David S. Hite and Professor Steven J. Hite, Educational Leadership in the Mckay School of Education

The purpose of my research was to inform governmental leaders, teachers, and parents in Uganda of the importance and effect of vision on the academic performance of elementary-aged children. The information gathered and studied will not only help the children of the country of Uganda, but will also help guide future research for children in both developing and developed countries whose methods of detecting and treating vision problems may be inadequate.

Students were screened for various eye conditions such as near-sightedness, far-sightedness, depth perception, refractive or pathological conditions, and eye-focal power. The tests that were be performed can be conducted with minimal training, such that even with simple training teachers would be able to help identify vision problems in their own classrooms (although this will not be a method implemented in this study). The results of these procedures were plotted against last year’s grades in all subjects and overall score or “Best of Eight” scores, of the participating students.

The subject of this research has great potential to help children with vision challenges in countries all around the world, both developing and developed. It is likely that many children do not succeed in their local schooling system, not because they are academically inept or are unable or unwilling to learn, but because their vision is so poor they literally cannot “see” their way forward to success. There is a high probability that there are a great number of children in developing countries with undiagnosed vision challenges who, even if they were aware of their vision liabilities, do not possess the resources needed to acquire the needed vision care. This research will help show Ugandan leaders that there is a great need in this domain, and that if they will support the diagnosis and remediation of students’ vision, the incredibly scarce educational resources they invest can be more successfully leveraged for the benefit of both their country and individual students. More directly, addressing easily corrected vision problems can lead to more effective and efficient delivery on both social and personal investments in education and the national economy.

The participants in this project were Ugandan school children who were enrolled in the Senior 4 Ordinary (S4-O) level of their education. I took a proportional stratified random cluster sample of 24 schools
that included schools of various types stratified by the conditions of location (rural and urban), funding type (private and government), catchments (boarding and daytime), and gender restrictions (all boys, all girls, mixed). The final group consisted of eight different schools selected from each of the previously mentioned groupings. Within the schools that participated I randomly selected at least 12 male students and 12 female students to participate.

Each student selected to participate in the study was asked to report basic information regarding variables such as age, gender, previous eye care, time spent studying, parent involvement in studying, self-declared visual ability (if poor, do they think that they are at a disadvantage), do they have the means to get proper vision care, and if long periods of reading or studying cause discomfort. This data will help us to characterize our participants and see a larger scope of why their academic performance has been the way it has. The vision characteristics of the participants were then determined by performing a few simple procedures. Basic visual acuity was measured for both near and far sightedness, which will provide a rough estimate on their basic vision. This is the standard test given to children in elementary school settings, which includes covering one eye and reading lines of letters that correlate with visual acuity. This data is represented with interval data, as in 20/20 or 15/20, etc. If the student had visual acuities higher than 20/25 a pinpoint acuity test was also administered which would reveal if the vision was due to a refractive or pathological problem. Depth perception was measured by the participant wearing a pair of stereo-vision glasses designed make objects in a special book appear to be three dimensional. The special optometric book designed for this procedure facilitates various activities for the participant to perform. Based on the answers and ability of the participant to complete certain objectives with the apparent three-dimensional objects, I determined whether the participant had a problem with depth perception. This information was recorded as either having depth perception problems or not. Focusing power represents the difference in focus locations of each individual eye. This was determined by covering one eye of the participant and having them focus on an object; the covering on the eye is then removed and the distance the covered eye moves in order to focus in on the object in unison with the uncovered eye was be measured. This measurement helps determine the amount of strain that the student puts forth in order to read and change their point of focus.

172 students were screened, 89 females and 82 males. The ages of the students ranged from 14 to 22 years old, with 80.2% of them between the ages of 16 and 18. Of the 172 students screened, only 24 of them had combined visual acuities worse than 20/25. Of the 24 that had this level of vision only two of them had corrective lenses, which, upon inspection, did not have the correction necessary for improved visual acuities.

When comparing the visual acuities of the students to their “best of eight” scores it was found that having good vision itself did not guarantee good exam scores. Of those with 20/25 or better, the range of scores included from the highest score to the lowest score. However, if we only look at those students who had visual acuities greater than 20/25, as the vision worsens their “best of eight” scores go up (in this schooling system the lower the scores the better). There was a significant relationship between the increasing visual acuities and declining academic performance.

While performing this research I ran into various circumstances that I did not expect, as well as outcomes that I had not expected. It was always a challenge to find a location that would be suitable to perform the screenings, one with enough light and that was secluded enough as to not distract the participants. Although the national language of Uganda is English, I think that language was one of the major impediments to this project. The differences in vocabulary comprehension and use of language created some interesting mis- communications. During the research I expected to find many more students with high visual acuities, but I found that perhaps only two or three at each school had any problems. These results can be attributed to any number of factors, but further research will be required to determine what causes this decreased number of high visual acuities.

This project, and the experience that it gave me, will be of great value in my future career as an optometrist. The opportunity to see the real- life effects of vision in the lives of people around the world will provide me with a global perspective of in my career. I will use the results from this study to jump-start both future research and humanitarian projects throughout my life.