Objectives: To outline the prevalence and disparities of vision problems among school-aged urban minority youth, causal pathways through which vision problems adversely affects academic achievement, and proven or promising approaches for schools to address these problems. Methods: Literature review. Results: More than 20% of school-aged youth have some kind of vision problem. In a nationally representative sample of more than 48,000 youth under age 18, those from lower income families were less likely to have diagnosed eye conditions than White children and children living in higher income families. When diagnosed with eye care problems, Black youth living in poverty received fewer and less intensive services. Causal pathways through which vision problems adversely affect academic achievement include sensory perceptions, cognition, and school connectedness. Vision screening is widespread in the nation's schools, but the educational (and public health) benefits from these efforts are jeopardized by lack of follow-up and coordination of efforts. Conclusions: Vision problems are highly and disproportionately prevalent among school-aged urban minority youth, have a negative impact on academic achievement through their effects on sensory perceptions, cognition, and school connectedness, and effective practices are available for schools to address these problems. School-based vision screening programs are a logical approach for the early detection and treatment of vision problems affecting youth and are widely implemented in the nation's schools. To more fully realize the educational (and public health) benefits of current investments in screening, programs will require improved follow-up and coordination between and among agencies conducting screening, school nurses, teachers and parents, and in some cases community resources. (Contains 1 figure.)