Background: Since 2015, Iowa law has required all kindergarteners and third graders to be screened for vision issues and referred for care if they “fail” the eye exam or vision screening. Ultimately it is the parent’s responsibility to have the child screened and provide “proof” of the screening to their child’s school; the vision screenings are not coordinated by a central entity. Most vision screenings are provided to these children by: 1) one of three non-profit organizations (Iowa KidSight, Prevent Blindness Iowa and Vision to Learn), 2) the schools–often the school nurses, and/or, 3) the child’s personal physician/health care provider. The schools are the only entity that provides information regarding vision screenings, along with other mandatory immunization information, to the Iowa Immunization Registry Information System (IRIS). This purpose of this report is to present data regarding kindergarteners who received vision screenings in each county in Iowa as reported to the IRIS for the 2023-24 and 2024-25 academic years.
Methods: IRIS data included the following information: 1) date of screening, 2) date of birth, 3) Zip code, 4) result of screening (pass or fail), 5) whether a referral was made following a “failed” screening (yes or no), 6) screening source–categorized into three groups: a) schools, b) non-profit vision screening organizations (NGOs) and c) private/office clinic settings Kindergarteners were identified in the IRIS data using a combination of birth month/year and screening date, that were consistent with Iowa kindergarten enrollment law (i.e., children must be five years of age on or before September 15 of the school year to enter kindergarten). As only the month and year of birth were available in IRIS data, birthdates were standardized by assigning the first day of the recorded birth month as their birth date. The month and year of the fifth birthday was then calculated and compared against the eligibility cutoff for the academic year. For example, children were classified as kindergarten‑eligible for the 2023-24 academic year if their fifth birthday occurred between September 1, 2022, and September 30, 2023, inclusive. The same selection process was used for the 2024-25 academic year as well. The percentage of kindergarteners screened in each county was estimated using the number of children in the IRIS data who were identified as having received a vision screening over the total number of kindergarteners in each county. Each county’s kindergarten population (the denominator for the percent screened) was based on data from the Iowa Department of Education (Iowa DoE) regarding the number of kindergarteners enrolled in each county.
Results For AY 24/25: Statewide 19,630 kindergarteners in Iowa were screened for vision care. Over 500 kindergarteners were screened in the eight counties most populated counties, while under 200 kindergarteners were screened in 79 less populated counties. 49% of kindergarten students statewide received a vision screening (19,630 out of the 40,200 kindergarteners), however, fewer than 80% of kindergarten students received a vision screening that was reported to IRIS in 83 of Iowa’s 99 counties with fewer than 50% of kindergarten students were screened in 62 of Iowa’s 99 counties. 1,833 kindergarten students statewide did not pass a vision screening. Five counties reported more than 100 students who did not pass the screening, while 69 counties reported 10 or fewer students. In AY 2024–25, the statewide vision screening failure rate among screened kindergarten students was 9%. More than 10% of screened kindergarten students failed their vision screening in 30 counties. Four counties reported more than 100 kindergarten students referred for care after failing a vision screening. Fewer than 75% of kindergarten students who failed their vision screening were referred for follow-up care in 36 counties. 69% of the screening data were from NGOs. Schools and private office/clinics contributed 24% and 7% respectively.
Discussion: IRIS provides the best “imperfect” data available for evaluating effectiveness of vision screenings for Iowa kindergarteners with serious limitations to the data. (e.g., it undercounts screenings not submitted to schools). Thus, there is significant room for improvement of screenings and data considering that <80% of kindergarteners were reported to have been screened in 83 of the 99 counties according to the IRIS data. Vision screening are critically important as they can impact a children’s ability to learn, and factor into long term behavior issues. The Iowa Dept of Health and Human Services and the Iowa Dept of Education both have indicated that they do not currently track IRIS vision screening data or coordinate vision screenings in the schools. A consideration could be to establish a regional coordination system, similar to the I-Smile program for dental care, to ensure all schools coordinate vision screenings and referrals for kindergarteners and third graders-this could be particularly important in rural areas where both vision screenings and follow up care is more limited.