The association between refractive cutoffs for spectacle provision and visual improvement among school-aged children in South Africa

Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis

AIM

To conduct a systematic review and meta-analysis assessing whether vision and/or eye disorders are associated with Autism Spectrum Disorder (ASD).

METHOD

Based on a pre-registered protocol (PROSPERO: CRD42022328485), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 5th February 2022, with no language/type of document restrictions. We included observational studies 1) reporting at least one measure of vision in people of any age with a diagnosis of ASD based on DSM or ICD criteria, or ADOS; or 2) reporting the prevalence of ASD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random-effects meta-analyses were used for data synthesis.

RESULTS

We included 49 studies in the narrative synthesis and 46 studies in the meta-analyses (15,629,159 individuals distributed across multiple different measures). We found meta-analytic evidence of increased prevalence of strabismus (OR = 4.72 [95% CI: 4.60, 4.85]) in people with versus those without ASD (non-significant heterogeneity: Q = 1.0545, p = 0.7881). We also found evidence of increased accommodation deficits (Hedge's g = 0.68 [CI: 0.28, 1.08]) (non-significant heterogeneity: Q = 6.9331, p = 0.0741), reduced peripheral vision (-0.82 [CI: -1.32, -0.33]) (non-significant heterogeneity: Q = 4.8075, p = 0.4398), reduced stereoacuity (0.73 [CI: -1.14, -0.31]) (non-significant heterogeneity: Q = 0.8974, p = 0.3435), increased color discrimination difficulties (0.69 [CI: 0.27,1.10]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890), reduced contrast sensitivity (0.45 [CI: -0.60, -0.30]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890) and increased retinal thickness (=0.29 [CI: 0.07, 0.51]) (non-significant heterogeneity: Q = 0.8113, p = 0.9918) in ASD.

DISCUSSION

ASD is associated with some self-reported and objectively measured functional vision problems, and structural alterations of the eye, even though we observed several methodological limitations in the individual studies included in our meta-analyses. Further research should clarify the causal relationship, if any, between ASD and problems of vision during early life.

PROSPERO REGISTRATION

CRD42022328485.

Modelling ready-made spectacle coverage for children and adults using a large global database

BACKGROUND/AIMS

To model the suitability of conventional ready-made spectacles (RMS) and interchangeable-lens ready-made spectacles (IRMS) with reference to prescribing guidelines among children and adults using a large, global database and to introduce a web-based application for exploring the database with user-defined eligibility criteria.

METHODS

Using refractive power and interpupillary distance data for near and distance spectacles prescribed to children and adults during OneSight clinics in 27 countries, from 2 January 2016 to 19 November 2019, we modelled the expected suitability of RMS and IRMS spectacle designs, compared with custom-made spectacles, according to published prescribing guidelines.

RESULTS

Records of 18 782 presbyopic adult prescriptions, 70 619 distance adult prescriptions and 40 862 paediatric prescriptions were included. Globally, 58.7%-63.9% of adults could be corrected at distance with RMS, depending on the prescribing cut-off. For presbyopic adult prescriptions, coverage was 44.1%-60.9%. Among children, 51.8% were eligible for conventional RMS. Coverage for all groups was similar to the above for IRMS. The most common reason for ineligibility for RMS in all service groups was astigmatism, responsible for 27.2% of all ineligible adult distance prescriptions using the strictest cut-off, 31.4% of children's prescriptions and 28.0% of all adults near prescriptions globally.

CONCLUSION

Despite their advantages in cost and convenience, coverage delivered by RMS is limited under current prescribing guidelines, particularly for children and presbyopic adults. Interchangeable designs do little to remediate this, despite extending coverage for anisometropia. Our free application allows users to estimate RMS coverage in specific target populations.

Implementing interventions to promote spectacle wearing among children with refractive errors: A systematic review and meta-analysis

Purpose

To investigate the level of compliance of children with refractive errors who are provided free spectacles, and to identify the reasons for non-compliance.

Methods

We systematically searched the PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library databases from the time these databases were established to April 2022, including studies published in English. The search terms were “randomized controlled trial” [Publication Type] OR “randomized” [Title/Abstract], OR “placebo” [Title/Abstract]) AND ((“Refractive Errors”[MeSH Terms] OR (“error refractive” [Title/Abstract] OR “errors refractive” [Title/Abstract] OR “refractive error” [Title/Abstract] OR “refractive disorders” [Title/Abstract] OR “disorder refractive” [Title/Abstract] OR “disorders refractive” [Title/Abstract] OR “refractive disorder” [Title/Abstract] OR “Ametropia” [Title/Abstract] OR “Ametropias” [Title/Abstract])) AND (“Eyeglasses” [MeSH Terms] OR (“Spectacles” [Title/Abstract] OR “Glasses”[Title/Abstract]) AND (“Adolescent” [MeSH Terms] OR (“Adolescents” [Title/Abstract] OR “Adolescence”[Title/Abstract]) OR “Child”[MeSH Terms] OR “Children”[Title/Abstract])). We only selected studies that were randomized controlled trials. Two researchers independently searched the databases, and 64 articles were retrieved after the initial screening. Two reviewers independently assessed the quality of the collected data.

Results

Fourteen articles were eligible for inclusion, and 11 studies were included in the meta-analysis. The overall compliance with spectacle use was 53.11%. There was a statistically significant effect of free spectacles on compliance among children (OR = 2.45; 95% CI = 1.39–4.30). In the subgroup analysis, longer follow-up time was associated with significantly lower reported ORs (6–12 vs. <6 months, OR = 2.30 vs. 3.18). Most studies concluded that sociomorphic factors, RE severity, and other factors contributed to children not wearing glasses at the end of the follow-up.

Conclusion

The combination of providing free spectacles along with educational interventions can lead to high levels of compliance among the study participants. Based on this study's findings, we recommend implementing policies that integrate the provision of free spectacles with educational interventions and other measures. In addition, a combination of additional health promotion strategies may be needed to improve the acceptability of refractive services and to encourage the consistent use of eyewear.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=338507, identifier: CRD42022338507.

