How Free Eyeglasses Are Boosting Test Scores in Baltimore

Three years ago, Johns Hopkins University researchers in Baltimore asked a seemingly simple straightforward question: Could the persistent gap in reading performance between poor students and wealthier ones be closed if they gave the poor students eyeglasses?

They knew that poorer students were less likely to have glasses than wealthier white children, but data were limited on whether simply helping children better focus on the page in front of them might improve their ability to master a skill essential for early learning. They screened several hundred second- and third-graders, gave two pairs of eyeglasses to the ones who needed them (about 60 percent of the group, based on a uniquely liberal prescribing standard) and then they tracked their school performance over the course of the year. The outcomes were notable enough even with the small sample size—reading proficiency improved significantly compared with the children who did not need eyeglasses—that the researchers in conjunction with private sector partners and the city of Baltimore decided to radically expand the study to the whole city to see if the results held.

Beginning in May 2016, the city of Baltimore assembled a public-private coalition made up of its health department, the public school system, Johns Hopkins Wilmer Eye Institute, Johns Hopkins School of Education, eyeglass retailer Warby Parker, and a national nonprofit called Vision To Learn. The three-year program, called Vision for Baltimore, plans to visit 150 schools over the course of the study and screen 60,000 students, making it the biggest study of its kind. The data officials expect to glean could radically alter how school systems across the country approach one of the most difficult and consequential problems in modern education. It may well be that the solution to the persistent gap in reading proficiency is not instructional, but a simple health issue that could be addressed with a pair eyeglasses that could cost a couple of hundred dollars at the mall.

“We know, based on common sense, that giving glasses for kids is important for education [and] health,” said Baltimore City Health Commissioner Leana Wen.

Dierra Sollers, a fifth-grader at Dr. Bernard Harris, Sr. Elementary School, tries on her new glasses, as schools CEO Dr. Sonja Brookins Santelises looks on. Sollers' glasses were symbolically the 1,000th pair given out to Baltimore public school students through the Vision for Baltimore program. | Kenneth K. Lam/Baltimore Sun/TNS via Getty Images | Getty Images

As of mid-August, Vision for Baltimore has performed nearly 18,000 screenings and distributed nearly 2,000 pairs of glasses for free. That’s on schedule of the program’s goal to give out 8,000 glasses before the end of the study. They estimate that just 20 percent of screened children who need glasses subsequently get them, leaving as many as 20,000 children citywide staring fuzzily at the board in their classrooms.

Experts attribute the glasses gap to Maryland law, which requires screening only or pre-K, first-and eighth-graders. A child who develops eyesight issues in second grade could wait years before being examined again, falling further behind peers. But even with mandatory screening, parents may not follow through. Parents might not be able to afford the glasses if they don’t qualify for Medicaid. (Maryland’s Medicaid system covers one pair of eyeglasses for minors per year, and will replace them in some cases.) The consequences of not addressing eyesight problems early can be dire and compounding. Studies over the past decade suggest that students who perform badly in school are misdiagnosed with behavioral disorders or special education needs when the culprit was their poor eyesight.

The solution was deceptively simple: If kids can’t get to the doctor, bring the doctor to the kids. Under the Vision for Baltimore program, a mobile clinic shows up to the school for about a week during the school year to determine whether a child may need glasses. In Baltimore, the city health department conducts the screening, which requires checking distance vision, depth perception and eye alignment. If the child fails the screening test, he is given a parental consent form for an optometry exam on the school campus. Two weeks later, an optician comes to the school to fit the glasses, which the child picks himself. Each student gets one pair.

Shandra Worthy-Owens, principal of Dr. Bernard Harris Sr. Elementary School, said V4B has been a success at her school. The project clinicians communicated weekly to make sure the school had the necessary forms and knew when the clinic would arrive on campus for screenings. “They just supported us throughout the whole process,” Worthy-Owens said. Her school staff conducted home visits, made extra phone calls and stayed late on campus to accommodate with parents’ work schedules.

About 100 students, a fourth of Worthy-Owens’ school’s total, received the glasses in March. Though there are no hard data yet on reading proficiency, Worthy-Owens said teachers at her school have noticed those students who received and regularly wear glasses from V4B have improved in the classroom. The glasses have even boosted student self-esteem: Her school spotlights the students for wearing their glasses on a bulletin board, she said, and none of them have been bullied. She attributes this to the way they promote the “coolness” of wearing them.

But the program still has to overcome a lack of cooperation from some parents, who often fail to fill out necessary paperwork. Families can provide a Medicaid number to cover the cost of the exam, for example, but many do not, or the number comes back wrong or illegible. The cost is covered with or without a Medicaid number, but Worthy-Owens said some parents did not want their children to get glasses even after they were identified, either because they fear the cost or resist revealing other personal information to the school. “Trust was an issue,” she said. “You have to have the relationship with the community in order for the consent process to work.” Worthy-Owens said she often has to persuade reluctant parents to fill out the one-page consent form, which asks for the child’s name, gender, birthdate, address, school and Medicaid identification number, as well as the parents’ names and phone number. Next year, the form will not ask for a Medicaid number so fewer parents will hesitate to turn it in. If the program can’t overcome hurdles like these, says Bob Slavin, who leads Johns Hopkins center for education reform, Vision for Baltimore doesn’t “have a prayer” of getting anywhere near its goal of reaching 20,000 in-need children.

The project is expensive and relies on philanthropy. Vision To Learn pays about $100 per child in each community—this covers each area’s mobile clinic, eyeglasses, vision tests, directors’ oversight and optometry team. The mobile clinic alone costs around $115,000—$100,000 to buy and renovate the van and $15,000 for medical equipment. The nonprofit receives revenue from insurance reimbursement and private donations. Baltimore’s health department pays $250,000 annually in salaries for its three screeners and office staff. The research team meets their own costs from donations and grants.

“When the kids are wearing glasses and they’re doing better, the attendance is higher, and the standardized test scores have improved, then you can really make the argument for why this needs to be built into what schools do,” said Megan Collins, a lead researcher in the study.

“We all know the need is there,” said Austin Beutner, chairman and founder of Vision To Learn. “We have a lot to come, not only in Baltimore.”

This story tagged under: Health Care