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

Abstract

IMPORTANCEVisual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential.OBJECTIVE To investigate predictors of spectacle wear and reasons for nonwear in students randomized to ready-made or custom-made spectacles. DESIGN, SETTING, AND PARTICIPANTSIn planned secondary objectives of a noninferiority randomized clinical trial, students aged 11 to 15 years who fulfilled eligibility criteria, which included improvement in vision with correction by at least 2 lines in the better eye, were recruited from government schools in Bangalore, India. Recruitment took place between January 12 and July 15, 2015, and analysis for the primary outcome occurred in August 2016. Data analysis for the secondary outcome was conducted in August 2018. Spectacle wear was assessed by masked observers at unannounced visits to schools 3 to 4 months after spectacles were distributed. Students not wearing their spectacles were asked an open-ended question to elicit reasons for nonwear.MAIN OUTCOMES AND MEASURES Predictors of spectacle wear and reasons for nonwear. RESULTSOf 460 students recruited and randomized (52.2% male; 46 students aged 11 to 12 years and 13 to 15 years in each trial arm), 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles (no difference between trial arms). Poorer presenting visual acuity (VA) and improvement in VA with correction predicted spectacle wear. Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12 (adjusted odds ratio, 2.84; 95% CI, 1.52-5.27). Improvement of VA with correction of 3 to 6 lines or more than 6 lines had adjusted odds ratios of 2.31 (95% CI, 1.19-4.50) and 2.57 (95% CI, 1.32-5.01), respectively, compared with an improvement of less than 3 lines. The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]). Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%).CONCLUSIONS AND RELEVANCE Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial. Predictors of spectacle wear, poorer presenting VA, and greater improvement in VA with correction are similar to other studies. Interventions to reduce teasing and bullying are required, and health education of parents is particularly needed for girls in this setting.

Prevalence of myopia and vision impairment in school students in Eastern China

“…A study of 7681 students aged 5 to16 years in rural Yunan of China found that among the students who needed glasses, only 18.9% owned them [18], which is lower than the study in urban (35.3%) [19] and rural (61.2%) China [20]. The reasons underlying low spectacles wearing among myopia might be multifactorial, including the lack of screening for detecting myopia, teasing or bullying by peers, the low attention and consciousness of the need for glasses, or the mis-conception by parents or students that wearing glasses will make the myopia worse [19–21]. A recent study found that the teasing or bullying by peers (48.6%) and the lost or forgot or stolen spectacles (26.1%) are the major reason of not wearing the prescribed glasses [21].…”

“…The reasons underlying low spectacles wearing among myopia might be multifactorial, including the lack of screening for detecting myopia, teasing or bullying by peers, the low attention and consciousness of the need for glasses, or the mis-conception by parents or students that wearing glasses will make the myopia worse [19–21]. A recent study found that the teasing or bullying by peers (48.6%) and the lost or forgot or stolen spectacles (26.1%) are the major reason of not wearing the prescribed glasses [21]. Thus, education on students and parents about the importance of timely screening for myopia and wearing glasses for best vision is very important to improve student learning and academic achievement.…”

Prevalence of Myopia and Vision Impairment in School Students in Eastern China

“…20 The reasons underlying low spectacles wearing among myopia might be multifactorial, including the lack of screening for detecting myopia, teasing or bullying by peers, the low attention and consciousness of the need for glasses, or the mis-conception by parents or students that wearing glasses will make the myopia worse. [19][20][21] A recent study found that the teasing or bullying by peers (48.6%) and the lost or forgot or stolen spectacles (26.1%) are the major reason of not wearing the prescribed glasses. 21 Thus, education on students and parents about the importance of timely screening for myopia and wearing glasses for best vision is very important to improve student learning and academic achievement.…”

“…[19][20][21] A recent study found that the teasing or bullying by peers (48.6%) and the lost or forgot or stolen spectacles (26.1%) are the major reason of not wearing the prescribed glasses. 21 Thus, education on students and parents about the importance of timely screening for myopia and wearing glasses for best vision is very important to improve student learning and academic achievement.…”

Effectiveness of a novel mobile health (Peek) and education intervention on spectacle wear amongst children in India: Results from a randomized superiority trial in India

“…We observed that the two trial arms were not balanced for VA at baseline. From previous research we know that poorer presenting VA is a predictor of spectacle wear [35] and we undertook post hoc analysis that stratified the risk difference of spectacle wear by baseline VA.…”