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What Happened Next? A study linking eyeglass use to improved reading ability expands beyond Baltimore

Posted December 13, 2017
"When we started the program, the return rate on forms was about 20 to 30 percent," says the Wilmer Eye Institute's Megan Collins (right). "In September this year, the return on those forms jumped to 65 percent. At least three schools we worked with had gotten to 100 percent. So those are good indicators."

Hear Megan Collins and Baltimore City Health Commissioner Leana Wen speak about Vision for Baltimore on "PBS News Hour"

Could a missing link in the educational chain for low-income students be a pair of eyeglasses? The Baltimore Reading and Eye Disease Study (BREDS), supported by the Robert M. and Diane v.S. Levy Foundation, asked that question in 2014. Researchers in the Wilmer Eye Institute and School of Education examined whether providing glasses to students correlated with improvement in the students’ reading scores. But as the study progressed, another question arose: How can schools both provide students access to quality eye care and ensure the children use glasses appropriately to reap the benefits?

Rising spoke with two of the principal investigators, assistant professor of ophthalmology Megan Collins and Robert Slavin, director of Hopkins’ Center for Research and Reform in Education, to catch up on their work’s progress — and geographic expansion — in this edition of What Happened Next?

What did you learn in the original BREDS study that led to further inquiry?

Slavin: We found that although 30 percent of children we examined had previously worn eyeglasses, roughly six percent of those children still had glasses. What that meant in a city the size of Baltimore was that many children were being held back in school, failing, or perhaps seeking tutoring or other costly services that may only be necessary because they did not have their eyeglasses. Not everyone who's failing in reading and math in Baltimore is failing because of poor vision, but that’s one relatively solvable part of the problem. Wouldn’t you want to solve that one before wasting effort going in a different direction that may not be the problem?

How do the different parts of this research fit together?

Collins: As we prepared a second phase of BREDS to look at this on a larger scale, we learned the Baltimore City Health Department (BCHD) was looking at a similar issue. We created Vision for Baltimore, a program spearheaded by BCHD, in partnership with Baltimore City Public Schools, the nonprofit optometric organization Vision To Learn, and Warby Parker. Through Vision for Baltimore, all students in grades pre-K through 8th grade in Baltimore City schools receive vision screenings and, if necessary, eye exams and eyeglasses. Everything is brought to the kids directly at their schools.

The program has been able to serve thousands of children in Baltimore, but we learned that building a strong rapport with schools is critical to the program's success and sustainability. This fall, we also launched Vision for Chicago, an 80-school research study looking at the impact of an augmented educational intervention campaign from a public health perspective — getting kids to use the program and wear their glasses, building teacher and student engagement, and looking at the long-term impact these efforts have on academic performance.

Why is philanthropic support for this work so important?

Slavin: Nationwide, many children in poverty are known to have vision problems yet, for some reason, just giving them glasses isn’t easing their educational struggles. Many people recognize this problem and think it’s important. Yet nobody at the federal level would fund this kind of research, to develop a standard practice. Without philanthropy, we’d never have been able to get these important, early-stage studies like BREDS done, to provide evidence that shows state governments or the federal government “here’s a big problem, and we have some potential solutions.”

How did Chicago become involved?

Collins: The interest is twofold. Although not originally from Chicago the Levys consider it their hometown and felt passionately about doing something there. Chicago also has the infrastructure — there are optometric providers who provide school-based eye care. But they face the same issues we do, which are participation, awareness of the connection between wearing glasses and doing well in school, and sustainability as far as having the kids keep their glasses on.

Is Vision for Baltimore showing the same kinds of results as BREDS did?

Collins: Vision for Baltimore and, now, Vision for Chicago, are longitudinal, randomized control trials. In Baltimore, we’ll look at years 2016 through 2019. Year 2 just started, and we won’t have the final results about impact on academic performance until after we get the Year 3 testing scores.

Are there other metrics that have shown the program’s progress to date?

Collins: How Vision for Baltimore works is, when a child fails a screening in school, he or she brings home a permission form that explains that the child failed a vision screening, but he or she can have an exam and get eyeglasses without any out-of-pocket cost to the parents as long as we have their consent. Last year, when we started the program, the return rate on forms was about 20 to 30 percent. In September this year, the return on those forms jumped to 65 percent. At least three schools we worked with had gotten to 100 percent. So those are good indicators.

Beyond the numbers, what are you hoping Vision for Baltimore and Chicago can achieve?

Slavin: An important aspect to note is that both Vision for Baltimore and Vision for Chicago are giant, randomized experiments — and that means they’re the quality of the best medical research. At the end of this, we should have rather definitive information about how much of a difference this kind of intervention can make. We’re documenting all the procedures we’ve followed. This isn’t just a good public policy story, or a heart rending story — this is good science. And that’s really crucial to our fundraising, to who we are, and to what we’re trying to accomplish.

To learn more about Vision for Baltimore and Vision for Chicago, please contact Kathy Anglemyer, senior associate director of development at the Wilmer Eye Institute, or Eleanor Landauer, senior associate director of development in the School of Education.