Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes

Abstract

The low prevalence of un/undercorrected RE and poor uptake of spectacles, even when provided free, raises doubts about the value of vision-screening programmes in Tanzanian secondary schools. Policy decisions on school vision screening in middle- and low-income countries should take account of the cost-effectiveness as well as competing demands for scarce resources.

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

“…free glasses 3,6,7 and educational interventions to promote spectacle wear 3,12 have generally shown low uptake, the current report demonstrated that free glasses combined with education on their use and a teacher incentive maintained wear in between two-thirds and 90% of children needing them over the course of a school year. The impact of the intervention on spectacle wear at 6 months was greater than that of family wealth, parental spectacle wear, and children's uncorrected VA. Our main study outcome, observed wear at the time of an unannounced examination, might be expected to underestimate true daily use of spectacles somewhat.…”

“…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.…”

“…Self-reported wear (''Always'' or ''For studying'') in the Treatment group at 6 months exceeded 90%, 3 times that among the Control group. Previous trials in Africa 7 and China 3 have demonstrated a near doubling in rates of spectacle wear among children by providing free glasses rather than requiring that spectacles be purchased. However, the published literature suggests that there are important limits to children's compliance with free spectacles.…”

“…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 limiting wear of glasses include discomfort or inconvenience, 6,8 concerns over being teased, 6,9 parental opposition, 6,10,11 lack of perceived need, 6,[8][9][10] and fear of damage to the eyes [8][9][10][11] (though a trial 4 has now demonstrated that spectacle wear is in fact protective against age-related declines in uncorrected visual acuity among children).…”

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) .…”