Visual impairment and myopia among first graders from three school districts in Southern California: Racial/ethnic disparities, yearly trends, geospatial distribution, and relative influence of individual, neighborhood, and school determinants

Vision loss in children can result in blindness, lower academic achievement, and psychological stress. Many U.S. states require school vision screenings among first graders to identify vision problems. No population-based study has examined the relative influence of multiple individual and environmental determinants on visual impairment and myopia in first graders. Ophthalmologists at the UCLA Jules Stein Eye Institute Mobile Eye Clinic (MEC) examined the eyes of 72% of all first-graders, aged between 5 and 7 years, in 17 schools within three schools districts: Hawthorne, Lawndale, and Rosemead, in Southern California, between 1999 and 2006. Among 11,335 children, 9% had visual impairment and 18.4% had myopia. A linear increase in the rates of visual impairment and myopia occurred between 1999 and 2006. The gap in rates between white and black children widened throughout the years; whites children had the lowest rates. In adjusted logistic regression models, children residing in neighborhoods with a greater proportion of families below the poverty line, experienced an increased likelihood of having visual impairment and myopia. In adjusted analyses, children in schools where a greater proportion of black children studied, had an increased likelihood of having visual impairment. Using Geographic Information Systems, relatively high prevalence rates of myopia or poor visual acuity existed in almost all Census tracts. A new conceptual model specifying relationships among determinants where environmental (neighborhood and school) factors were direct predictors of visual impairment, fit the data acceptably, using structural equation models. Given the high prevalence of visual impairment and myopia overall and by census tract, annual increases in prevalence, rising gaps in disparities, and associations with poverty, recommendations are to require ophthalmic eye exams such as those offered by the MEC instead of basic screenings that miss more cases of vision loss, develop interventions to increase adherence to vision care recommendations, offer complementary eye exams in programs for low-income families such as Learning to Read, School Readiness, and Healthy Start programs, and support the Vision Care for Kids Act calling for comprehensive eye exams, which was passed on March 31st, 2009 in the U.S. House of Representatives.