Although a comprehensive eye exam for every child would be ideal, photoscreening offers a practical solution. Its speed and ease of use make it an effective tool for screening large numbers of children, especially in resource-limited settings. Photo: Getty Images. Click image to enlarge.

The risk of progressing to amblyopia is greatly reduced by addressing visual problems before full visual pathway development occurs. Children from lower socioeconomic statuses are at an increased risk of having undiagnosed visual problems. A recent study in Ophthalmic Epidemiology compared vision screening results of children in schools in western South Dakota with Title 1 or non-Title 1 designations to investigate the link between poverty and vision. They found that families with reduced resources may have higher rates of amblyopia risk factors and uncorrected significant refractive error, making it critical that healthcare policies and vision screening programs are mindful of these disparities so that they may begin reducing barriers for equitable eyecare.

Title 1 is a US federal education program that distributes funds to schools that have at least a 40% student population from low-income households, with the goal of bridging gaps between communities of varying socioeconomic statuses. Data from KidsFIRST vision screenings conducted with the Spot photoscreener (Welch Allyn) performed in Rapid City Area elementary schools were compared across multiple parameters. Students were referred for eye examinations based on identifying the following problems: anisometropia, anisocoria, astigmatism, myopia, hyperopia, gaze misalignment or a combination.

Overall, eye exam referral rates have increased since 2012 (11.9% in 2012, 19.7% in 2023), with a disproportionate increase in referrals from Title 1 schools (25.2% in 2023) vs. non-Title 1 schools (11.9% in 2023). This is largely due to a significantly higher prevalence of astigmatism referrals in Title 1 students (20.9%) compared with non-Title 1 students (7.5%). Although a higher percentage of Title 1 students are reported to have eye correction (24.4% vs. 16.6%), only a slightly higher percentage of Title 1 students wore eye correction during screening (11.5% vs. 10.5%).

Of interest, increased risk for astigmatism has been associated with African American, Hispanic and Asian children, while American Indians have a reportedly lower prevalence of astigmatism, according to some studies. “While race or ethnicity of the children referred was not analyzed in this study, further investigation as to whether significantly higher rates of astigmatism in Title 1 schools are related to racial differences in vision care is warranted,” the study authors noted.

Although a screening rate of over 81% was reported for all children receiving screenings since 2021 in this study, the researchers noted that this left the remaining 19% of children in this community who would receive screening if childhood vision screening was mandatory. “These figures do not reflect the many communities across the state that may lack access to free vision screening services,” they added. “To address this gap, we recommend that South Dakota implement a statewide childhood vision screening policy.”