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Nathan G Congdon, Xiaochen Ma, Zhongqiang Zhou, Hongmei Yi, Xiaopeng Pang, Yaojiang Shi, Qianyun Chen, Mirjam Meltzer, Mingguang He, Scott Rozelle; Provision of spectacles improves academic performance of primary school children in a randomized trial in China. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3625.
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© ARVO (1962-2015); The Authors (2016-present)
To understand the impact of providing glasses on educational performance in rural China.
A list of primary schools was obtained for all 18 counties in two prefectures in Gansu and Shaanxi Provinces. One school from each township in these countiese was selected at random, and within each school, one class was randomly chosen in each of the 4th and 5th grades. All children with uncorrected visual acuity (VA) <= 6/12 in either eye underwent cycloplegic refraction with subjective refinement by a trained refractionist. In September 2012, at the beginning of the school year, children were randomized by school to receive free glasses at school, to get a voucher to collect free glasses at a facility in their county, or to the control group where families were told when children needed glasses, which were given only at study closeout. A 90-minute mathematics test designed for the study was administered to all chldren at baseline and at the end of the school year in May 2013. Socioeconomic and demographic factors were measured for children and families.
Among 19,975 children at 253 schools, 4849 (24.2%) failed vision screening, 4673 (96.4%) completed refraction, 3054 (65.3%) met criteria to receive glasses and 1003, 947 and 1104 respectively were randomized to Free Glasses, Vouchers and Control. The unadjusted change in test score among children in the Free Glasses group was 0.1 Standard Deviations (SD) higher than for Controls (P = 0.03). In regression models of final test score adjusting for baseline score and other potential predictors, statistically significant predictors of better score included membership in the Free Glasses group (0.11 SD, P = 0.03), older age (0.13 SD/year, P < 0.001), more myopic refractive error (0.05 SD/Diopter, P = 0.001) and residence in Shaanxi (a richer province than Gansu) (0.1 SD, P = 0.02). The effect of free glasses was greater than having family wealth in the top tercile versus the lowest tercile (0.01 SD, P = 0.80) and having a parent with >= 12 years of education (0.03 SD, P = 0.37).
Provision of free spectacles has a significant impact on educational attainment which equalled or exceeded financial and parental educational advantages in this setting. Trial evidence, previously unavailable, is particularly important because the causal directionality between spectacle wear and academic performance is otherwise ambiguous.
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