance.

Results: The MCT was used by 125 of the school corporations, and some other technique was used by 14 school corporations. Significant differences were seen when comparing the mean referral rates of school corporations that conduct the MCT against school corporations that do not conduct the MCT (P = 0.001) and in the rate of referral by median family income of the children screened (P = 0.050). A median family income of $46,500 was identified as the level at which the income-specific difference in referral rates ceased to be significant (P = 0.074). In spite of an observed tendency toward a higher referral rate for children who performed below average on the standardized Indiana Statewide Testing for Educational Progress Plus (ISTEP+) exam, results were found to be not significant (P = 0.116) when comparing the percentage of grade 1 children referred to an eye care provider in 2000-2001 with their percentages of passing both the English/language arts and mathematics components of the 2002-2003 ISTEP+ exam (in grade 3).

Conclusion: Schools using the highly sensitive and specific MCT identified more visually at-risk children than schools using alternative, less sensitive vision screening techniques, and the percentage of grade 1 children referred to an eye care provider was higher for school corporations with lower median family incomes. Although statistically insignificant, the results indicate that students who fail the vision screening in grade 1 tend to be more at risk for poorer academic performance on standardized testing in grade 3.