Visual acuity and refractive findings in children prescribed glasses from a school-based vision program

PURPOSE

We report visual acuity improvement and refractive profiles in children prescribed glasses by a school-based vision program (SBVP) in Baltimore, Maryland.

METHODS

In this cross-sectional analysis, pre-kindergarten through 8th grade students who failed vision screening underwent an eye examination. Students prescribed glasses are included. Visual acuity improvement was the difference between presenting and best-corrected visual acuity based on noncycloplegic manifest refraction. Clinically significant refractive error (CSRE) was defined as ≥0.75 D myopia, ≥2.00 D hyperopia without strabismus, ≥1.00 D hyperopia with esodeviation, or ≥1.50 D astigmatism AND presenting visual acuity ≤20/40 or ≥2-line interocular difference with the better-seeing eye ≤20/30. Characteristics associated with greater visual acuity improvement were explored.

RESULTS

Of the 4,972 students, mean age was 9.4 ± 2.7 years; 77% were black, and 18% were Hispanic. Myopia, hyperopia, astigmatism, and CSRE were found in 65%, 24%, 60%, and 46% students, respectively. In the better-seeing eyes, 70% gained ≥2 lines. Of students with CSRE, improvement of at least 5 lines in the worse-seeing eye increased from 30.9% in pre-kindergarten and kindergarten to 77.3% in 7th and 8th grade (P_trend < 0.001). Students with CSRE had a higher rate of gaining at least 2 lines' improvement in their worse-seeing eyes compared with those without (98.7% vs 80.6%). Older students as well as black and Hispanic students were more likely to have improvement of at least 2 lines.

CONCLUSIONS

Most students prescribed glasses from our SBVP had clinically significant visual deficits corrected.

Factors influencing post-screening visits of students to local vision centres in rural northwest China

CLINICAL RELEVANCE

Children with uncorrected visual impairment have lower scores on a variety of motor and cognitive tests. Exploring the influencing factors of low-income groups seeking vision care services is helpful for identifying relevant barriers and necessary measures to improve the utilization rate of vision care services.

BACKGROUND

The community-based vision center (VC) is a popular model for solving vision problem of students in rural China. Compliance is the key factor to the success of the VC model. Factors determining compliance with visitations to VC among primary school students after screening were explored.

METHODS

A cross-sectional study was conducted with 15,763 students from 228 primary schools. Information was collected through questionnaires and vision examinations. The determinants that affect visits of students to the VC were analyzed using logistic regression.

RESULTS

Among the 15,763 sample, 5,361 (34%) students had a visual impairment. At baseline, only 962 (18%) of students with visual impairment sought vision care services. After a local VC was established, among the 5,163 students who needed to be referred, only 2,237 (43.33%) students visited the VC. Multivariate logistic regression models for predicting students visit the VC revealed that the following characteristics were significant predictors: poor uncorrected visual acuity (P < 0.001), a higher grade level (P = 0.008; P = 0.010), 'left-behind' children (P < 0.001), short living distance between home and the VC (P < 0.001), and the fact that these students lived in Gansu province (P < 0.001).

CONCLUSIONS

Establishing a VC that provides students with vision screening and free vision care services can increase the rate of seeking vision health services for students in rural areas, but the compliance rate still needs to be improved. The influencing factors for student compliance have been identified.

Early Age of the First Myopic Spectacle Prescription, as an Indicator of Early Onset of Myopia, Is a Risk Factor for High Myopia in Adulthood

Purpose

The present study investigated the risk factors for high myopia in adulthood, with a focus on the age at which children wore their first spectacles.

Methods

Adults aged between 20 and 45 years were invited to complete a questionnaire about age, sex, current refractive error, high myopia in parents, early onset of myopia presented by the age of the first myopic spectacle prescription, refractive power of the first spectacles, and life habits at different educational stages. The associations between these factors and high myopia in adulthood were then evaluated and analyzed.

Results

In total, 331 participants were enrolled. Their average refractive error was −4.03 diopters, and high myopia was noted in 27.5% of the study participants. Only 3.3% of participants had fathers with high myopia, while 6.0% had mothers with high myopia. The participants received their first myopic spectacle prescription at a mean age of 13.35 years, with a mean refractive error of −1.63 diopters. The significant risk factors for developing high myopia in adult life were earlier age of the first spectacles prescribed (p < 0.001), higher refractive power of the first spectacles (p < 0.001), mother with high myopia (p=0.015), and after-school class attendance in senior high school (p=0.018). Those who wore their first spectacles at <9 years of age were more predisposed to high myopia than those who did so at ≧13 years, with an odds ratio of 24.9.

Conclusion

The present study shows that earlier onset of myopia, which is presented by the age of the first myopic spectacle prescription, higher myopic refraction of the first spectacles, mothers with high myopia, and after-school class attendance in senior high school are risk factors for high myopia in adulthood. It suggests that delaying the onset of myopia in children is important for the prevention of high myopia in later life.

An Intervention to Promote Adherence to Glasses Wearing Among Urban Public Elementary School Students: Associations With Classroom Behavior

Glasses wearing at school remains low even when glasses are provided. This study investigated whether a classroom intervention to promote glasses wearing was associated with increased glasses wearing and improved classroom behavior. A pretest, posttest design was implemented with 44 students in Grades 1-4 at an urban public elementary school. Over 5 weeks, teachers encouraged eyeglass wearing through a classroom tracker, verbal reminders, and incentives. Glasses wearing and student behavior were monitored using the Direct Behavior Rating Scale of academic engagement and behavior for 13 weeks, including 4 weeks before and after the intervention. Glasses wearing increased from 56% to 73% (95% confidence interval [CI] = [0.08, 0.26]) in the first 2 weeks of the intervention, but not after a spring recess. The intervention was associated with significantly improved academic engagement (4.31%, 95% CI [2.17, 6.45]), respect (3.55%, 95% CI [1.77, 5.34]), and disruption (-4.28%, 95% CI [-6.51, -2.06]) compared to baseline. Higher academic engagement and disruption persisted 4 weeks after the intervention ended. A classroom-based glasses tracking and incentive system is associated with improved eyeglass wearing and classroom behavior among elementary students. A longer term randomized trial is needed to confirm these promising results.

