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

Abstract

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. ConclusionsThe 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.

Interventions to Promote Follow-up After Trabeculectomy Surgery in Rural Southern China

“…Multimedia educational interventions, when used alone, have been unsuccessful in increasing acceptance of low-cost comprehensive eye examinations 24 or cataract surgery 25 or in promoting purchase of children's spectacles. 26 Although a focus group study 27 indicated that patients in rural China may not be comfortable with direct cash payments to encourage medical compliance, Ma et al 28 have reported that the offer of free spectacles doubled spectacle wear at a later unannounced examination, which is consistent with improved adherence observed in the present study. It appears that the offer of free medical goods, such as medication and spectacles, may be particularly effective in this setting in changing behavior and gives the added advantage of direct clinical benefit to patients.…”

“…b Three patients were unavailable for follow-up at 2 weeks and 4 patients were unavailable for follow-up at 1 mo after surgery. The result of the current study, in which adherence was nearly doubled with an intervention costing less than US$25 per patient, may be compared with other reports [24][25][26][27][28] on interventions to enhance uptake of or adherence with eye care in rural China. Multimedia educational interventions, when used alone, have been unsuccessful in increasing acceptance of low-cost comprehensive eye examinations 24 or cataract surgery 25 or in promoting purchase of children's spectacles.…”

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

“…1 If not treated, refractive error is associated with loss of visual function 2 and reduced educational performance in children. 3 Though refractive error can be safely 4 and inexpensively managed with glasses, as few as 1 in 6 children needing spectacles have them in rural parts of the developing world. 3 Spectacle distribution programs for children can lead to normalization of visual function 5 and trial-proven, significant improvements in educational outcomes.…”

“…3 Though refractive error can be safely 4 and inexpensively managed with glasses, as few as 1 in 6 children needing spectacles have them in rural parts of the developing world. 3 Spectacle distribution programs for children can lead to normalization of visual function 5 and trial-proven, significant improvements in educational outcomes. 3 However, programs in China, 3 Mexico, 6 and Africa 7 have reported poor compliance with free spectacles, with rates of observed, short-term wear at unannounced visits ranging from 13% to 41%.…”

Factors Underlying Different Myopia Prevalence between Middle- and Low-income Provinces in China

“…Study methods including institutional review board approvals and consent have been described elsewhere. 1 The study was carried out in Yulin prefecture, Shaanxi, and Tianshui prefecture, Gansu Province, which are nearby areas. Shaanxi's gross domestic product per capita is $US6108 and was ranked 14th among China's 31 administrative regions in 2012, while Gansu is the second-poorest province in the country (per capita gross domestic product of $US3100).…”