Students who received eyeglasses through the school-based Vision for Baltimore program scored higher on reading and math tests, Johns Hopkins researchers from the Wilmer Eye Institute and School of Education found in the largest clinical study of the impact of glasses on education ever conducted in the United States. Students who struggled the most academically before receiving glasses showed the greatest improvement, the researchers found.
Results of the study, with implications for the millions of children who suffer from vision impairment but lack access to pediatric eye care, are published today by JAMA Ophthalmology.
"We rigorously demonstrated that giving kids the glasses they need helps them succeed in school," said senior author Megan Collins, a pediatric ophthalmologist at the Wilmer Eye Institute, associate faculty at the Johns Hopkins Berman Institute of Bioethics, and co-director of the Johns Hopkins Consortium for School-Based Health Solutions. "The success of the Vision for Baltimore program model and research findings could advance health and educational equity for students across the country."
The team studied students who received eye examinations and glasses through the Vision for Baltimore program, an effort launched in 2016 after Johns Hopkins researchers identified an acute need for vision care among the city's public school students: as many as 15,000 of the city's 60,000 pre-K through 8th-grade students likely needed glasses, though many didn't know it or have the means to get them.
Vision for Baltimore, which is beginning its sixth year, is operated and funded in partnership with the Johns Hopkins schools of Education and Medicine, Baltimore City Public Schools, the Baltimore City Health Department, eyewear retailer Warby Parker, and national nonprofit Vision To Learn. The Baltimore City Health Department conducts screenings, Vision To Learn performs eye exams, and Warby Parker donates the glasses. In addition to providing more than $1 million in support, Johns Hopkins works closely with the program team to provide technical assistance.
In its first five years, Vision for Baltimore tested the vision of more than 64,000 students and distributed more than 8,000 pairs of glasses. The Johns Hopkins study is the most robust work to date evaluating whether receiving glasses through a school-based vision program affects a child's performance in school.
The three-year randomized clinical trial, conducted from 2016 to 2019, analyzed the performance of 2,304 students in grades 3 to 7 who received screenings, eye examinations, and eyeglasses from Vision for Baltimore. The team looked at their scores on standardized reading and math tests, measuring both 1-year and 2-year impact.
Reading scores increased significantly after one year for students who got glasses, compared to students who got glasses later. There was also significant improvement in math for students in elementary grades.
Researchers found particularly striking improvements for girls, special education students, and students who had been among the lowest performing.
"The glasses offered the biggest benefit to the very kids who needed it the most—the ones who were really struggling in school," Collins said.
The overall gains for students with glasses were essentially equivalent to two to four months of additional education compared to students without glasses, said lead author Amanda J. Neitzel, deputy director of evidence research at the Johns Hopkins Center for Research and Reform in Education. For students performing in the lowest quartile and students participating in special education, wearing glasses equated to four to six months of additional learning—almost half a school year.
"This is how you close gaps," Neitzel said.
The academic improvements seen after one year were not sustained over two years. Researchers suspect this could be a result of students wearing their glasses less over time, possibly due to losing or breaking them.
To maintain the academic achievement, the researchers say in addition to providing the initial exams and glasses, school-based vision programs should develop stronger efforts to make sure children are wearing the glasses and to replace them if needed.
"This study, grounded in thorough and rigorous research, has proven our most fundamental assumption in launching Vision for Baltimore six years ago—that providing kids glasses in their schools will significantly improve academic success," Johns Hopkins University President Ron Daniels said. "These results validate the dedication of all of the program's committed partners, from the principals, staff, and teachers across Baltimore City schools to the optometrists at Vision to Learn and the school vision advocates from Johns Hopkins. Looking forward, we hope to work with our state and city leaders to ensure that this impactful program has sustainable funding for years to come."
Added Sonja Brookins Santelises, chief executive officer of Baltimore City Public Schools: "Vision for Baltimore means more than just corrected vision for students in city schools. It's a gift that supports their ability to see and interact clearly with their lessons, as well as a boost to self-esteem. We are thankful for this program because it removes a barrier to success for our students, especially those struggling with access to medical care."
Warby Parker Co-Founder and Co-CEO Neil Blumenthal agreed that the findings support what his team has seen.
"The results from the three-year clinical study facilitated by Johns Hopkins and Vision for Baltimore prove what we've seen first-hand in our Pupils Project Program—that a single pair of glasses can significantly improve a child's ability to learn and succeed in school," Blumenthal said. "With these results, our goal is to continue to expand our Pupils Project program as we work towards vision for all."
To sustain and expand Vision for Baltimore, the partners will continue to seek state support through public insurance programs, as well as local, regional and national philanthropic support, and hope that other locations nationwide can adopt their own versions of the program.
"Vision To Learn was founded with the mission to make sure no child is without the glasses they need to succeed in school and in life," said founder Austin Beutner, adding that the organization has provided nearly a quarter of million children with glasses in more than 500 underserved communities nationwide. "Our efforts depend on caring local partners and we're grateful for the leadership of Johns Hopkins and the commitment of all our partners in Baltimore."
Added Baltimore City Health Commissioner Letitia Dzirasa: "Baltimore City children achieve academic success when they are sent to class fully prepared to learn. In 2016, the Vision for Baltimore partnership made a pledge to eliminate barriers to care and provide high-quality vision services to every student from pre-kindergarten through the eighth grade. Vision for Baltimore is about providing every child the opportunity to see clearly, regardless of ability to pay, and today we proudly celebrate the results of that effort."
Co-authors of the JAMA Ophthalmology study include: Betsy Wolf of the Department of Education's Institute of Education Sciences; Xinxing Guo, Ahmed F. Shakarchi, and Michael X. Repka of the Wilmer Eye Institute, Johns Hopkins School of Medicine; Nancy A. Madden of the Johns Hopkins Center for Research and Reform in Education; and David S. Friedman of the Harvard Medical School. Robert Slavin, director of the Center for Research and Reform in Education, who died in April, was a key member of the research team.
The work was funded by the Abell Foundation, Laura and John Arnold Foundation, and Hackerman Foundation.