There is strong evidence that vision screening and the provision of eyeglasses contribute to improved social outcomes. There is also sufficient evidence that it contributes to improved health outcomes for school-aged children.
The findings below synthesize the results of the studies on vision screening and eyeglasses across three domains of measurement:
According to the National Center for Children’s Vision and Eye Health (2020), vision plays a critical role in children’s physical, cognitive, and social development. Up to one in 17 young children and one in five preschool-age children enrolled in Head Start have an undiagnosed vision disorder[1]. The Centers for Disease Control and Prevention (CDC) estimates that approximately 6.8% of children younger than 18 years have a diagnosed eye and vision condition, and nearly 3% of children younger than 18 years are blind or visually impaired, defined as having trouble seeing even when wearing glasses or contact lenses[2]. Conditions which commonly account for visual disabilities in children include amblyopia (lazy eye), strabismus (cross eyes), and significant refractive errors[3]. The United States Preventive Services Task Force (USPSTF) has issued a category “B” recommendation for vision screening at least once in all children aged three to five years to detect amblyopia or its risk factors (e.g., strabismus, refractive errors, and cloudiness in the eye), and many states have further specific vision screening requirements. However, less than 15% of all preschool children receive an eye exam, and less than 22% of preschool children receive some type of vision screening[4].
Vision impairment beginning in childhood may have lifelong impacts. Data from the 2016 National Health Interview Survey (NHIS) examined social drivers of health among adults who self-reported visual difficulties. The survey found that self-reported visual difficulty was significantly associated with lower educational attainment, increased likelihood of healthcare coverage through Medicaid, food insecurity, problems paying medical bills, trouble finding a doctor, and cost-related medication underuse[5].
Healthy People 2030 has multiple objectives directly related to both vision health and academic outcomes, which may impact individuals experiencing poor vision health. These objectives include increasing the proportion of children aged three to five years who receive vision screening, reducing vision loss in children and adolescents, increasing the proportion of 4th-graders with math skills at or above the proficient level, and increasing the proportion of 4th-graders with reading skills at or above the proficient level[6].
Reimbursement for vision services in school settings is largely facilitated through the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which mandates that state Medicaid programs cover vision screenings, eye exams, and eyeglasses for children[7]. While federal law requires this coverage, there are administrative challenges to seeking Medicaid reimbursement for services delivered on school grounds[8]. Given that schools serve as a primary point of contact for nearly all children, they act as a natural hub for meeting these federal requirements, ensuring that preventative care is delivered where children spend much of their time[9]. Recent policy changes by the Centers for Medicare & Medicaid Services (CMS) have simplified the process for school districts to seek reimbursement for healthcare services, including vision care, for all Medicaid-enrolled students[10],[11].
Nonprofit and community-based programs also provide substantive support for free vision screenings for school-aged children[12]. Additionally, school districts sometimes partner directly with optometric providers and local health departments to run programs which aim to serve children regardless of their insurance status[13].
Parents, teachers, and students from Los Angeles, California. All participants were either students who received vision screenings and glasses through a program called Vision to Learn (VTL) or were parents or teachers of students who received screenings and glasses through VTL.
VTL, a school-based vision screening program, that provided free corrective lenses to low-income students in Los Angeles. School nurses performed school-wide vision screenings and students identified with a deficit were referred to the program.
Qualitative study. N=65.
Social: Students and teachers both spoke of how they noticed that access to glasses helped students concentrate better on their schoolwork, both in the classroom and at home. Additionally, students mentioned how their glasses helped eliminate headaches and trouble seeing the blackboard at school. Parents also spoke of how they noticed similar benefits. Additionally, they noted how the VTL program helped to reduce the financial and emotional stress they felt from not being able to provide glasses for their children. The study concluded that access to glasses for children who need them may have a positive impact on students, parents, and teachers due to both improved school function and psychosocial wellbeing from the child receiving glasses.
Students whose families earn lower incomes in first to fifth grade attending 24 public elementary schools in Los Angeles, California. On average, schools served over 550 students, the vast majority of whom qualified for free/reduced price meals (89%) and were minority (76% Latino, 18% African American). Of the 406 VTL participants, 46% were boys and 57% were in grades one to three at the time they were served.
