Impact of spectacles wear on uncorrected visual acuity among urban migrant primary school children in China: a cluster-randomised clinical trial

Does Vision Health Knowledge Matter? A Cross-Sectional Study of Primary School Students in Rural China

Purpose

To estimate the prevalence, consequences of, and factors associated with poor vision health knowledge among students, parents, and teachers in rural China.

Methods

This cross-sectional study was conducted with 17,902 students among 251 primary schools in rural China. The primary outcomes were eyeglasses ownership and wear rates, measured by self-reported eyeglasses ownership and wear status. Descriptive and multivariable regression analyses were performed.

Results

Students, parents, and teachers had a high prevalence of poor vision health knowledge, with 90% of students, 86% of parents, and 56% of teachers scoring 4 or below on the study's vision knowledge test. Among 2,893 students needing eyeglasses, only 563 (19.46%) owned eyeglasses and 450 (15.55%) wore them. Both student and parental vision health knowledge were positively associated with eyeglasses ownership (p < 0.001 and p < 0.001, respectively). Parental vision health knowledge also showed a positive association with eyeglasses wear (p=0.098). Students with higher parental vision health knowledge and male students had higher vision health knowledge. Parents with higher education levels, at least one family member wearing eyeglasses, medium to high family wealth demonstrated higher levels of vision health knowledge.

Conclusion

We found that poor vision health knowledge is prevalent among children, parents, and teachers in rural western China, and that prevalent visual impairment among children is accompanied by low eyeglasses ownership and wear rates. We also found positive and significant correlations between students' and parental vision health knowledge and students' eyeglasses ownership, as well as between parental vision health knowledge and students' eyeglasses wear rates, suggesting that efforts are needed to improve vision health knowledge among students and parents in rural China.

Implementing interventions to promote spectacle wearing among children with refractive errors: A systematic review and meta-analysis

Purpose

To investigate the level of compliance of children with refractive errors who are provided free spectacles, and to identify the reasons for non-compliance.

Methods

We systematically searched the PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library databases from the time these databases were established to April 2022, including studies published in English. The search terms were "randomized controlled trial" [Publication Type] OR "randomized" [Title/Abstract], OR "placebo" [Title/Abstract]) AND (("Refractive Errors"[MeSH Terms] OR ("error refractive" [Title/Abstract] OR "errors refractive" [Title/Abstract] OR "refractive error" [Title/Abstract] OR "refractive disorders" [Title/Abstract] OR "disorder refractive" [Title/Abstract] OR "disorders refractive" [Title/Abstract] OR "refractive disorder" [Title/Abstract] OR "Ametropia" [Title/Abstract] OR "Ametropias" [Title/Abstract])) AND ("Eyeglasses" [MeSH Terms] OR ("Spectacles" [Title/Abstract] OR "Glasses"[Title/Abstract]) AND ("Adolescent" [MeSH Terms] OR ("Adolescents" [Title/Abstract] OR "Adolescence"[Title/Abstract]) OR "Child"[MeSH Terms] OR "Children"[Title/Abstract])). We only selected studies that were randomized controlled trials. Two researchers independently searched the databases, and 64 articles were retrieved after the initial screening. Two reviewers independently assessed the quality of the collected data.

Results

Fourteen articles were eligible for inclusion, and 11 studies were included in the meta-analysis. The overall compliance with spectacle use was 53.11%. There was a statistically significant effect of free spectacles on compliance among children (OR = 2.45; 95% CI = 1.39-4.30). In the subgroup analysis, longer follow-up time was associated with significantly lower reported ORs (6-12 vs. <6 months, OR = 2.30 vs. 3.18). Most studies concluded that sociomorphic factors, RE severity, and other factors contributed to children not wearing glasses at the end of the follow-up.

Conclusion

The combination of providing free spectacles along with educational interventions can lead to high levels of compliance among the study participants. Based on this study's findings, we recommend implementing policies that integrate the provision of free spectacles with educational interventions and other measures. In addition, a combination of additional health promotion strategies may be needed to improve the acceptability of refractive services and to encourage the consistent use of eyewear.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=338507, identifier: CRD42022338507.

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.

The prevalence and correlates of vision impairment and glasses ownership among ethnic minority and Han schoolchildren in rural China

PURPOSE

To determine the prevalence of visual impairment and glasses ownership among Han Chinese and Hui minority junior high school children in Ningxia Hui Autonomous Region, China.

DESIGN

Population-based cross-sectional study.

METHODS

Vision screening was conducted on 20,376 children (age 12-15 years) in all 124 rural junior high schools in Ningxia. Personal and family characteristics, glasses ownership, and academic performance were assessed through a survey questionnaire and standardized mathematics test, respectively.

RESULTS

The prevalence of visual acuity (VA) ≤6/12 in either eye was significantly higher among Han (54.5%) than Hui (45.2%) children (P<0.001), and was significantly positively associated with age, female sex, Han ethnicity, parental outmigration for work, shorter time spent outside during recess, shorter time spent watching television and higher time spent studying. Among children with VA≤6/12 in both eyes, only 56.8% of Han and 41.5% of Hui children had glasses (P<0.001). Glasses ownership was significantly associated with worse vision, greater family wealth, female sex, higher test scores, age, parental outmigration for work, understanding of myopia and glasses, higher time spent studying and Han ethnicity.

CONCLUSION

One of the first of its kind, this report on Han and Hui ethnic schoolchildren confirms a high prevalence of visual impairment among both populations, but slightly higher among the Han. Both groups, especially the Hui, have low rates of glasses ownership. Future interventions and policies designed to improve glasses usage should focus on populations with lower incomes and seek to correct erroneous beliefs about the safety of glasses and efficacy of traditional eye exercises.