Bridging the eye-care gap in Baltimore city schools

Dr. Megan Collins, an ophthalmologist and glasses-wearer since first grade, co-founded Vision for Baltimore to bring much needed vision screenings and glasses to kids from pre-K to eigth grade in Baltimore city schools. (Vision for Baltimore/Johns Hopkins University)

By Shivani Majmudar
Medill Reports

BALTIMORE, Md.– Pediatric ophthalmologist Dr. Megan Collins took her clinic on “house calls” for the first time nearly seven years ago. Instead of examining children’s eyes and vision in the comfort of her office space, where there were ample tools for screening and private space to talk to the kids and their families, she went to her patients at their natural space: elementary school classrooms.

“It was such a powerful experience because I got to see kids in their school environment, how they interacted and the specific challenges they had,” she recalled.

Collins is an associate professor at the Wilmer Eye Institute of Johns Hopkins Medical Institutions. After meeting Collins this spring, I followed her through several Zoom meetings with educators, school administrators and nurses, often all in the same day. As a children’s eye doctor, she was a natural fit in the space of vision and education. I was surprised to learn she’d only been working with schools for a few years.

When she visited her first Baltimore City Public School wearing her white coat and carrying her ophthalmoscope, she was not expecting the chaos of throngs of children running through the hallways. The chaos didn’t end there.

She saw some kids whose glasses were duct-taped together and met others who had simply lost their glasses years before, never to see them replaced. Just 6%-9% of kids in Baltimore had glasses, although nearly 25% of the population needed them, according to data from Johns Hopkins. As a result, many second- and third-graders struggled to read or see the board in class. If kids are not proficient in reading by the end of third grade, it significantly derails their academic trajectory, Collins says.

“These were kids that I likely would not have seen in my clinic,” she said. “It underscored the massive, unmet need for pediatric eye care, and schools are a natural place to meet kids where they’re at.”

Addressing the need for vision care in schools also gave Collins the unique opportunity to bring together synergies from her diverse academic backgrounds in ophthalmology, public health and ethics.

Growing up, Collins was always fascinated by the humanities, in part because her mother was a high school humanities teacher near their home in Connecticut. Her interest in medicine stemmed from her childhood battle against Lyme disease, an infection that spreads by ticks. At the time, however, Lyme disease was fairly unknown, and it took her several months to get the correct diagnosis. As she bounced between hospital beds across the East Coast, she found herself enamored by the hospital setting.

“I enjoyed watching doctors interact with the rest of my medical team,” she said. “But I also remember being really frustrated by doctors who I thought were bad at communicating. I wanted to be a doctor who knew how to communicate better with their patients to help them overcome diseases.”

Studying the humanities, she says, is one way she learned the art of communication. After medical school, she pursued master’s degrees in bioethics and public health, despite strong discouragement from others. People would say the fields seemed “dramatically opposed” from the niche specialty of pediatric ophthalmology, she recalls, but their words only motivated her further to find ways to intertwine her interests.

When Collins stepped back into schools as a physician, it gave her a chance to work at the perfect intersection of medicine, education, public health and ethics. The overwhelming need for accessible, pediatric eye care led Collins and her colleagues in ophthalmology and education at Johns Hopkins to launch Vision for Baltimore, a public health program designed to bring glasses to thousands of Baltimore city school students, in 2016.

V4B, as it’s known, leverages the support of several key partners to guide students through the entire process of acquiring glasses – from the initial vision screening conducted by the Baltimore City Health Department to shipping customized glasses from Warby Parker directly to kids’ homes. Students do not have to leave school grounds for any appointment, and all students are eligible to participate, regardless of their ability to pay.

Vision to Learn, one of Vision for Baltimore’s community partners, conducts full eye exams for students right outside schools in their mobile clinic. (Vision for Baltimore/Baltimore City Health Department)

Today, the program has served students in 137 elementary and middle schools across the city, providing nearly 8,000 pairs of glasses. But V4B doesn’t just disappear after handing kids their glasses – they place vision advocates in schools to monitor that students are regularly using them and to promote a glasses-wearing culture.

“If you give someone glasses, but you don’t explain why they need to wear them, how to take care of them, what to do if they get lost or broken, you’re not maximizing your impact on the patient,” Collins said. This education is one of the most important aspects of the program, she says, because it directly contributes to its immediate success and sustainability.

Thinking about vision outside of the clinic and bringing care into the space of education was a huge learning curve, Collins says, although now it’s part of her everyday medical routine. She found herself drawing on the knowledge and experience she gained from her time in school. For the V4B team, Collins’ position as a medical doctor, public health expert and ethicist has been one of the program’s biggest assets, says Amanda Neitzel, an assistant research scientist at Johns Hopkins’ School of Education.

“Having someone like Megan who is an expert in ophthalmology and public health is so useful because these questions come up all the time,” Neitzel said, adding it was especially important in deciding how to safely run the program during the COVID-19 pandemic (eye exams can be high-risk because doctors can’t always stay 6 feet away from patients). “Her backgrounds help us balance the needs of individual students with our goal of improving vision care for the pediatric community at large.”

When V4B started screening kids again in schools, they created an efficient system where providers would spend only the required time within 6 feet of patients, often less than five minutes. The rest of the visit, social distancing protocols were strictly in place, as well as masking policies.

Over the last several years, V4B evolved from an interesting research study into an independent model for school-based vision care reform. Collins says its success stems from the meaningful partnerships the V4B team has crafted with government, community and for-profit organizations – together, they built a space for students who are often overlooked by traditional systems to receive eye care.

While this is true, Collins is humble – an attribute shared by the world’s greatest public health leaders and something I’ve had the pleasure to see for myself working alongside her for the last month.

“What’s exciting about this project is that it’s still going five years later. Most projects in education last for a couple of years while they’re hot and shiny, and then go away once funding dries up,” Neitzel said. “Megan’s passion and willpower is what holds V4B together.”

Shivani Majmudar covers health disparities, science and policy at Medill. You can follow her on Twitter @spmajmudarr