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China: A Cluster Randomized Clinical Trial

Importance

Visual impairment is common among children in rural China, but fewer than one-third of children with poor vision own and wear eyeglasses.

Objective

To study the effect of hospital-based vision centers on academic performance, ownership of eyeglasses, and eyeglasses-wearing behavior in rural Chinese children.

Design, Setting, and Participants

Cluster randomized, investigator-masked, clinical trial from September 2014 through June 2015. A vision center capable of providing refractive services was established in the Hospital of Yongshou County, a nationally designated poor county in rural Shaanxi Province, western China. All 31 rural primary schools in Yongshou County participated; participants were all children in grades 4 through 6 (aged approximately 10-12 years) with uncorrected visual acuity of Snellen 6/12 or worse in either eye (2613 children). Data analysis was conducted March through May 2016, and data were analyzed by the intention-to-treat principle.

Interventions

After teacher-led vision screening early in the school year (September-October 2014), schools were randomly assigned to either early referral (December 2014-February 2015) to the vision center for refraction and free eyeglasses if needed or late referral (March-June 2015) for the identical intervention.

Main Outcomes and Measures

The primary outcome was score on a study-administered mathematics test (June 2015) adjusted for baseline score. Secondary outcomes were self-reported eyeglasses ownership and wear at final examination (June 2015).

Results

All 2613 children evaluated were of Han Chinese race/ethnicity, and 1209 (46.3%) were female. Twelve hundred children (45.9%) met the vision criteria. Among these, 543 (45.3%) were randomized to early screening and 657 (54.7%) to late screening; 433 (79.7%) of the early screening group and 516 (78.5%) of the late screening group completed the study. Of eligible children, 120 (27.7%) owned eyeglasses at baseline. The adjusted effect on test scores comparing early and late groups was 0.25 SD (95% CI, 0.01-0.48; 1-sided P = .04), with the point estimate equivalent to half a semester of additional learning. At the end of the study, 347 of the 433 participants in the early group (80%) reported owning eyeglasses and 326 (75%) reported wearing eyeglasses; among the 516 participants in the late group, 371 (61%) reported owning and 286 (55%) reported wearing eyeglasses.

Conclusions and Relevance

In this study, early provision of free eyeglasses was seen to improve children's academic performance and wearing of spectacles. These findings suggest that a county hospital-based vision center may be an effective way to improve children's educational opportunities in rural China.

Trial Registration

isrctn.org Identifier: ISRCTN03252665.

Prevalence of vision impairment and refractive error in school learners in Calabar, Nigeria

Background: Uncorrected refractive error could negatively affect learning and academic performance, there is still inadequate information for planning school health.Aim: To determine the proportion of students with vision impairment because of uncorrected refractive error, and prevalent types among learners aged 10–18 years.Setting: The study site included two of 18 local government areas of the Cross River State in Nigeria, with 23 public and mission secondary schools.Methods: A two-stage cluster sampling method was used to enrol 4241 study participants from eight selected secondary schools.Results: The prevalence of vision impairment (presenting visual acuity worse than 6/12) was 7.9% (95% confidence interval [CI]: 7.17% – 8.6%). The prevalence of vision impairment because of refractive error was 7.2% (95% CI: 6.41% – 7.96%) in the better eye. Astigmatism was the predominant type of refractive error with a prevalence of 4.2% (95% CI: 3.6% – 4.8%), followed by myopia (1.72%; 95% CI: 1.3% – 2.1%) and hyperopia (1.3%; 95% CI: 0.9% – 1.6%). There were statistically significant differences in proportions of female participants who presented with myopic astigmatism (30.8%; p 0.012). Statistically significant difference in proportions was found in older (33.3%; p 0.0004) and male (29.6%; p 0.0003) participants who presented with hyperopic astigmatism compared to younger and female participants, respectively. Myopia accounted for 4.8% (95% CI: 4.2% – 5.5%) and was significantly higher in female participants (5.5%; p 0.033).Conclusion: Refractive error was the major cause of vision impairment and myopic astigmatism was the predominant type of refractive error among secondary school children in Calabar.

Compliance and Predictors of Spectacle Wear in Schoolchildren and Reasons for Non-Wear: A Review of the Literature

Purpose: Uncorrected refractive errors are the leading cause of visual impairment in children, affecting children in all settings. The majority of refractive errors can be corrected with spectacles. High compliance with spectacle wear is required for children to realize the benefit, such as higher academic achievement. This review collates evidence on compliance with spectacle wear, factors which predict spectacle wear and reasons for non-compliance among schoolchildren.Methods: Literature searches were conducted on Medline, Embase, Global Health and the Cochrane Library. The date range was January 2000 to November 2017 and there were no language restrictions. The search retrieved a total of 1299 references, 522 duplicate records were removed leaving 777 references to assess. Twenty-five studies were included in the review.Results: Evidence suggests that greater severity of uncorrected refractive error and lower levels of uncorrected visual acuity are associated with higher levels of spectacle wear. Addressing socio-demographic reasons for non-compliance is complex as they are context specific. Evidence that children become less compliant with spectacle wear with increasing age is not consistent. Quantitative data indicate girls are more likely to be compliant with spectacles wear than boys, but qualitative studies highlight specific challenges faced by girls.Conclusion: There was considerable variation between studies in how spectacle compliance was defined, the time interval between dispensing the spectacles and assessment, and how compliance was assessed. There is need to standardize all aspects of the assessment of compliance. Further qualitative and quantitative studies are required in a range of settings to assess the biomedical and socio-demographic factors which affect spectacle wear compliance using standard definitions.

Population prevalence of myopia, glasses wear and free glasses acceptance among minority versus Han schoolchildren in China

Aim

To measure myopia, glasses wear and free glasses acceptance among minority and Han children in China.

Methods

Visual acuity testing and questionnaires assessing ethnicity, study time, and parental and teacher factors were administered to a population-based sample of 9–12 year old minority and Han children in Yunnan and Guangdong, and their teachers and parents. Refraction was performed on children with uncorrected visual acuity (VA) < = 6/12 in either eye, and acceptance of free glasses assessed.

