Importance Uncorrected refractive error in school-aged children may affect learning.

Objective To assess the effect of a school-based vision program on academic achievement among students in grades 3 to 7.

Design, Setting, and Participants This cluster randomized clinical trial was conducted in Baltimore City Public Schools during school years from 2016 to 2019 among 2304 students in grades 3 to 7 who received eye examinations and eyeglasses.

Intervention Participating schools were randomized 1:1:1 to receive eye examinations and eyeglasses during 1 of 3 school years (2016-2017, 2017-2018, and 2018-2019).

Main Outcomes and Measures The primary outcome was 1-year intervention impact, measured by effect size (ES), defined as the difference in score on an academic test (i-Ready or Partnership for Assessment of Readiness for College and Careers tests on reading and mathematics) between intervention and control groups measured in SD units, comparing cohort 1 (intervention) with cohorts 2 and 3 (control) at the end of program year 1 and comparing cohort 2 (intervention) with cohort 3 (control) at the end of program year 2. The secondary outcome was 2-year intervention impact, comparing ES in cohort 1 (intervention) with cohort 3 (control) at the end of program year 2. Hierarchical linear modeling was used to assess the impact of the intervention. Analysis was performed on an intention-to-treat basis.

Results Among the 2304 students included in the study, 1260 (54.7%) were girls, with a mean (SD) age of 9.4 (1.4) years. The analysis included 964 students (41 schools) in cohort 1, 775 students (41 schools) in cohort 2, and 565 students (38 schools) in cohort 3. There were 1789 Black students (77.6%), 388 Latinx students (16.8%), and 406 students in special education (17.6%). There was an overall 1-year positive impact (ES, 0.09; P = .02) as assessed by the i-Ready reading test during school year 2016-2017. Positive impact was also observed among female students (ES, 0.15; P < .001), those in special education (ES, 0.25; P < .001), and students who performed in the lowest quartile at baseline (ES, 0.28; P < .001) on i-Ready reading and among students in elementary grades on i-Ready mathematics (ES, 0.03; P < .001) during school year 2016-2017. The intervention did not show a sustained impact at 2 years or on Partnership for Assessment of Readiness for College and Careers testing.

Conclusions and Relevance Students in grades 3 to 7 who received eyeglasses through a school-based vision program achieved better reading scores. Students had improved academic achievement over 1 year; however, a sustained impact was not observed after 2 years.

Trial Registration The Registry of Efficacy and Effectiveness Studies Identifier: 1573.1v1

重要性 学龄儿童未矫正的屈光不正可能会影响学习。

目的 评估校本视力计划对 3 至 7 年级学生学业成绩的影响。

设计、设置和参与者 这项整群随机临床试验于 2016 年至 2019 年学年在巴尔的摩市公立学校进行，2304 名 3 至 7 年级学生接受了眼科检查和眼镜检查。

干预 参与的学校在 3 个学年中的 1 个学年（2016-2017、2017-2018 和 2018-2019）期间以 1:1:1 的比例随机接受眼科检查和配镜。

主要成果和措施 主要成果是 1 年干预影响，按效果大小 (ES) 衡量，定义为学术测试（i-Ready 或合作伙伴关系评估大学和职业准备就绪测试在阅读和以 SD 单位测量的干预组和对照组之间的数学），在项目第 1 年结束时比较队列 1（干预）与队列 2 和队列 3（控制），并在项目结束时比较队列 2（干预）和队列 3（控制）计划第 2 年。次要结果是 2 年干预影响，在计划第 2 年结束时比较队列 1（干预）和队列 3（对照）的 ES。分层线性模型用于评估干预的影响。分析是在意向治疗的基础上进行的。

结果 在纳入研究的2304名学生中，1260名（54.7%）为女生，平均（SD）年龄为9.4（1.4）岁。分析包括队列 1 中的 964 名学生（41 所学校）、队列 2 中的 775 名学生（41 所学校）和队列 3 中的 565 名学生（38 所学校）。有 1789 名黑人学生（77.6%）、388 名拉丁裔学生（16.8%） )，以及 406 名特殊教育学生 (17.6%)。 根据 2016-2017 学年的 i-Ready 阅读测试评估，总体上产生了 1 年的积极影响（ES，0.09；P = .02）。在女学生 (ES, 0.15; P  < .001)、特殊教育学生 (ES, 0.25; P  < .001) 和基线时表现处于最低四分位数的学生 (ES, 0.28; P < .001) 在2016-2017 学年 i-Ready 阅读和小学学生中 i-Ready 数学 (ES, 0.03; P < .001)。干预在 2 年或对大学和职业测试准备情况评估合作伙伴关系没有显示出持续影响。

结论和相关性 通过基于学校的视力计划获得眼镜的 3 至 7 年级学生取得了更好的阅读成绩。学生在一年以上的学习成绩有所提高；但是，2 年后没有观察到持续的影响。

试验注册 疗效和有效性研究登记处标识符：1573.1v1