ABSTRACT: A population-based cohort of all children entering kindergarten in a three-year period (N = 2,938) was followed retrospectively from kindergarten through 12th grade to estimate incidence of abnormal school vision screening tests and rates of follow-up by community ophthalmologists or optometrists. Overall 28% of children had at least one abnormal school vision screening test. Abnormal screening with referral increased from 1.2% of five-year-olds to 9.1% of 13-year-olds. Overall, 91% of children referred had further evaluation by eye care professionals. However, visits to an eye care professional often were delayed; median time was 0.8 years for children seeing an ophthalmologist and 1.8 years for children seeing an optometrist. Results support the continued use of simple visual acuity screening in schools. Consideration should be given to screening children beyond age 12 and developing methods to increase the rapidity of parental response to referral recommendations.