Main outcome measures

Baseline myopia (uncorrected visual acuity < = 6/12 in > = 1 eye and spherical equivalent refractive power < = -0.5D in both eyes); baseline glasses wear; free glasses acceptance.

Results

Among 10,037 children (mean age 10.6 years, 52.3% boys), 800 (8.0%) were myopic, 4.04% among Yunnan Minority children (OR 0.47, 95%CI 0.33, 0.67, P<0.001), 6.48% in Yunnan Han (OR 0.65, 95%CI 0.45, 0.93, P = 0.019), 9.87% in Guangdong Han (Reference). Differences remained significant after adjusting for study time and parental glasses wear. Difference in baseline glasses ownership (Yunnan Minority 4.95%, Yunnan Han 6.15%, Guangdong Han 15.3%) was not significant after adjustment for VA. Yunnan minority children (71.0%) were more likely than Yunnan Han (59.6%) or Guangdong Han (36.8%) to accept free glasses. The difference was significant after adjustment only compared to Guangdong Han (OR 3.34, 95% CI 1.62, 6.90, P = 0.001).

Conclusion

Myopia is more common among Han children and in wealthier Guangdong. Baseline differences in glasses wear could be explained by student, teacher and parental factors. Yunnan Minority children were more likely to accept free glasses.

Cycloplegia and spectacle prescribing in children: attitudes of UK optometrists

PURPOSE

To survey a large number of UK-based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years.

METHODS

One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years.

RESULTS

Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre-school children (aged 2-4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5-7 years: 25% vs 47%, 8-11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann-Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non-strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age.

CONCLUSIONS

This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK-based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence-based resources to inform their decision-making relating to use of cycloplegia in paediatric examination.

Impact of a Local Vision Care Center on Glasses Ownership and Wearing Behavior in Northwestern Rural China: A Cluster-Randomized Controlled Trial

Visual impairment is common among rural Chinese children, but fewer than a quarter of children who need glasses actually own and use them. To study the effect of rural county hospital vision centers (VC) on self-reported glasses ownership and wearing behavior (primary outcome) among rural children in China, we conducted a cluster-randomized controlled trial at a VC in the government hospital of Qinan County, a nationally-designated poor county. All rural primary schools (n = 164) in the county were invited to participate. Schools were randomly assigned to either the treatment group to receive free vision care and eyeglasses, if needed, or control group, who received glasses only at the end of the study. Among 2806 eligible children with visiual impairment (visual acuity ≤ 6/12 in either eye), 93 (3.31%) were lost to follow-up, leaving 2713 students (45.0% boys). Among these, glasses ownership at the end of the school year was 68.6% among 1252 treatment group students (82 schools), and 26.4% (p < 0.01) among 1461 controls (82 schools). The rate of wearing glasses was 55.2% in the treatment group and 23.4% (p < 0.01) among the control group. In logistic regression models, treatment group membership was significantly associated with spectacle ownership (Odds Ratio [OR] = 11.9, p < 0.001) and wearing behavior (OR = 7.2, p < 0.001). County hospital-based vision centers appear effective in delivering childrens' glasses in rural China.

Knowledge and practices of parents about child eye health care in the public sector in Swaziland

BACKGROUND

 Swaziland, like many other developing countries, lacks appropriate eye health services, particularly for children.

AIM

 To determine the knowledge and practices of parents about child eye health care in the public sector in Swaziland.

SETTING

 The setting for this study was Swaziland.

METHODS

 A descriptive study involving cross-sectional sampling methodology and quantitative analysis was employed with 173 randomly selected parents whose children attended public schools in Swaziland.

RESULTS

 Out of 173 participants, 104 (60.1%) parents reported that they have never taken their children for an eye test and 69 (31.7%) felt that their children's vision was fine. Ninety-seven (53.1%) parents indicated having no knowledge about child eye conditions and no significant association was found between level of education and knowledge of eye conditions affecting children (p = 0.112). Having an immediate family member who wore spectacles increased the likelihood of a child being taken for eye testing (p = 0.001), but decreased the likelihood of being well informed about eye health (p = 0.218). Of those parents who reported taking their children for eye tests, 34 (49.3%) reported that they were given eye drops and 31 (44.9%) stated that their children were prescribed spectacles. Eighty-seven (50.3%) parents accepted the idea of their children wearing spectacles.

CONCLUSION

 The findings of the study suggest the need for parents to be informed about basic child eye health care and the importance of their children having regular eye examinations.

Spectacle Compliance and Its Determinants in a School Vision Screening Pilot in Botswana

PURPOSE

The effectiveness of school eye health programmes relies on many factors, including compliance with spectacle wear. The objectives of this study were to determine spectacle compliance in a school vision screening pilot programme in Botswana, and investigate factors predictive of compliance.

METHODS

The study was an observational, cross-sectional follow-up of a pilot school screening programme. Unannounced compliance checks were completed after 3-4 months in a convenience sample of 19 schools. Sex, age, school level, visual acuity, and refractive error were analysed using logistic regression to investigate factors predictive of compliance.

FINDINGS

Compliance data were recorded for 193/286 (67.5%) children; 62.2% were female and the median age was 15 years (interquartile range 12-17 years). 60.1% of the sample were compliant with spectacle wear. Girls were more likely to be compliant than boys (adjusted odds ratio (aOR) = 2.32, 95% confidence interval (CI) 1.03-5.27). Children at primary and junior secondary school were more likely to be complaint than senior secondary school children (aOR = 16.96, 95% CI 5.60-51.39; and aOR = 3.39, 95% CI 1.39-8.22, respectively). Children with binocular uncorrected visual acuity (UCVA) of 6/7.5 to 6/12 were 2.76 (95% CI1.05-7.23) times more likely to be compliant than children with binocular UCVA of 6/6.

CONCLUSION

Compliance was higher in Botswana than previous African studies; however, improvement in this area would increase the effectiveness of the programme. Further investigation into barriers to spectacle wear affecting boys and older children is warranted. A prescribing protocol to avoid low prescriptions - especially where binocular UCVA is 6/6 - is desirable.

