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

Compliance and Determinants of Spectacle Wear Among Moroccan Adults Residing Beni-Mellal Khénifra Region

Background and Objective

Ensuring a high level of adherence to wearing spectacles is essential to preserve eye health and achieve optimal vision correction. Comprehending the factors influencing adherence to wearing spectacles can inform strategies to improve eye care outcomes. This study aimed to assess the prevalence and factors influencing adherence to wearing spectacles among Moroccan adults residing the Beni-Mellal Khenifra region.

Methods

A cross-sectional interview survey was conducted involving 389 adult spectacle wearers. Participants were recruited through a multilevel random sampling technique and interviewed using a structured questionnaire. This questionnaire collected data on demographics, spectacle prescription, usage patterns, and barriers to compliance. Compliance was assessed based on self-reported frequency and duration of spectacle wear according to the prescription. Possible factors influencing the wearing of spectacles were investigated using both univariate and multivariate regression models.

Results

This study revealed that 57.6% of participants adhered to the recommended use of spectacles. Factors associated with compliance were higher education level, longer duration of spectacle use, awareness about the importance of spectacle wear, absence of a family history, specific refractive error types, and increased severity of refractive errors. Participants reported various reasons for not adhering to the recommended use of spectacles, with the most common being forgetfulness, perceiving improved vision without spectacle, discomfort while wearing spectacle, difficulty adapting to spectacle, and loss of spectacle.

Conclusion

Given the high prevalence of non-compliance to spectacle wear among adults in the Beni-Mellal Khenifra region, it is evident that additional efforts are required to improve understanding and education regarding the advantages of consistent spectacle usage. Targeted educational and awareness initiatives have the potential to substantially enhance adherence rates and consequently improve visual health outcomes in the region.

Priorities in school eye health in low and middle-income countries a scoping review

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Myopia control: Seeing beyond efficacy

SIGNIFICANCE

The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors-compliance, quality of vision, quality of life, and safety-are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.

Gender Disparities in the Global Burden of Refractive Disorders in Children: An Analysis From the Global Burden of Disease Study 2019

PURPOSE

To investigate gender disparities in the global burden of refractive disorders in children younger than 15 years by year, age, and national developmental status using disability-adjusted life years (DALYs).

METHODS

Global, regional, and national gender-specific DALY numbers and rates of refractive disorders in children were obtained by year (from 1990 to 2019) and age group (0 to 4, 5 to 9, and 10 to 14 years) from the Global Burden of Disease Study 2019. Data from the Inequality-adjusted Human Development Index in 2019 as an indicator of national developmental status were extracted from the Human Development Report. Pearson correlation and linear regression analyses were performed to explore the association between female-to-male DALY rate ratios and national developmental status.

RESULTS

Gender disparities in DALY numbers and rates of refractive disorders in children have persisted and shown little improvement from 1990 to 2019. Girls had a higher burden than boys of the same age, and gender disparities increased with age (1.120 in preschool children aged 0 to 4 years, 1.124 in younger school-aged children aged 5 to 9 years, and 1.135 in older school-aged children aged 10 to 14 years). Female-to-male DALY rate ratios were negatively related to Inequality-adjusted Human Development Index values (standardized b = -0.189, P < .05).

CONCLUSIONS

Gender disparities in the global burden of refractive disorders in children have persisted for decades, with girls who are older and from lower-income countries having a higher burden than boys. Gender-specific health policies should be made to manage refractive disorders in children. [J Pediatr Ophthalmol Strabismus. 2024;61(1):51-58.].

Factors Associated with the Spectacle Wear Compliance among Primary School Students with Refractive Error in Rural China

PURPOSE

To study the factors determining spectacle-wear compliance and reasons for non-wear among students in rural China.

METHODS

This study was based on a spectacle intervention trial among 162 schools in rural China. Students with refractive errors were randomly assigned to either a free or voucher group to receive spectacles at baseline. Spectacle-wear compliance was assessed through an unannounced follow-up 7 months after spectacles were distributed. Students not wearing spectacles were also asked their reasons for non-wear. The collected data underwent descriptive, bivariate, and logistic regression analyses.

