Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China

Abstract

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.

Visual impairment and spectacles ownership among upper secondary school students in northwestern China

“…Vision problems among upper secondary school students are of particular concern in rural China because visual impairment has been shown to increase as students age through the school system; notably lower secondary school students experience higher rates of impairment and uncorrected poor vision, compared with primary school students. 10 Therefore, there may be a greater need for quality vision care among upper secondary school students.…”

The Effect of Providing Free Eyeglasses on Children’s Mental Health Outcomes in China: A Cluster-Randomized Controlled Trial

“…One study, for example, has shown that the provision of glasses in schools boosts standardized test scores among primary school students [1]. A similarly study found that the existence of systematic screening and referrals for free refraction and prescription eyeglasses at a local vision clinic raised test scores for children in surrounding schools [9]. Studies in other settings have shown similar positive results [1,3,4]…”

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

“…Our research team previously established a hospital-based VC in Yongshou County, a nationally-designated poor county in rural Shaanxi Province, also in northwestern China. A study of this VC, also conducted by our research team, found a significant effect of rural hospital-based VCs on self-reported glasses ownership and glasses wearing [18]. Qinan is a larger county than Yongshou: its population (591,254) [19] is nearly three times that of Yongshou (208,065) [28].…”

“…Despite the popularity of VCs, there is only one study has evaluated the quality and effect of the vision care services they deliver in rural China [18]. The study showed that a VC had a positive impact on children’s eyeglass ownership and wearing behavior, but because the location was in a small, relatively affluent rural county, we do not know whether this model would be effective in other settings.…”

“…We hypothesized that access to the VC-provided optometric services would lead to an increase in eyeglasses ownership, and consequently higher rates of wearing eyeglasses (primary outcome). Both to reduce costs and to promote eyeglass wearing, we involved the teachers of sample students in the VA screening program, as randomized trials conducted elsewhere have shown that the involvement of teachers in school-based programs can significantly increase rates of eyeglass ownership and eyeglass wearing [7,18].…”