Column: Vision care in schools deserves second look

By Joshua Benton
Staff Writer

Page 1B

A big bold E, followed by F P T O Z.

And, if all is well, L P E D, P E C F D, and E D F C Z P.

Bring back any childhood memories? At some point, someone slapped a poster on a wall, stood you 20 linoleum tiles away and made you read as many of those letters as you could.

That nice school nurse may have been doing you a disservice. An increasing pile of evidence says the way schools check their students’ vision is broken. And some say it’s time for strong action.

“Most optometrists will tell you that the current system isn’t adequate,” said Clarke Newman, past president of the Texas Optometry Association. “Too many kids have problems that don’t get caught.”

The role of eye care in education has been on my mind because of Richard Rothstein’s terrific new book, Class and Schools. It’s a thought-provoking look at the reasons why, despite our best efforts, the achievement gaps between rich and poor and whites and minorities persist.

His answer: The impact of poverty is too strong for schools to truly overcome. You can’t close the achievement gap as long as basic class differences persist. Schools are, in the end, minor players in children’s education compared with their home environments.

Mr. Rothstein’s book is more than a little depressing. Even worse, it’s convincing. Track down a copy if you’re interested.

But what piqued my interest was his cataloging of all the ways poor students get stuck with a raw deal. They’re more likely to be born prematurely, to be exposed to lead, to have no books in the home, and to have less-educated parents. And they’re twice as likely as middle-class children to have severe vision problems.

“There are a whole bunch of kids who don’t have access to the eye care they need,” said John Todd Cornett, an Amarillo optometrist and a local school board member. “As a profession, we haven’t done enough to overcome that inertia.”

If a kid gets to kindergarten and has trouble reading his letters, the teacher thinks he’s slow – maybe a candidate for special ed. But in a lot of cases, he just can’t see the letters in front of him.

“Kids typically aren’t very good at reporting vision problems because they don’t know it’s possible to see things more clearly,” said Karla Zadnik, an Ohio State University professor whose research has shown high rates of vision problems in poor communities.

Texas leaves eye-care decisions up to individual school districts, and many don’t do more than slap that old eye chart on the wall once a year. But those screenings don’t do much beyond diagnose nearsightedness.

That’s great for kids who can’t see the chalkboard from their seats. But nearsightedness is rare among young kids – only about 2 percent of kindergartners have it. Farsightedness and astigmatism are much more common, particularly among the poor. And those are precisely the problems that can make reading a book frustrating and exhausting.

Vision problems are a huge part of academic difficulties. Harvard researcher Antonia Orfield did a study of inner-city Boston kids that showed between 10 percent and 30 percent of the variation in their reading test scores was attributable purely to untreated vision problems. When the kids who needed vision help got it, their test scores increased 4.5 percentile points in one year. Kids who didn’t get any help went up just 0.6 points.

If eye problems are a big academic drag, and the current school screenings aren’t getting the job done, what’s the answer? The example researchers point to is Kentucky. In 2000, Kentucky made a full doctor’s eye exam mandatory for a child enrolling in public school – just as mandatory as a measles vaccination. The idea is to catch eye problems before a kid runs into trouble reading. Any teacher will tell you that it’s awfully hard for a child who has early trouble reading to ever recover.

Kentucky educators and optometrists call it a success. “Parents love it,” said Bill Reynolds, a Kentucky optometrist who helped get the law passed. “They realize it makes sense to catch these problems early.”

Officials feared a backlash from parents over the cost of an exam – typically $30 to $80. But it never materialized. Nearly every child in the state was covered by private insurance, the state’s poor children’s insurance program or donations from optometrists. The Legislature dedicated a special fund to pay for kids who can’t afford even those options, but it costs the state less than $5,000 a year – total.

A number of states are considering the Kentucky model or something like it. When the Texas Legislature comes back into session in January, it will be looking for ways to boost academic achievement while keeping costs low. They may want to think about what the first George Bush might have called “the vision thing.”