Vision and Blindness

If you wear reading glasses, please remove them for a moment, and continue reading.

Back to normal? For a moment, you had an experience like that of about 30% of Baltimore students. Some have myopia (nearsightedness) and some hyperopia (farsightedness), and some other problems. But few have glasses. A study in grades 2-3 found that only 6% of students had glasses in school, and 30% needed them. Kids being kids, even those who have glasses may soon lose or break them, and glasses are rarely replaced for kids in inner-city schools. As a result, some students can’t see the whiteboard, some can’t see their books, and many quietly think they are not smart because they struggle to focus on the printed word. In Maryland, students’ vision is tested only at school entry (usually pre-k), first grade, and eighth grade. If routine screenings find a problem, a note goes to parents asking them to get a formal assessment. In Baltimore, this results in about 10% of children who need glasses getting them. And then what do you think happens to those glasses between first and eighth grade?

I’ve been involved with studies of vision in inner-city schools along with colleagues Megan Collins, David Friedman, Michael Repka, and others from the Wilmer Eye Clinic at Johns Hopkins Medical Institutions, and Nancy Madden and others from the Johns Hopkins School of Education. The name of the project is Vision for Baltimore, and it operates under the authority of the Baltimore City Health Department, which has been a strong supporter. What we are finding is in one sense a privileged glimpse into the perfectly obvious. Inner city children who need glasses don’t often get them. We tested all students in grades 2-3 in 12 high-poverty Baltimore schools, and we gave those who needed them free glasses. We also followed up to make sure the students were wearing glasses, and we replaced those that were lost or broken. Students who received the glasses gained significantly on reading tests in comparison to those who never needed glasses. Of course. Yet this was the first U.S. study of its kind to show an effect of glasses on reading (two Chinese studies had found the same).

We are now doing a much larger study. A philanthropic group called Vision to Learn (VTL) wanted to provide assessments and free glasses to every elementary and middle school student in Baltimore over a three-year period. VTL has mobile vision vans, staffed with an optometrist and an optician. The vans can test all students who were found in screening to need assessment, and then provide free glasses if needed. With funding from Baltimore’s Abell Foundation and the Laura and John Arnold Foundation, we arranged to randomly assign schools to receive their vision services either in the first, second, or third year, enabling us to find the impact of these services in reading and math performance, mostly on state tests.

It will be a couple of years before we will know the results of our research, but I can tell you this much. As in our smaller study, we found that very few children already had glasses, and about 30% needed them. This fall, the first glasses are arriving, and the students are blown away. One fifth grade girl said, “Is this the way things are supposed to look?”

Now think about that girl. If she needs glasses now, she has probably needed them for years. How much damage was done to her essential early education? How much was her self-esteem damaged by learning problems due to nothing more than poor vision?

I should hasten to add that eyeglasses for students who need them are an inexpensive intervention. In the enormous quantities involved, a pair of glasses that kids are eager to wear may cost less than $20. Further, Medicaid pays for eyeglasses for all children who qualify as low income, which equates to nearly every child in Baltimore. Vision to Learn has worked out ways to make this easy to administer, so that modest funds from an existing federal program can be used for this essential service.

Vision is important. We hope our work and that of others around the U.S. will develop simple, replicable means of improving the achievement of disadvantaged children by giving them needed eyeglasses. But what I really want to talk about today is not vision, but blindness. Moral blindness. Policy blindness. Pragmatic blindness.

It so happens that vision is an excellent case to illustrate our moral, policy, and pragmatic blindness. We spend approximately $11,000 per child per year, on average, to educate a child. From all that expenditure, we want successful, capable, skilled students, who can enter higher education or the workforce with confidence and well-founded hopes of success. We want students who will follow the rules because they know that they can succeed if they do.

Yet we let $20 worth of eyeglasses stand in their way.

We spend vast amounts of money on special education, remedial services, even tutoring. Yet some proportion of the children who receive these services just needed eyeglasses instead. The policy world has tried for years to reduce special education costs and integrate children in regular classes. Many likely never needed special education to begin with.

Yet we let $20 worth of eyeglasses per child stand in our way.

We know that young people who fail in school are far more likely to become delinquent and later criminal. The costs of policing and incarceration are huge, and we need to reduce them.

Yet we let $20 worth of eyeglasses per child stand in our way.

There are lots of very difficult problems in education. This does not happen to be one of them. Can we all agree to put glasses on every disadvantaged child who needs them? This will not solve all of our problems, but if would be a heck of a start. While we’re at it, we also ought to look into hearing and other medical problems that hold kids back.

There are none so blind as those who will not see.

Correction

In an earlier version of this blog, I forgot to mention the name of the project and the authority under which is operates. I apologize for the omission.

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