A free, school-based vision program serving the Los Angeles Unified School District.
Observational study with a comparison group. N=406 in the intervention group and N=23,393 in the comparison group.
Social: Students increased 4.5 percentage points in language arts in the second year after receiving glasses. There was no change in math achievement overall; however, those with baseline performance in the bottom tercile had an immediate and sustained improvement of 10 to 24 percentage points from baseline.
First- and second-grade students across eight New York City public schools. Four schools were randomized to receive A Vision for Success. Included students were required to be enrolled as a first- or second-grade student in one of the eight participating schools, to have failed the previous year’s mandated school-based vision screening, and to have passive parental consent to participate.
A school-based program (A Vision for Success) that provides eyeglasses to children in New York City. Children from schools in the intervention group received a customary, mandatory, school-based vision screening by the New York City Office of School Health. Those who failed the screening received school-based professional optometric screening and those for whom eyeglasses were indicated received two pairs of eyeglasses (one to be kept by the teacher). Furthermore, these children’s teachers were asked to monitor and encourage eyeglass use at school. The other four schools were assigned to the control group (standard practice) in which children received the same customary, mandatory, school-based vision screening and referral for parents to take the child for an eye examination, where indicated.
Randomized controlled study. N=265 first- and second-grade students, of which 127 were in the intervention group.
Social: Baseline (pre-intervention) rates of eyeglass use for students in the intervention and control groups were 22% and 19%, respectively. At follow-up, eyeglass use rose to 47% in the intervention group, whereas the control group’s rate remained consistent at 19%.
76 Title I elementary schools, which primarily serve low-income students, in three large central Florida school districts.
Vision screening alone or accompanied by eye exams and eyeglasses, provided by a nonprofit organization.
Randomized controlled trial. N=15,422 fourth- and fifth-grade students within three school districts.
Social: The study found that providing additional/enhanced screening alone is generally insufficient to improve student achievement in math and reading. By contrast, providing screening along with free eye exams and free glasses to students with vision problems improved student achievement. Averaging over all students (including those without vision problems), this more comprehensive intervention increased the probability of passing the Florida Comprehensive Achievement Tests in reading and math by approximately two percentage points.
Students in kindergarten through grade five in 45 elementary schools in a large urban school district (the School District of Philadelphia).
The Wills Eye Vision Screening Program for Children is a community-based vision screening program for children in urban Philadelphia elementary schools that provided vision screening, remedied refractive error by providing glasses, and referred children with suspected nonrefractive eye disease for eye care.
Pre-post analysis. N=10,726 children who were screened, 1,321 who were found to have refractive error and 1,015 who returned their consent forms.
Social: Results found that eyeglasses were worn most of the time by 67.4% of children and never or rarely worn by 18.6% of children. Additionally, when eyeglasses were prescribed and worn, children with initially high reading performance were less likely to decline. Improvement was not observed for children who initially scored Developmental Reading Assessment (DRA) level 1 or 2 (below basic or basic, respectively). When eyeglasses were prescribed and worn, Asian children were more likely to achieve higher reading level scores on the Pennsylvania System of School Assessment. This trend was also observed in Black and Hispanic children without reaching statistical significance. The study concluded that wearing glasses contributes to maintaining academic achievement in reading scores for some individuals.
Third to seventh-grade children in 120 Baltimore City Public Schools.
A citywide school-based vision program, Vision for Baltimore (V4B). The schools were distributed into three cohorts. Cohorts one, two, and three received V4B interventions in the first, second, and third [study] years, respectively. V4B services include vision screenings, eye exams, and eyeglasses, if needed.
Randomized controlled trial. N=2,304.
Social: Study results found an improvement in students’ reading scores over one year, especially among girls, those in special education, and students in the lowest quartile at baseline. However, a sustained benefit was not observed over two years. The study concluded that participating students who received eyeglasses did achieve better reading scores after one year; however, this improvement in achievement was not seen two years post-intervention.
