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Introduction Socio-economic status (SES) influences paediatric visual health by affecting eye care access, refractive error prevalence and spectacle provision. This study examines the link between household income and paediatric vision outcomes in Orange County, California, USA using data from the University of California, Irvine EyeMobile Pediatric Clinic (2021–2024).Methods Vision screening was conducted on 15 842 children (ages 3–10). Subsequent comprehensive eye examinations were performed on 3350 children who failed initial screening. Socio-economic stratification was based on zip-code-level median household income (MHI), categorised as below-average or above-average for Orange County. A retrospective cross-sectional analysis of examination data compared visual acuity, refractive error and spectacle provision rates between the two SES groups.Results Children from below-average MHI areas had higher screening failure rates than those from above-average MHI areas (24.6% vs 18.5%) and a higher odds of screening failure (OR 1.44, 95% CI 1.33 to 1.57). They also demonstrated a higher need for spectacles (70.3% vs 64.8%), with an increased odds of requiring spectacles (OR 1.28, 95% CI 1.05 to 1.56). The prevalence of astigmatism was higher among children from areas with below-average MHI (75.3% vs 66.1%), corresponding to a significantly higher odds of astigmatism (OR 1.56, 95% CI 1.36 to 1.79). Best-corrected distance visual acuity improved with the provision of spectacles in both income groups; however, children from lower-income communities were more likely to present with uncorrected visual impairment during screening, consistent with the higher screening failure rates observed.Conclusion Children from lower-income communities demonstrated higher rates of uncorrected visual impairment and a greater need for vision care services, while children from higher-income communities also faced substantial unmet vision needs. A mobile school-based vision screening programme, such as the EyeMobile, could significantly benefit both groups by promoting equitable access to vision care.