Interventions to improve school-based eye-care services in low- and middle-income countries: a systematic review

Objective

To review interventions improving eye-care services for schoolchildren in low- and middle-income countries.

Methods

We searched online databases (CINAHL, Embase®, ERIC, MEDLINE®, ProQuest, PubMed® and Web of Science^TM) for articles published between January 2000 and May 2018. Eligible studies evaluated the delivery of school-based eye-care programmes, reporting results in terms of spectacle compliance rates, quality of screening or attitude changes. We considered studies to be ineligible if no follow-up data were reported. Two authors screened titles, abstracts and full-text articles, and we extracted data from eligible full-text articles using the availability, accessibility, acceptability and quality rights-based conceptual framework.

Findings

Of 24 559 publications screened, 48 articles from 13 countries met the inclusion criteria. Factors involved in the successful provision of school-based eye-care interventions included communication between health services and schools, the willingness of schools to schedule sufficient time, and the support of principals, staff and parents. Several studies found that where the numbers of eye-care specialists are insufficient, training teachers in vision screening enables the provision of a good-quality and cost–effective service. As well as the cost of spectacles, barriers to seeking eye-care included poor literacy, misconceptions and lack of eye health knowledge among parents.

Conclusion

The provision of school-based eye-care programmes has great potential to reduce ocular morbidity and developmental delays caused by childhood vision impairment and blindness. Policy-based support, while also attempting to reduce misconceptions and stigma among children and their parents, is crucial for continued access.

Teachers' influence on purchase and wear of children's glasses in rural China: The PRICE study

IMPORTANCE

Uncorrected refractive error causes 90% of poor vision among Chinese children.

BACKGROUND

Little is known about teachers' influence on children's glasses wear.

DESIGN

Cohort study.

PARTICIPANTS

Children at 138 randomly selected primary schools in Guangdong and Yunnan provinces, China, with uncorrected visual acuity (VA) ≤6/12 in either eye correctable to >6/12 in both eyes, and their teachers.

METHODS

Teachers and children underwent VA testing and completed questionnaires about spectacles use and attitudes towards children's vision.

MAIN OUTCOME MEASURES

Children's acceptance of free glasses, spectacle purchase and wear.

RESULTS

A total of 882 children (mean age 10.6 years, 45.5% boys) and 276 teachers (mean age 37.9 years, 67.8% female) participated. Among teachers, 20.4% (56/275) believed glasses worsened children's vision, 68.4% (188/275) felt eye exercises prevented myopia, 55.0% (151/275) thought children with modest myopia should not wear glasses and 93.1% (256/275) encouraged children to obtain glasses. Teacher factors associated with children's glasses-related behaviour included believing glasses harm children's vision (decreased purchase, univariate model: relative risk [RR] 0.65, 95% CI 0.43, 0.98, P < 0.05); supporting children's classroom glasses wear (increased glasses wear, univariate model: RR 2.20, 95% CI 1.23, 3.95, P < 0.01); and advising children to obtain glasses (increased free glasses acceptance, multivariate model: RR 2.74, 95% CI 1.29, 5.84, P < 0.01; increased wear, univariate model: RR 2.93, 95% CI 1.45, 5.90, P < 0.01), but not teacher's ownership/wear of glasses.

CONCLUSIONS AND RELEVANCE

Though teachers had limited knowledge about children's vision, they influenced children's glasses acceptance.

Cluster-randomized controlled trial of the effects of free glasses on purchase of children's glasses in China: The PRICE (Potentiating Rural Investment in Children's Eyecare) study

BACKGROUND

Offering free glasses can be important to increase children's wear. We sought to assess whether "Upgrade glasses" could avoid reduced glasses sales when offering free glasses to children in China.

METHODS

In this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) was assessed 6 months after randomization.

RESULTS

Among 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56-1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69.

CONCLUSIONS

Upgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014.

Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial

PURPOSE

To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children.

DESIGN

Cluster-randomized controlled trial.

METHODS

Children with visual acuity (VA) ≤6/12 in either eye owing to refractive error in 94 randomly chosen primary schools underwent randomization by school to receive free glasses, education on their use, and a teacher incentive (Intervention), or glasses prescriptions only (Control). Intervention group teachers received a tablet computer if ≥80% of children given glasses wore them during unannounced visits 6 weeks and 6 months (main outcome) after intervention.

RESULTS

Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomly allocated, 358 (49.2%, 47 schools) to Intervention and 370 (50.8%, 47 schools) to Control. Among these, 693 children (95.2%) completed the study and underwent analysis. Spectacle wear was significantly higher at 6 months among Intervention children (Observed [main outcome]: 68.3% vs 23.9%, adjusted odds ratio [OR] = 11.5, 95% confidence interval [CI] 5.91-22.5, P < .001; Self-reported: 90.6% vs 32.1%, OR = 43.7, 95% CI = 21.7-88.5, P < .001). Other predictors of observed wear at 6 months included baseline spectacle wear (P < .001), uncorrected VA <6/18 (P = .01), and parental spectacle wear (P = .02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives.

CONCLUSIONS

Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions.

Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial

OBJECTIVE

To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia.

DESIGN

Cluster randomized, investigator masked, controlled trial.

SETTING

252 primary schools in two prefectures in western China, 2012-13.

PARTICIPANTS

3177 of 19,934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study.

INTERVENTIONS

Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class.

MAIN OUTCOME MEASURES

Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations.

RESULTS

Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, -0.04 to 0.09) or family wealth (0.01, -0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect.

CONCLUSIONS

The provision of free glasses to Chinese children with myopia improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting.Trial Registration Current Controlled Trials ISRCTN03252665.

A descriptive study on compliance of spectacle-wear in children of primary schools at Qassim Province, Saudi Arabia

BACKGROUND

Uncorrected Refractive errors are the most common cause of avoidable visual impairment in children worldwide. Importance of school screening of refractive errors are one of the most important initiatives outlined in WHO Vision 2020 targets for control of avoidable visual impairment in children. But the benefit depends on the compliance of the spectacle wear by children.

