Predictors of Adequate Correction Following Vision Screening Failure

Abstract

Purpose To determine if compliance with referral one 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 (CLEERE) Study with habitual logMAR visual acuity (VA) ≥ 0.26 (20/40 +2 or worse) in either eye due to uncorrected or under-corrected 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 exam (screening model), while 306 children seen primarily in AZ and AL received a free complete exam 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 if 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 on whom data on parental factors was 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.

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

“…Amongst the quantitative studies, increasing age was associated with lower spectacle wear in four studies [11][12][13][14] whereas in two studies, in India and the USA, younger children were less compliant. 15,16 A study in China of school children who reported already owning spectacles, also reported compliance to be lower in younger children [ . A further study in India reported compliance to be highest in the youngest of three age groups but did not report complete statistics to support this.…”

“…30 Uncorrected visual acuity and lines of improvement in visual acuity Seven studies reported higher compliance with lower levels of uncorrected visual acuity. 16,17,22,23,26,28,38 An eighth study reported compliance to be better with 'poor VA' compared to 'better VA', but no analyses were reported. 32 Two studies found no significant difference in compliance according to uncorrected visual acuity.…”

“…16,17,22,38 In two USA studies, the odds of compliance increased by 1.13 (95% CI 1.06-1.20) and 1.6 (95% CI 1.4-1.8) per line (0.1 logMAR) worse uncorrected visual acuity in the better eye. 16,38 An observational study in China also reported an odds ratio per line logMAR increase [OR=1.46 (95% CI 1.26-1.69)] although the authors used the mean uncorrected visual acuity score of right and left eyes. 17 In a cluster RCT in China the odds of compliance was lower with worse uncorrected visual acuity in the better eye [OR=0.287 (95% CI 0.106-0.774)], however, the unit of change was not reported.…”

Visual acuity and refractive status of Omani students with refractive error in grades 1, 4 and 7: A retrospective cohort study

“…From the study sample, there were 239 emmetropes in grade 1. Data were missing for four students, and 43 students had RE (Hyperopia [ 3 ] + mild myopia [26], moderate myopia [ 1 ] and astigmatic myopia [ 13 ]). Of the 239 emmetropes in grade 1, there were 144 (60%) who remained emmetropic by grade 4.…”

“…[ 12 ] VA <6/18 due to RE is a predictor of poor compliance with spectacle wear. [ 13 ] Thus, better counseling of students and parents regarding the need for spectacles and continual use for overall development of the child could improve compliance.…”