Spectacle Wear Among Children in a School-Based Program for Ready-Made vs Custom-Made Spectacles in India

Abstract

IMPORTANCE Uncorrected refractive errors are the most common cause of visual impairment in children despite correction being highly cost-effective. OBJECTIVE To determine whether less expensive ready-made spectacles produce rates of spectacle wear at 3 to 4 months comparable to those of more expensive custom-made spectacles among eligible school-aged children. DESIGN, SETTING, AND PARTICIPANTS This noninferiority, double-masked, randomized clinical trial recruited children aged 11 to 15 years from January 12 through July 31, 2015, from government schools in urban and periurban areas surrounding Bangalore, India. Follow-up occurred from August 1 through September 31, 2015. Participants met the following eligibility criteria for ready-made spectacles: failed vision screening at the 6/9 level in each eye; refraction was indicated; acuity improved with correction by 2 or more lines in the better-seeing eye; the corrected acuity with the spherical equivalent was not more than 1 line less than with full correction; anisometropia measured less than 1.0 diopter; and an appropriate frame was available. INTERVENTIONS Eligible children were randomized to ready-made or custom-made spectacles. MAIN OUTCOMES AND MEASURES Proportion of children wearing their spectacles at unannounced visits 3 to 4 months after the intervention. RESULTS Of 23 345 children aged 11 to 15 years who underwent screening, 694 had visual acuity of less than 6/9 in both eyes, and 535 underwent assessment for eligibility. A total of 460 children (227 female [49.3%] and 233 male [50.7%]; mean [SD] age, 13.4 [1.3] years) were eligible for ready-made spectacles (2.0% undergoing screening and 86.0% undergoing assessment) and were randomized to ready-made (n = 232) or custom-made (n = 228) spectacles. Follow-up rates at 3 to 4 months were similar (184 [79.3%] in the ready-made group and 178 [78.1%] in the custom-made group). Rates of spectacle wear in the 2 arms were similar among 139 of 184 children (75.5%) in the ready-made arm and 131 of 178 children (73.6%) in the custom-made arm (risk difference, 1.8%; 95% CI, −7.1% to 10.8%). CONCLUSIONS AND RELEVANCE Most children were eligible for ready-made spectacles, and the proportion wearing ready-made spectacles was not inferior to the proportion wearing custom-made spectacles at 3 to 4 months. These findings suggest that ready-made spectacles could substantially reduce costs for school-based eye health programs in India without compromising spectacle wear, at least in the short term.

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

“…school health counsellors 23 or teachers 54 ) and appropriate spectacle correction protocols. Examples of correction protocols include only prescribing spectacles for moderate or severe refractive error, 34 , 56 and the use of ready-made spectacles 40 , 47 . The geographical inaccessibility of specialist eye-care services was also a barrier reported by parents 32 , 48 …”

“…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 …”

“…As poorer visual acuity has been associated with increased spectacle acceptance and compliance, several studies have recommended only prescribing spectacles to children with more severe refractive error 34 , 47 , 54 , 56 . However, a randomized controlled trial investigating the effect of various refractive cut-off protocols on compliance found no associations 35 .…”

Predictors of Spectacle Wear and Reasons for Nonwear in Students Randomized to Ready-made or Custom-made Spectacles

“…The trial protocol 32 was published in January 2016. Primary outcome data 33 (ie, spectacle wear at unannounced follow-up visits) were published in June 2017. Institutional review board approval was from the ethics committee at London School of Hygiene and Tropical Medicine and the institutional review board at Sankara Eye Institute, Bangalore, India.…”

Spectacle-Wear

“…Visual survey in school going children is very helpful in detecting early refractive error. [1][2][3] We can visually rehabilitate the children in early age and prevent their visual loss. Among top priorities of World Health Organization "Vision 2025 is the Right to Sight" for the correction of refractive error in children in low and middle income countries.…”