Spectacle compliance amongst rural secondary school children in Pune district, India

Abstract

Background:Refractive errors (RE) are the most common cause of avoidable visual impairment in children. But benefits of visual aids, which are means for correcting RE, depend on the compliance of visual aids by end users.Aim:To study the compliance of spectacle wear among rural school children in Pune district as part of the sarva siksha abhiyan (education for all scheme) after 6 - 12 months of providing free spectacles.Settings and Design:Cross-sectional follow-up study of rural secondary school children in western India.Materials and Methods:The students were examined by a team of optometrists who collected the demographic details, observed if the child was wearing the spectacles, and performed an ocular examination. The students were asked to give reasons for non-wear in a closed-ended questionnaire.Statistical Analysis:Chi-square test and multiple logistic regression used for data analysis.Results:Of the 2312 students who were dispensed spectacles in 2009, 1018 were re-examined in 2010. 523 students (51.4%) were female, the mean age was 12.1 years 300 (29.5%) were wearing their spectacles, 492 (68.5%) students claimed to have them at home while 211 (29.4%) reported not having them at all. Compliance of spectacle wear was positively associated to the magnitude of refractive error (P < 0.001), father's education (P = 0.016), female sex (P = 0.029) and negatively associated to the visual acuity of the better eye (P < 0.001) and area of residence (P < 0.0001). Of those that were examined and found to be myopic (N = 499), 220 (44%) wore their spectacles to examination. Factors associated with compliance to spectacle usage in the myopic population included increasing refractive error (P < 0.001), worsening visual acuity (P < 0.001), and higher academic performance (P < 0.001). The causes for not wearing spectacles were ‘lost spectacles’ 67(9.3%), ‘broken spectacles’ 125 (17.4%), ‘forgot spectacles at home’ 117 (16.3%), ‘uses spectacles sometimes’ 109 (15.2%), ‘teased about spectacles’ 142 (19.8%) and ‘do not like the spectacles’ 86 (12%).Conclusion:Spectacle compliance was poor amongst school children in rural Pune; many having significant vision loss as a result.

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

“…3,6,7,[23][24][25] Observed rates of wear were low, ranging from 13% to 41%. 3,6,7,21,23,24 All of the few studies reporting higher rates (46% by Keay and associates in China, 25 56% by Vincent and associates in Thai refugee camps, 22 and 58% by von-Bischhoffshaussen and associates in Chile 20 ) relied on self-report and/or estimates of teachers or parents, 20,22 and had low (58%-76%) rates of follow-up 20,22 or assessment times as short as 1 month after spectacle distribution. 25 It would appear that longer-term (over the course of a school year) compliance with free spectacles, as measured by objective indicators such as observed wear at unannounced examinations, is low among children without additional interventions.…”

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

“…As many as 13 million worldwide, have uncorrected refractive error, numerous programs have attempted to address the problem of uncorrected refractive error through school-based vision testing and spectacle distribution programs. Unfortunately, most programs have found that at follow up, the majority of children provided spectacles at no charge were not wearing them or non compliant on wearing refractive correction (5,7,(13)(14)(15)21) Reasons for non-compliance vary by study and population, most common reasons were lost or broken eyeglasses, concern about appearance or teasing, worry that the eyeglasses will make the eyes worse, eyeglasses kept at home or used only for special occasions (1-7, 16, 21) .…”

“…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.…”