School nurses can play a key role in the detection of significant refractive error. The purpose of this study was to assess the impact of a statewide school nurse vision screening program by evaluating the outcomes of screening among first, third, and fifth graders in 10 schools in North Carolina during the 2009-2010 school year. Of the 2,726 children who were screened, 7.7% (n = 209) were abnormal, of which 89% (n = 186) were placed into a comprehensive database for follow-up. No documentation of any follow-up was available for 35% (n = 65) of these children. Of the 106 with complete eye examination data available, 54.7% (n = 58) had myopia, 22.6% (n = 24) had hyperopia, 11.3% (n = 12) had astigmatism, 1.9% (n = 2) had anisometropia, and 9.4% (n = 10) were normal. Even with incomplete follow-up, this screening activity led to identification of 3 cases for every 100 children screened, underscoring the importance of high-quality school-based vision screening programs. (Contains 1 figure.)