Need for eyeglasses and prescription updates in students receiving a school-based eye exam

SIGNIFICANCE: School-based vision programs can improve children's access to vision care in underserved areas. Little is known about the need for eyeglasses among students not wearing them compared with the need for prescription updates. A greater understanding of prescription trends will help identify gaps in care and inform resource allocation. PURPOSE: We aim to describe the baseline eyeglasses-wearing status and the need for new and updated eyeglasses prescriptions for students participating in a large school-based vision program. METHODS: This cross-sectional analysis examined retrospective data from the 2016-2022 operations of the Helen Keller Intl's United States Vision Program. Included students were pre-kindergarten to grade 12 and had received a school-based eye examination after a failed vision screening. Data extracted included student demographics, self-reported eyeglasses-wearing status, lensometer measurement, refractive error, and eyeglasses prescription. Multivariate logistic regression models were implemented to understand the factors associated with eyeglasses prescription and prescription change, defined as at least 0.50 D spherical equivalent change or 0.75 D cylindrical change between lensometer measurement and final prescription. RESULTS: Of the 97,069 students included in the analysis, 27.3% of students were self-reported current wearers of eyeglasses, 30.5% were inactive wearers of eyeglasses, and 42.2% were nonwearers. Overall, 72,784 (75%) students were prescribed eyeglasses. Among them, 48,600/72,784 (67%) were not current wearers. On multivariate logistic regression, students were more likely to be prescribed eyeglasses if they were in higher grade levels (grades 11 to 12 compared with grades 1 to 2, odds ratio: 2.39, 95% confidence interval: 2.17 to 2.64) and were current wearers (odds ratio: 8.82, 95% confidence interval: 8.24 to 9.43). Among current wearers, students with at least 6 D myopia and at least 3 D astigmatism had the greatest likelihood of spherical equivalent and cylindrical prescription change, respectively. CONCLUSIONS: Within a large sample of students enrolled in a school-based vision program, more than half reported having eyeglasses. However, two in three students who needed eyeglasses were not wearing them. The need for eyeglasses was notable across all age groups, especially among higher grade levels and those with more severe refractive error. Most students who failed a vision screening while wearing eyeglasses needed an eyeglasses prescription update.