Middle school children enrolled in four schools in Washington Heights, New York City.
A school-based program (ChildSight) that provided free vision screenings and eyeglasses on-site.
Descriptive study. N=5,851 children screened.
Health: The program successfully treated 88.3% of the children within the school who needed glasses. Prior to the intervention, only 10% of children who needed glasses had them, indicating a huge need to provide glasses.
Second and third graders in 12 disadvantaged Baltimore City schools in Maryland. 84.5% of students were African-American, 8.5% were Hispanic, and 4.4% were White. All students qualified for free lunch.
Vision screening and eyeglass provision where needed. Students who needed glasses were given two pairs, one for home and one for school, as well as replacements if glasses were lost or broken. School staff assisted in ensuring that students wore their glasses, storing them safely, and replacing glasses when necessary.
Observational study with a comparison group. N=317 screened students, of which 182 were given glasses.
Social: Students who received glasses improved significantly more on the Woodcock reading measures (Woodcock Letter-Word Identification and Word attack scales) than those who never needed glasses.
Children and adolescents attending school between four and 17 years of age who had been diagnosed with uncorrected hyperopia of any degree, and with or without astigmatism, without any ocular comorbidities, including strabismus and amblyopia.
Hyperopic spectacle correction.
A systematic review and meta-analysis. 25 (21 observational and four interventional) were reviewed and found to meet study inclusion and exclusion criteria.
Social: Two interventional studies found hyperopic spectacle correction significantly improved reading speed.
[1] National Center for Children’s Vision and Eye Health at Prevent Blindness. (2020). Children’s Vision and Eye Health: A Snapshot of CurrentNational Issues (2nd ed.). https://preventblindness.org/wp-content/uploads/2020/07/Snapshot-Report-2020condensedF.pdf
[2] Centers for Disease Control and Prevention. (2024, May 15). Fast facts: Vision loss. https://www.cdc.gov/vision-health/data-research/vision-loss-facts/index.html
[3] Prevent Blindness. Common Children’s Vision Problems. preventblindness.org/common-childrens-vision-problems-prevalence/
[4] United States Preventive Services Task Force (USPSTF). (2017). Vision in children ages 6 months to 5 years: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/vision-in-children-ages-6-months-to-5-years-screening
[5] Su, N. H., Moxon, N. R., Wang, A., et al. (2020). Associations of social determinants of health and self-reported visual difficulty: analysis of the 2016 National Health Interview survey. Ophthalmic Epidemiology, 27(2), 93–97.
[6] Healthy People 2030. Goal: Improve the health and well-being of children. odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/children
[7] Medicaid.gov. (2022). Early and Periodic Screening, Diagnostic, and Treatment. https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment
[8] Bullinger, L. R., Shi, S. J. (2025). The Effects of Medicaid Coverage for School-Based Health Services on the Supply of School-Based Healthcare Clinics: Evidence From the "Free Care Rule" Reversal and FQHCs. Health Serv Res., 60(Suppl 2):e14452.
[9] Healthy Students, Promising Futures. (2024). Federal Guidance on School Medicaid. healthystudentspromisingfutures.org/federal-support/
[10] Centers for Medicare & Medicaid Services (CMS). (2024, January 24). CMS Announces $50 Million in Grants to Deliver Critical School-Based Health Services to Children. https://www.cms.gov/newsroom/press-releases/cms-announces-50-million-grants-deliver-critical-school-based-health-services-children
[11] Medicaid and CHIP Payment and Access Commission (MACPAC). (2024, March). School-based services for students enrolled in Medicaid. https://www.macpac.gov/wp-content/uploads/2024/04/School-Based-Services-for-Students-Enrolled-in-Medicaid.pdf
[12] National Eye Institute. (2025, September, 11). Get Free or Low-Cost Eye Care. https://www.nei.nih.gov/eye-health-information/healthy-vision/finding-eye-doctor/get-free-or-low-cost-eye-care
[13] Chicago Public Schools. Vision Services. https://www.cps.edu/services-and-supports/health-and-wellness/exams-screenings/vision-services/
