A Randomized, Clinical Trial Evaluating Ready-Made and Custom Spectacles Delivered Via a School-Based Screening Program in China

Abstract

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 ≥1 diopter (D) of uncorrected spherical equivalent (SE) refractive error. Students were excluded with ≥2.00 D astigmatism, ≥2 D myopic anisometropia, and ≥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.

A Descriptive Study on Compliance of Spectacle , Wear in Children of Primary Schools at Qassim Province , Saudi Arabia

“…Various studies (1,4,16) have been reported the use of spectacle sometimes or part time wear among their participants like in our study as one of the reasons of non compliance. Holguin et al (1) also reported about forgetting spectacles at home (16%) as one of the reasons of non compliance like our study we found this reason in 6.55% boys and 2.81% girls.…”

“…If a student had spectacles but was not wearing it, the student was considered as "non-compliant". Children not wearing glasses were asked whether they had the eyeglasses with them and to identify 1 of 10 different reasons for noncompliance, which had been identified from other researches (1)(2)(3)(4)(5)(6)(7) as the most common reasons for spectacle noncompliance in school children.…”

“…The dictionary (The Oxford Concise Dictionary) meaning of compliance refers to "Obedience to a request or command", in respect to our study, we used to prescribe for spectacles but it is useful only at time when child patients are wearing them. Refractive errors are commonly found as the causative agent for visual impairment in the most surveyed population and this impairment is easily treatable (1)(2)(3)(4)(5)(6)(7) . Previous studies shows prevalence of refractive error differs with geographic location, age, gender, education level, and amount of near work (1)(2)(3)(4)(5)(6)(7) .…”

“…Refractive errors are commonly found as the causative agent for visual impairment in the most surveyed population and this impairment is easily treatable (1)(2)(3)(4)(5)(6)(7) . Previous studies shows prevalence of refractive error differs with geographic location, age, gender, education level, and amount of near work (1)(2)(3)(4)(5)(6)(7) . Moderate hyperopia can be overcome by accommodation and many school aged children are most commonly found with myopic errors, these conditions have significance in economic, educational effectiveness including poor academic performance, reduced school performance, and social activity (5) .…”

“…Studies from Mexico, U.K., China, U.S.A, India, Oman, South Africa and Brazil (1)(2)(3)(4)(5)(6)(7) showed that compliance is only 50-60 %. This means that, the entire process of refraction and dispensing has gone waste to a large extent and the child will not benefit from the refractive correction.…”