Background: An estimated 1 in 5 American children has a vision problem. Children living in poor urban environments have twice the normal rate of vision problems. Uncorrected vision problems can worsen over time and result in permanent vision loss. Early detection and treatment of vision problems is therefore essential in optimizing children's health and development. Federal-, state-, and school-based prevention efforts continue to evolve to identify and serve children with vision problems. Methods: Review of current literature on (1) major vision problems among children, (2) unique problems faced by low-income children with poor vision, and (3) the rise in health policy and program efforts to support the goal of healthy vision for each child. The preliminary relationship established between vision and academic performance is also discussed. Results: Low-income children have a disproportionate amount of vision problems and face several barriers to acquiring vision care. Varied actions among states include legislation requiring screening and follow-up before entry into elementary school. Conclusions: States and schools can take concrete steps to increase the number of children identified and treated for vision problems. Health policy and programs should also address common barriers to children receiving and wearing their glasses at home and in the classroom. Further research is necessary to assess the relationship between children's vision and educational outcomes. To the extent that vision is associated with academic success, policies and programs can be shaped to address the achievement gap that exists among our nation's youth and to support the goal of healthy vision for each child. (Contains 1 table.)