Retrospective cross-sectional study evaluating screening failure rates, eye exam completion, eyeglass prescribing, and follow-up intervals among 41,236 pre-K through 5th grade students (ages 4–13) in a school-based vision program (SBVP) in Fort Worth, TX (2022–2024), focusing on a predominantly Hispanic, economically disadvantaged district.
21.1% of students failed screening; only 44.6% of those completed a follow-up eye exam. Hispanic and Black students had higher odds of screening failure (OR 1.35 and 1.36, respectively). After failure, Hispanic students were more likely to complete an exam (OR 1.27), while Black students were less likely (OR 0.82). Greater school-level economic disadvantage was linked to both higher failure rates and higher exam completion. Among students examined, 14.2% needed follow-up within 6 months, driven largely by amblyopia (68.9%) and strabismus (64.1%) diagnoses.
Retrospective cross-sectional design limits causal inference. The study does not track whether students successfully reached follow-up care after referral. Findings are from a single urban Texas district and may not generalize broadly.
SBVPs in high-poverty settings reveal substantial unmet vision needs and racial disparities in care completion — Black students who fail screening are less likely to follow through with an exam. Clinicians and program planners should build active referral tracking and targeted outreach for Black students, and ensure children with amblyopia or strabismus have clear pathways to timely follow-up care.
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