Posted by: Francis Koster Published: December 18, 2023

The Goal of This Newsletter is to Help You See… (December 1, 2023)

The goal of this newsletter is to help you see ways to improve student learning by interventions outside the classroom.


As I mentioned in previous newsletters, unrecognized student health issues are one of the two primary reasons for low student success and poor school rankings.  Contrary to common belief, poor learning is not usually the fault of the teacher, or poor parenting.  It is something else unseen.

In America, there are half-a-dozen organizations that rank order the performance of individual schools, school districts, and the cumulative total of all school systems in a state compared to all the other states. Some of these ranking systems include the success/failure of state higher education institutions, some only look at K-12 graduation rates and/or standardized test results, and others take a comprehensive look at a number of variables. Using one of the most respected of those, called Scholaroo, North Carolina’s public school system ranks forty-fourth (44th) in school quality out of the 50 states.[1]

Perhaps not surprisingly, our per-capita funding for students positions us even lower, at forty-eighth (48th) out of 50. [2]

A contributor to this low ranking is the fact that of all  50 states, North Carolina has one of the weakest set of requirements for screening students for vision issues – students must be “screened” (has a legal definition) only once in their entire K-12 experience, and that is when they first enter primary school, or are a new first time enrollee in a school who has not been screened elsewhere in the school district. [3]   No further assessment of vision is required as the student advances to middle or high school, even though the percentage of students losing optimal vision for learning triples as they enter puberty age.[4]

According to many sources (see footnotes), around 1 in 4 school aged children require treatment for vision conditions, and most of these children and their families or their teachers do not know it. [5],[6]

If you do the math, that amounts to 360,000 students In North Carolina. [7]

This week I will attempt to help you “see” this  major issue more clearly (I know that sounds silly, but I am trying to make you smile).

Look 😊at this poster, called the Snellen chart.  You have undoubtably squinted at it several times in your life.   Did you know it was invented in 1862? [8]  For its time it was an amazing innovation. In spite of major technical advances which have created better vision testing options since the 1990’s,  it is still the most widely used vision testing tool.

It is normally done at 20 feet, and if the child can see the 6th row down, at 20 feet, they are classified as having 20/20 vision.[9]


I bet you do not know that it has limitations that can disadvantage students.[10]

The Snellen Test done at 20 ft. does not identify the following problems:

  • The ability to see things that are close (Most learning is done within an arm’s length; such as reading from a book or working at a desk.)
  • Eye coordination (binocularity) and focusing
  • Convergence (a visual skill required for reading)
  • Eye movement and tracking
  • Depth perception and peripheral vision
  • Visualization
  • Strabismus (crossed or wandering eye)

Sorting out a school child’s learning issues is complicated.  For example, several studies have shown that up to 40% of students diagnosed with a learning disability actually have a vision issue rather than a learning disability. [11]

Once the North Carolina student has been “screened” in the first year of education, school systems often rely on school nurses to identify maturing students who developed vision problems after their first “screening”.  In 2022/23, due to the legislature’s funding levels for schools, North Carolina had only one school nurse for every 1,000 students.[12]   The national recommended ratio is one for every 750.

The school nurse workload is largely focused on known students with diagnosed chronic conditions like asthma or diabetes, and kids who turn up at the nurses door with a cold, headache, or other illness – and if the nurse has too many kids lined up outside the door, unless the school does a survey, the chances of the nurse spotting a student squinting as they look as a hallway poster are slim.

Before we go further, let me remind you that in the arena of student health, there is a need for using a precise vocabulary. The words “testing for”  and “screening for” are often used in policy documents, legal forms, and the healthcare billing process, and often define specific ways that “tests” or “screenings” must be carried out – and they can vary from state to state or school district to school districts.

When I am speaking  about the benefits of checking out large numbers of children to surface unsuspected health issues that reduce learning rates, I deliberately use the word “survey” – and suggest you do also, because you can use newer technology to “survey”, and when you uncover a student who may need professional attention, you can send them for “testing” or “screening” and stay out to trouble.

This is important because If one in four k-12 students [13 [14] have unrecognized vision challenges, some form of mass overview “survey” is needed.  Conducting such a survey It is a huge opportunity to raise your standardized test scores, statewide school ranking, local property values, and ultimately funding for local schools .


In the next issues of this newsletter, I will be introducing you to school system's leadership that have created innovative programs to grab this opportunity.  As you might anticipate, these often include the use of trained volunteers, and new software programs that run on laptops and other digital tools.  And just to help you see into the future, they have a great return on investment for the school system.



[1] ranked%2035th%20in,and%2038th%20in%20student%20safety.














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Francis P. Koster Ed.D.

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Francis P. Koster, Ed. D.

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