PURPOSE

To study the prevalence and determinants of compliance of spectacle wear among children and to investigate the reasons of non compliance associated with the spectacle wear in primary school children.

MATERIALS AND METHODS

This was a cross-sectional descriptive study of 631 students who had been prescribed spectacles for constant wear during school screening programme done by our Department of Optometry, College of Applied Medical Sciences, Qassim University during 2010-2011. After six months, experienced Optometrists conducted a follow-up visit where these students were assessed about spectacle compliance. Information on age, gender, type of refractive error, reasons for non compliance were collected and analyzed.

RESULTS

The non-compliance rate of spectacle wear in primary school children is 66.80%. A significantly higher proportion of boys 244(69.13%) were not wearing their spectacles compared to girls 178 (64.03%) (P<0.05). Non-compliance was not related to age of the students (P<0.05), but older and myopic children were slightly more non-compliant. The main reasons for non-compliance in primary school boys and girls for using spectacles were disapproving spectacle wear by parents, not like to wear spectacles, broken spectacles and many children feel spectacles are not needed or causes head ache.

CONCLUSIONS

Comprehensive eye care for primary school children with refractive error is practised in Qassim Province, but limited information is available on the magnitude of the compliance for spectacle wear and their reasons. School children were not compliant because of many issues that could and should be addressed. This information is crucial for establishing a program and will strengthen its efforts for a better eye care in primary school children with refractive errors.

Clinical outcomes following the dispensing of ready-made and recycled spectacles: a systematic literature review

Uncorrected refractive error is the leading cause of global visual impairment. Given resource constraints in developing countries, the gold standard method of refractive error correction, custom-made spectacles, is unlikely to be available for some time. Therefore, ready-made and recycled spectacles are in wide use in the developing world. To ensure that refractive error interventions are successful, it is important that only appropriate modes of refractive error correction are used. As a basis for policy development, a systematic literature review was conducted of interventional studies analysing visual function, patient satisfaction and continued use outcomes of ready-made and recycled spectacles dispensed to individuals in developing countries with refractive errors or presbyopia. PubMed and CINAHL were searched by MESH terms and keywords related to ready-made and recycled spectacle interventions, yielding 185 non-duplicated papers. After applying exclusion criteria, eight papers describing seven studies of clinical outcomes of dispensing ready-made spectacles were retained for analysis. The two randomised controlled trials and five non-experimental studies suggest that ready-made spectacles can provide sufficient visual function for a large portion of the world's population with refractive error, including those with astigmatism and/or anisometropia. The follow-up period for many of the studies was too short to confidently comment on patient satisfaction and continued-use outcomes. No studies were found that met inclusion criteria and discussed recycled spectacles. The literature also notes concerns about quality and cost effectiveness of recycled spectacles, as well as their tendency to increase developing countries' reliance on outside sources of help. In light of the findings, the dispensing of ready-made spectacles should be favoured over the dispensing of recycled spectacles in developing countries.

Spectacle compliance amongst rural secondary school children in Pune district, India

BACKGROUND

Refractive errors (RE) are the most common cause of avoidable visual impairment in children. But benefits of visual aids, which are means for correcting RE, depend on the compliance of visual aids by end users.

AIM

To study the compliance of spectacle wear among rural school children in Pune district as part of the sarva siksha abhiyan (education for all scheme) after 6 - 12 months of providing free spectacles.

SETTINGS AND DESIGN

Cross-sectional follow-up study of rural secondary school children in western India.

MATERIALS AND METHODS

The students were examined by a team of optometrists who collected the demographic details, observed if the child was wearing the spectacles, and performed an ocular examination. The students were asked to give reasons for non-wear in a closed-ended questionnaire.

STATISTICAL ANALYSIS

Chi-square test and multiple logistic regression used for data analysis.

RESULTS

Of the 2312 students who were dispensed spectacles in 2009, 1018 were re-examined in 2010. 523 students (51.4%) were female, the mean age was 12.1 years 300 (29.5%) were wearing their spectacles, 492 (68.5%) students claimed to have them at home while 211 (29.4%) reported not having them at all. Compliance of spectacle wear was positively associated to the magnitude of refractive error (P < 0.001), father's education (P = 0.016), female sex (P = 0.029) and negatively associated to the visual acuity of the better eye (P < 0.001) and area of residence (P < 0.0001). Of those that were examined and found to be myopic (N = 499), 220 (44%) wore their spectacles to examination. Factors associated with compliance to spectacle usage in the myopic population included increasing refractive error (P < 0.001), worsening visual acuity (P < 0.001), and higher academic performance (P < 0.001). The causes for not wearing spectacles were 'lost spectacles' 67(9.3%), 'broken spectacles' 125 (17.4%), 'forgot spectacles at home' 117 (16.3%), 'uses spectacles sometimes' 109 (15.2%), 'teased about spectacles' 142 (19.8%) and 'do not like the spectacles' 86 (12%).

CONCLUSION

Spectacle compliance was poor amongst school children in rural Pune; many having significant vision loss as a result.

The influence of compliance with the use of refractive correction in hyperopic children on accommodation

PURPOSE

To indicate the relationship between constant, correct use of hyperopic spectacles and relaxation of accommodation in children.

METHODS

After thorough ophthalmic examination (cycloplegia included), 52 children 2.5 to 9 years old were detected with hyperopia >3 D, out of all examined within a year. These children were fully or partially corrected, with hyperopic glasses, depending on whether accommodative esotropia was or was not present. Constant and correct use of spectacles was strongly suggested to all children. During follow-up 3 and 6 months later, the amount of manifest hyperopia was measured in each case by an autorefractometer (without the use of cycloplegic factor).

RESULTS

Out of the 52 children, 37 who participated in our study fully complied with hyperopic spectacle treatment, wearing their glasses constantly and correctly. The 15 others wore their glasses partially or not at all or made incorrect use of them. During follow-up 3 and 6 months later, refractive measurements of manifest hyperopia in the first group of children were identical or similar to the refractive power of their glasses. On the contrary, in the second group of children, strong accommodation did not allow the expression of hyperopia, and in a few cases myopic refractive measurements appeared (similar to those on the first examination, before spectacle treatment was prescribed).