RESULTS

A total of 1904 students received spectacles at baseline, 1826 (95.9%) of whom were present at the 7-month follow-up. Among those students, 41.7% wore their spectacles. There was no significant difference in compliance rates between the free and voucher groups. Predictors of wearing spectacles at follow-up included older age (Odds ratio = 1.56, 95% CI: 1.12-2.19), the severity of refractive error (3.68, 2.23-6.07), wearing spectacles before baseline (3.91, 2.53-6.04) and having friends who wore spectacles (1.87, 1.32-2.63). When students could see the blackboard from their seats (0.68, 0.51-0.89) and thought that wearing spectacles was bad looking (0.76, 0.57-1.00), they were reluctant to wear spectacles. The two main reasons for non-wear were the widespread perception that wearing spectacles would weaken eyesight (32.8%) and the inconvenience of wearing spectacles during activities (23.6%).

CONCLUSIONS

The main reason that accounts for the low compliance of spectacle wear was misconceptions around spectacle. School-based spectacle programs should consider enhancing the compliance rates to maximize the benefits of spectacle wear.

Prevalence of myopia and uncorrected myopia among 721 032 schoolchildren in a city-wide vision screening in southern China: the Shantou Myopia Study

AIMS

To explore the prevalence and risk factors for myopia and uncorrected myopia in schoolchildren in southern China.

METHODS

The government-led Shantou Myopia Study was conducted from September 2020 to June 2021. Non-cycloplegic refraction was performed. Uncorrected visual acuity (UCVA) was measured along with presenting visual acuity if participants wore spectacles. Spherical equivalent refraction (SER) is defined as the spherical dioptres added to half of the cylindrical dioptres. Myopia is defined as SER <-0.50 dioptre with UCVA of <20/20 in at least one eye.

RESULTS

This study enrolled 724 828 schoolchildren (77.8% of all schoolchildren in Shantou) from 901 schools. Data from 721 032 schoolchildren (99.5%) were analysed (mean age 11.53±3.13 years, 6-20 years, 373 230 boys and 347 802 girls). Among them, 373 459 (51.8%) had myopia: 37.1% of 465 696 children in primary schools, 75.4% of 170 164 children in junior high schools and 84.8% of 85 172 children in senior high schools. The prevalence of myopia increases non-linearly with age. Older age, female and urban living environment were independently associated with myopia prevalence and myopic SER. Among the 373 459 children with myopia, 60.0% had no refractive correction: 74.9%, 53.9% and 35.5% in primary, junior high and senior high schools, respectively.

CONCLUSION

The overall prevalence of myopia among schoolchildren in Shantou was 51.8%, higher than the national average in China. The proportion of uncorrected myopia is high, especially in primary schools. Our results indicate the need for public education on eye care among schoolchildren even in a municipal city.

Parental perspectives on factors influencing eyeglass wear compliance in preschoolers from low-income families in San Francisco

PURPOSE

To investigate factors associated with spectacle wear among low-income preschoolers who receive glasses through the See Well to Learn (SWTL) program.

METHODS

Qualitative study of parental perceptions of factors contributing to compliance during a longitudinal study of eyeglass wear utilizing thematic analysis of a series of three scripted phone calls during the 2017-2018 school year. Participants were parents of 164 children ages 3-5, from 51 Head Start preschools in the greater San Francisco region.

RESULTS

A total of 470 scripted parental telephone calls were successfully completed during the study period. Six major themes affecting glasses compliance in this group were identified including: (1) awareness of need and noted visual improvement; (2) continuous efforts to improve compliance by working with parent; (3) collaborative efforts between home and school such as parent-teacher encouragement; (4) child comfort and eyewear preferences; (5) the importance of two functional pairs of eyewear to achieve full-time wear; and (6) coordination of care offered by the SWTL program.

CONCLUSIONS

This study offers insight into factors contributing to child eyewear compliance during critical years of vision development. These findings offer lessons to improve compliance and identify a need to adjust California's current policies on vision coverage for children.

