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

Abstract

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. OR [ 43.7,.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. (Am J Ophthalmol 2015;160(5): 889-896. Ó 2015 by Elsevier Inc. All rights reserved.)

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

“…The supply of low-cost spectacles was identified as increasing spectacle acceptance in China, 24 , 39 , 45 , 46 Mexico 26 and Timor-Leste 21 . However, other studies reported that spectacle acceptance may be low with free or low-cost spectacles, 38 , 42 , 43 which can be linked to parental concerns of poor quality 65 …”

“…Studies assessing the feasibility of school-based eye-care interventions, such as the targeting of trachoma in the United Republic of Tanzania, 58 vision screening in Peru, 30 South Africa 29 and Thailand, 56 and the provision of free spectacles in China, 39 noted that success was dependent on multidisciplinary support from health and education ministries. The level of collaboration between ministries may either facilitate 20 , 28 , 30 , 58 or inhibit 62 the coordination and success of interventions at the school level.…”

“…While an intervention designed to promote spectacle purchase was deemed ineffective in China, 65 one that included free spectacles was shown to increase spectacle wear in India 41 . Free spectacles also resulted in higher compliance compared with provision of a prescription only, 38 a prescription and a letter to the parents, 39 or when provided in conjunction with an education programme 46 . In observational studies following school-based eye-care programmes, spectacle compliance ranged from 13.4% (66/493) in Mexico 34 to 87.1% (54/62) in Brazil 37 …”

“…Ready-made spectacles are often a cost–effective and acceptable strategy for reducing the time of a clinician’s visit and to dispense spectacles, 40 , 47 and were acceptable to many children 39 , 44 , 47 …”

“…Elsewhere, strategies used to increase teacher screening quality and engagement included: involving all class teachers in the vision screening programme, as compared with selected teachers; 53 using adequate and structured training to increase knowledge and screening performance; 29 , 58 involving ophthalmologists in training to increase motivation; 53 and greater emphasis on accurately measuring visual acuity 56 . Financial incentives may encourage teachers to participate, 51 , 56 and were shown to increase spectacle compliance through additional teacher motivation 39 …”