CONCLUSIONS

Constant and correct use of hyperopic spectacles leads to relaxation of accommodation in children and is thus an accurate indicator of compliance.

Predictors of adequate correction following vision screening failure

PURPOSE

To determine whether compliance with referral 1 year after vision screening failure was associated with care model, demographic, or ocular factors.

METHODS

Data were analyzed from 798 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study with habitual logMAR visual acuity (VA) ≥0.26 (20/40 + 2 or worse) in either eye due to uncorrected or undercorrected refractive error and who returned the following year. The parents of 492 children failing in TX and CA were sent letters indicating the need for a complete vision examination (screening model), while 306 children seen primarily in AZ and AL received a free complete examination and eyeglasses if needed (complete care model). Presenting to follow-up with adequate correction (logMAR <0.26) in each eye was considered compliant. Logistic regression models for compliance were fit to assess whether care model, ethnicity, sex, age, uncorrected logMAR in the better eye, or parental income, education, or myopia were predictors.

RESULTS

Overall compliance was 28%. Age [p = 0.01, odds ratio (OR) = 1.12] and uncorrected logMAR (p < 0.001, OR = 1.13) were associated with compliance but care model, ethnicity, and sex were not. Among the 447 children for whom data on parental factors were available, 27% were compliant. In this model, age, ethnicity, sex, parental income, parental education, and parental myopia were not associated with compliance, but uncorrected logMAR (p = 0.005; OR = 1.13) was predictive. An interaction between unaided VA and care model predicted improved compliance with poorer unaided VA in the complete care model.

CONCLUSIONS

Expensive complete care screening programs may not improve compliance over typical notification and referral screening protocols in school-aged children, unless unaided VA is worse than the common 20/40 referral criteria. Unaided VA had less impact on predicted compliance in the screening-only protocol.

Spectacle wear in children given spectacles through a school-based program

PURPOSE

To investigate factors associated with spectacle wear in a group of primarily Native-American children provided spectacles free of charge through a school-based vision program.

METHODS

Spectacle wear was studied in 247 participants provided two pairs of spectacles the previous year. Univariate and multivariate logistic regression models assessed whether gender, race, parental education levels, family income, uncorrected distance visual acuity, refractive error, or the children's attitudes and beliefs about their vision and spectacles were associated with spectacle wear.

RESULTS

Two thirds of the participants (165/247) were not wearing their spectacles at their annual examination. The most common reasons given for non-wear were lost (44.9%) or broken (35.3%) spectacles. A 1 diopter increase in myopic spherical equivalent was associated with more than a twofold increase in the odds of wearing spectacles [odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.7 to 3.7]. Among non-myopic participants, increasing amounts of astigmatism in the better- and worse-seeing eye were associated with an increased likelihood of spectacle wear (p ≤ 0.02). In multivariate analysis, only poorer uncorrected acuity in the better-seeing eye (p < 0.001) and shorter acceptance time (p = 0.007) were found to be significantly associated with spectacle wear. For each line of poorer uncorrected acuity in the better-seeing eye, the likelihood that the participant was wearing spectacles increased by 60% (adjusted odds ratio = 1.6; 95% CI = 1.4 to 1.8). Not surprisingly, participants who reported never getting used to their spectacles were less likely to be wearing spectacles than those who reported getting used to wearing glasses in a few days (adjusted OR = 5.7, 95% CI = 1.9 to 17.5).

CONCLUSIONS

Despite being provided with two pairs of spectacles, loss and breakage were the most commonly reported reasons for not wearing spectacles. The best predictive factor for determining whether participants were wearing spectacles was their uncorrected acuity.

School-based approaches to the correction of refractive error in children

The World Health Organization estimates that 13 million children aged 5-15 years worldwide are visually impaired from uncorrected refractive error. School vision screening programs can identify and treat or refer children with refractive error. We concentrate on the findings of various screening studies and attempt to identify key factors in the success and sustainability of such programs in the developing world. We reviewed original and review articles describing children's vision and refractive error screening programs published in English and listed in PubMed, Medline OVID, Google Scholar, and Oxford University Electronic Resources databases. Data were abstracted on study objective, design, setting, participants, and outcomes, including accuracy of screening, quality of refractive services, barriers to uptake, impact on quality of life, and cost-effectiveness of programs. Inadequately corrected refractive error is an important global cause of visual impairment in childhood. School-based vision screening carried out by teachers and other ancillary personnel may be an effective means of detecting affected children and improving their visual function with spectacles. The need for services and potential impact of school-based programs varies widely between areas, depending on prevalence of refractive error and competing conditions and rates of school attendance. Barriers to acceptance of services include the cost and quality of available refractive care and mistaken beliefs that glasses will harm children's eyes. Further research is needed in areas such as the cost-effectiveness of different screening approaches and impact of education to promote acceptance of spectacle-wear. School vision programs should be integrated into comprehensive efforts to promote healthy children and their families.

Prescribing for hyperopia in childhood and teenage by academic optometrists

PURPOSE

The purpose of this study was to examine the prescribing patterns of academic optometrists for infants, children, and teenagers with hyperopia and the factors that affected the decision to prescribe. A comparison was made to published guidelines for prescribing for hyperopia in children.

METHODS

The Waterloo Eye Study (WatES) database is a database of all patients attending the Primary Care Clinic or the Pediatric Clinic at the School of Optometry, University of Waterloo, between February 2007 and January 2008. Records for 698 patients aged from birth to 19 years with hyperopia but without strabismus or significant anisometropia were extracted. They were analyzed to determine the factors that predicted whether a child was prescribed spectacles and the 50% prescribing points for hyperopia and astigmatism according to age.