Comparison of Short-Term Effects of Treatment of Accommodative Infacility with Low Plus Addition in Single Vision Rx or Vision Therapy: A Pilot Study

PURPOSE

To compare the short-term treatment effect of low plus reading addition (ADD) and home-based vision therapy (VT) in a small group of symptomatic children with accommodative infacility (AIF) being the most significant dysfunction.

METHODS

Nineteen children, 8 to 12 years of age, with a first-time diagnosis of AIF were consecutively and alternately allocated to treatment with ADD (+0.50 D addition in single vision Rx) or VT (accommodation exercises using Hart Charts) for a period of 6 weeks. Accommodation facility (AF) was measured monocularly (MAF-R, MAF-L) and binocularly (BAF) with +2 D/-2 D flipper and registered in cycles per minute (cpm). Symptoms were graded using the convergence insufficiency symptom survey (CISS). Measurements were compared before and after treatment and between groups using nonparametric statistics (p < 0.05).

RESULTS

Ten children were allocated to ADD (median age 9.0 F:5) and 9 to VT (median age 11.0 F:7). Baseline median measurements of MAF-R, MAF-L, BAF and CISS were 3.0, 3.0, 2.2 cpm, and 27.5 points, respectively, for ADD, and 2.0, 2.0, 2.0 cpm, and 27.0 points, respectively, for VT. There were no significant differences between groups at baseline. After 6 weeks of treatment, the median change of MAF-R, MAF-L, BAF and CISS was +5.0, +4.5, +4.7 cpm, and -7.5 points, respectively, for ADD and +8.0, +8.0, +10.0 cpm, and -20.0 points, respectively for VT. All changes within groups were significant. Comparison of groups showed a significantly greater effect of treatment with VT compared to ADD for BAF (p = 0.008) and CISS (p = 0.017).

CONCLUSION

In children with newly diagnosed AIF, treatment with accommodation exercises for 6 weeks gives greater short-term relief of symptoms and improvement of binocular accommodative facility compared to treatment with spectacle single vision correction with a weak plus addition.

Magnitude and Determinants of Computer Vision Syndrome Among Radiologists in Saudi Arabia: A National Survey

RATIONALE AND OBJECTIVES

To assess the magnitude and determinants of computer vision syndrome (CVS) among radiologists in Saudi Arabia using a reliable and validated survey instrument.

MATERIALS AND METHODS

This nationwide cross-sectional web-based survey took place in April 2021 and included all radiologists and radiology residents residing practicing in Saudi Arabia. We used the reliable and validated CVS questionnaire. Univariate and multivariate analyses were carried out using nonparametric methods. The CVS score was correlated with different demographic- and health-related variables. The Mann-Whitney U test and Kruskal-Wallis test were used to determine if there was a statistically significant difference between subgroups.

RESULTS

The survey was completed by 416 participants. The prevalence of CVS was 65.4% (95% CI: 60.8-70.0). The median CVS score was 7.5 (interquartile range: 4.0; 12.0). Mild CVS was observed in 188 participants (69.1%), moderate CVS was observed in 69 (25.4%), and severe CVS was observed in 15 (5.5%). The most common symptoms perceived by participants were headache (72.1%), dryness (70.7%), burning (63.7%), blurred vision (56.3%), and increased sensitivity to light (55.5%). Multinomial regression analysis suggested that female sex (p < 0.001), work as a general radiologist (p = 0.05), and the use of eyeglasses (p = 0.001) were significant predictors of CVS.

CONCLUSION

The prevalence of CVS among radiologists in our study was high. Local and international societies need to establish and implement legislative and preventive measures to ensure the safety and ocular and visual health of radiologists.