RESULTS

Univariate analysis showed that the level of hyperopia, astigmatism, age, distance, and near phoria and presence of symptoms were associated with the prescription of spectacles (p < 0.05). Multivariate analysis showed that the prescription of spectacles was predicted by age, highest sphere (either right or left eye), highest cylinder, the presence of symptoms, and distance phoria. Among 0 to 3 year olds, all the children with 5 D or more of hyperopia had been prescribed spectacles. Among the 4 to 6 year olds, this point was 3.25 D; and for the 7 to 19 year olds, it was 2.25 D. The levels at which 50% of the population had been prescribed spectacles was 3.7, 1.8, and 1.1 D for the 0 to 3 year olds, 4 to 6 year olds, and 7 to 19 year olds, respectively. There was frequently a difference between the refraction and the prescription such that the younger children, in particular, were often under corrected for both hyperopia and astigmatism.

CONCLUSIONS

The optometrists in this academic setting appear to follow the available optometric guidelines for prescribing for hyperopia. They tend to prescribe for lower levels of hyperopia than U.S. ophthalmologists.

To prescribe or not to prescribe? Guidelines for spectacle prescribing in infants and children

This paper discusses the considerations for prescribing a refractive correction in infants and children up to and including school age, with reference to the current literature. The focus is on children who do not have other disorders, for example, binocular vision anomalies, such as strabismus, significant heterophoria or convergence excess. However, refractive amblyogenic factors are discussed, as is prescribing for refractive amblyopia. Based on this discussion, guidelines are proposed, which indicate when to prescribe spectacles and what amount of refractive error should be corrected. It may be argued that these are premature because there are many questions that remain unanswered and we do not have the quality of evidence that we would like; the clinician, however, must make decisions on whether and what to prescribe when examining a child. These guidelines are to aid clinicians in their current clinical decision making.

Reported wearing compliance of ready-made spectacles at 6 and 12 months

PURPOSE

Ready-made spectacles are often used in low-resource environments, but to date, there has been little evaluation of the continued use of these spectacles over time. The aim of this study was to assess wearing compliance of those who received ready-made spectacles.

METHODS

The International Rescue Committee trains refugee health workers to provide simple refractive services and dispense ready-made spherical lenses to residents of refugee camps on the Thailand-Burma border. We conducted follow-up interviews in five camps among all eligible and available spectacle recipients who had been examined either 6 (n = 230) or 12 months earlier (n = 187). Interviewers asked about continued use of spectacles and, among those who had discontinued spectacle use, asked the reason for discontinuing.

RESULTS

Reported spectacle wear was significantly higher at 6 months compared with 12 months (73.9 vs. 55.6%, p < 0.001). At 6 months, wearing compliance was significantly higher for females than males (79.2 vs. 67.6%, p = 0.033), but gender differences in wearing compliance were not seen at 12 months, and no differences were found between 10-year age groups at 6 or 12 months. Wearing compliance rates among recipients seen at different camps were significantly different at both 6 months (range, 58.1 to 87.5%, p = 0.005) and 12 months (range, 32 to 85.7%, p = 0.002). The top reason given for discontinued spectacle wear was broken frames, followed by vision-related complaints, scratched lenses, lost spectacles, and appearance.

CONCLUSIONS

Our findings suggest that spectacle wearing compliance studies will not be comparable unless a standard time frame is used to assess compliance. We found assessing self-reported compliance to be a useful tool in guiding our program. Understanding the reasons for non-compliance will help guide corrective action and planning of interventions designed to increase wearing rates.

A randomized, clinical trial evaluating ready-made and custom spectacles delivered via a school-based screening program in China

PURPOSE

We sought to evaluate visual performance and satisfaction with ready-made spectacles (RMS) in Chinese school-aged children with uncorrected refractive error.

DESIGN

Randomized, double-blind, clinical trial.

PARTICIPANTS

Junior high school students from urban Guangzhou, China, aged approximately 12 to 15 years with > or =1 diopter (D) of uncorrected spherical equivalent (SE) refractive error. Students were excluded with > or =2.00 D astigmatism, > or =2 D myopic anisometropia, and > or =1 D hyperopic anisometropia and ocular disease affecting vision.

METHODS

Refractive error was determined by cycloplegic subjective refraction. Students were randomly assigned to receive RMS or custom spectacles (CS) and assessed after 1 month of use. We required 175 students to complete in each arm to be able to measure a 15% difference in compliance.

MAIN OUTCOME MEASURES

Compliance with spectacles lens wear, patterns of use, vision, symptoms, and perceived value.

RESULTS

Screening identified 965 of 4607 (20.9%) students with reduced distance vision; 212 of the 965 (22.0%) refused evaluation and 187 of the 965 (20.8%) had <1 D of SE refractive error. Sixty-one (6.3%) were referred for further evaluation and the remaining 495 (51.3%) participated. Social, demographic, and ocular parameters were similar in the 2 groups. Average SE refractive error was -2.57+/-1.31 (mean value +/- standard deviation [SD]). Spectacle vision (Snellen acuity, mean +/- SD) was worse with RMS in the eye with lower SE (20/25(-0.5)+/-0.9 lines vs 20/25(+1)+/-0.7 lines; P = 0.004) and higher SE (20/25(-2)+/-1.2 lines vs 20/25(+1)+/-0.8; P<0.001). There were no differences (P>0.05) in the rate of use (94.3% vs 92.2%), wearing to the 1-month visit (46.9% vs 51.5%), planned use (93.3% vs 93.7%), value (89.5% vs 91.7% "moderate or high value or most valued possession"), or symptoms (blur, 21.1% vs 19.4% [P = 0.8] and other symptoms [P>0.2]).

CONCLUSIONS

Although visual acuity was better with CS, no difference was found in acceptability in this population of students with predominantly simple myopic refractive error. This study supports the use of RMS in a school-based refractive services program, saving costs and improving the logistics of service delivery.

Reducing the visual burden of glaucoma in Asia: what we know and what we need to know

Despite great progress in elucidating risk factors and effective treatments for eye disease in the last decades, blindness prevalence in the developing and developed world is either static or rising. A research agenda is needed to develop and test specific strategies to reduce the burden of blindness from glaucoma and other common eye diseases. Current knowledge about open and closed-angle glaucoma is reviewed and a strategy to reduce glaucoma blindness in Asia is suggested. A critical component of this strategy is enhanced training in the detection of narrow angles and optic nerve damage by direct examination. Specific research topics that could inform such a strategy are outlined.