A Cooperative Management App for Parents with Myopic Children Wearing Orthokeratology Lenses: Mixed Methods Pilot Study

Orthokeratology (OK) lens wear is an effective modality to inhibit axial elongation in myopic children. Willingness for commitment from both parents and children contributes to the success of OK treatment. We aimed to develop and assess the usability of a mobile application on OK lens wear by quantitatively and qualitatively evaluating parents with myopic children and eye care professionals (ECPs). Moreover, the preliminary outcome was also evaluated in this study. The app was developed and tested using a co-design approach involving key stakeholders. Two prototype tests were conducted during the feasibility and utility assessment. The app features include self-reported compliance documentation, analytics, and personalized and generalized messages for compliance behaviors of OK lenses. After the trial period, the full usage of app functions ranged from 40% to 60% among the enrolled parents. After app implementation, the compliance with follow-up visits substantially improved. Qualitative data show that the high-satisfaction app functions reported by parents were the app’s reminder and axial length recording, although it was recommended that the number of compliance questions should be reduced to minimize the survey completion time. Additionally, who should complete the recording of the axial length data as well as the management and reminder for the follow-up visit remained controversial. This is the first app developed to improve parents of myopic children’s compliance with OK lens wear and to assist ECPs and parents in collaboratively monitoring and managing the use and care of OK lenses among myopic children. This study highlights the importance of interdisciplinary collaboration in the design, development, and validation of such an app.

IMI Impact of Myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.

Objective Monitoring of Spectacle Wearing Times in Adult Subjects Using the Theramon® Thermosensor

Purpose

To find a reliable method to determine the wearing times of glasses in adults objectively on the basis of temperature measurements of the small-sized theramon^® thermosensor device (TM) from orthodontics. Furthermore, the reliability of the determined wearing times during well and poor position of spectacles was explored. To address the previously reported lack of accuracy during higher outside temperatures, this study was conducted in midsummer and autumn.

Patients and Methods

Twenty adults wore their spectacles with three TMs attached to both inner sides and the right outer side in a period of three consecutive days. They were asked to report wearing and non-wearing times, indoor and outdoor activities and subjective perception of spectacle position as accurately as possible. To find the most reliable way to determine spectacle wearing times compared to protocolled wearing times, we applied and evaluated temperature categorizing methods and visual analysis of time logged temperatures. Percent error and percent accuracy of each method were calculated. The methods mentioned were applied and evaluated to determine poor spectacle position.

Results

Median percent errors of the most reliable determination methods were <10% with an accuracy between 90% and 96%. Comparing the most reliable methods, determinations on the basis of midsummer measurements (median percent error 0% to 2%, median percent accuracy 96%) were more accurate than on the basis of autumn measurements (median percent error -5% to -20%, median percent accuracy 90%). Poor spectacle position could be determined with a median percent error of 0% and a median percent accuracy of 100% by analysing the temperature measurements of TM's visually.

Conclusion

A reliable and objective determination of spectacle wearing times is possible on the basis of TM temperature measurements in a standard clinical setting. Measurements of one inner TM seem to be sufficient to determine the wearing times and are more appealing. Poor spectacle position can be determined reliably by analysing visually the time logged temperatures. The findings of this study require further studies on larger groups of affected, amblyopic patients and children, to analyse the real impact of spectacle wearing times and poor spectacle position on visual development.

Prevalence and Factors Associated With Eyeglass Wear Compliance Among Preschoolers From Low-Income Families in San Francisco, California

IMPORTANCE

Despite growing support for early school-based vision screening and eyeglass provision, few studies have rigorously monitored the compliance of eyeglass wear among preschool-aged children who receive eyeglasses through such programs.

OBJECTIVE

To assess the prevalence and factors associated with eyeglass wear compliance among preschoolers from low-income families who receive eyeglasses through the See Well to Learn program.

DESIGN, SETTING, AND PARTICIPANTS

Longitudinal cross-sectional study of eyeglass wear compliance patterns among 188 children 3 to 5 years of age from 51 Bay Area Head Start preschools in San Francisco, California. The study conducted during the 2017 to 2018 school year included students with a failed vision screening who met predetermined refractive criteria following cycloplegic refraction and received eyeglasses through the See Well to Learn program.

EXPOSURES

Eyeglass distribution.

MAIN OUTCOMES AND MEASURES

Eyeglass wear compliance, measured by a school-year's worth of weekly teacher reports, was a longitudinal measure of consistent eyeglass wear, defined by eyeglass wear for more than 50% of every school day (compliance score of 4).

RESULTS

Of 188 students (91 boys [49%]; 94 girls [51%]; mean [SD] age, 3.89 [0.5] years), 133 (71%; 95% CI, 64%-77%) maintained a mean compliance score throughout the school year of 4 or higher. Compliance prevalence was relatively stable throughout the school year, ranging from 139 students (74%) to 164 students (87%). Baseline uncorrected visual acuity in both the better-seeing and worse-seeing eyes was the only assessed factor that was associated with compliance. In the better-seeing eye, the mean uncorrected visual acuity of students with eyeglass wear compliance was 0.473 logMAR (95% CI, 0.433-0.514) (Snellen equivalent, 20/60) compared with 0.394 logMAR (95% CI, 0.334-0.454) (Snellen equivalent, 20/50) for students with noncompliance (P = .03). In the worse-seeing eye, the mean uncorrected visual acuity of students with compliance was 0.576 logMAR (95% CI, 0.530-0.623) (Snellen equivalent, 20/75) compared with 0.492 logMAR (95% CI, 0.433-0.551) (Snellen equivalent, 20/62) for students with noncompliance (P = .03). In the better-seeing eye, the difference between students with compliance vs noncompliance was 0.079 logMAR (95% CI, 0.009-0.150) (5 Snellen letter difference) compared with 0.084 logMAR (95% CI, 0.007-0.160) (5 Snellen letter difference) in the worse-seeing eye.

CONCLUSIONS AND RELEVANCE

This study found that nearly 3 of 4 preschool students consistently wore their glasses at school during their first year of use, supporting the continued implementation of preschool-based vision screening programs. These findings suggest that programs involving school-based screening and eyeglass delivery may lessen disparities in accessing pediatric vision care. Consistent with previous studies, students with poorer uncorrected baseline visual acuity were found to be more likely to wear eyeglasses compliantly.

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

BACKGROUND

Uncorrected refractive errors can be corrected by spectacles which improve visual functioning, academic performance and quality of life. However, spectacle wear can be low due to teasing/bullying, parental disapproval and no perceived benefit.Hypothesis: higher proportion of children with uncorrected refractive errors in the schools allocated to the intervention will wear their spectacles 3-4 months after they are dispensed.

METHODS

A superiority, cluster-randomised controlled trial was undertaken in 50 government schools in Hyderabad, India using a superiority margin of 20%. Schools were the unit of randomization. Schools were randomized to intervention or a standard school programme. The same clinical procedures were followed in both arms and free spectacles were delivered to schools. Children 11-15 years with a presenting Snellen visual acuity of <6/9.5 in one or both eyes whose binocular acuity improved by ≥2 lines were recruited.In the intervention arm, classroom health education was delivered before vision screening using printed images which mimic the visual blur of uncorrected refractive error (PeekSim). Children requiring spectacles selected one image to give their parents who were also sent automated voice messages in the local language through Peek. The primary outcome was spectacle wear at 3-4 months, assessed by masked field workers at unannounced school visits. www.controlled-trials.com ISRCTN78134921 Registered on 29 June 2016.

FINDINGS

701 children were prescribed spectacles (intervention arm: 376, control arm: 325). 535/701 (80%) were assessed at 3-4 months: intervention arm: 291/352 (82.7%); standard arm: 244/314 (77.7%). Spectacle wear was 156/291 (53.6%) in the intervention arm and 129/244 (52.9%) in the standard arm, a difference of 0.7% (95% confidence interval (CI), -0.08, 0.09). amongst the 291 (78%) parents contacted, only 13.9% had received the child delivered PeekSim image, 70.3% received the voice messages and 97.2% understood them.

INTERPRETATION

Spectacle wear was similar in both arms of the trial, one explanation being that health education for parents was not fully received. Health education messages to create behaviour change need to be targeted at the recipient and influencers in an appropriate, acceptable and accessible medium.

FUNDING

USAID (Childhood Blindness Programme), Seeing is Believing Innovation Fund and the Vision Impact Institute.