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N. G. Congdon, M. Zheng, A. Sharma, K. Choi, Y. Song, M. Zhang, M. Wang, L. Li, X. Liu, D. S. C. Lam; Determinants of Spectacle Wear and Results of an Intervention to Increase Uptake of Glasses Among Rural Chinese Secondary School Students: The X-PRES Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2605.
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© ARVO (1962-2015); The Authors (2016-present)
Uncorrected refractive error is the leading cause of low vision among children in Asia, but few studies have examined programs to reduce this burden. We sought: 1. To study the prevalence and determinants of spectacle wear among rural, Chinese children requiring spectacles and 2.To analyze the response to an intervention to increase spectacle uptake.
Acuity, refraction, spectacle wear and visual function were measured for children in a random, cluster sample of students drawn from all secondary schools in Xichang, China. Information on obtaining glasses and the benefits of spectacles was provided to children, families and teachers. Purchase of new spectacles and reasons for non-purchase were assessed by direct examination three months later.
Mean age was 14.7 +/- 0.8 years among 1892 examined subjects (84.7% of the sample). Among 948 children (50.1%) benefitting from glasses (presenting VA <= 6/12 in either eye, improving >= 2 lines with refraction), 369 (38.8%) did not own spectacles. Among 580 children owning glasses, 18.0% could not produce them at school. Among 476 children wearing glasses, 25.1% had spectacles that could not improve their vision to > 6/12 in both eyes. Thus, 62.3% (591/948) of children whose vision could benefit from glasses did not own or wear appropriate spectacles. Children not owning and wearing glasses had better self-reported visual function but worse presenting vision than children wearing spectacles, and had refractive errors of -2.06 +/- 1.15D and -2.78 +/- 1.32 D respectively. A common reason for non-wear (17%) was the belief that glasses weaken the eyes. Among children requiring spectacles, 88.6% were followed up, and 210 (35.2%) had purchased new glasses. Most (70%) subjects paid US$13-26. Among children with bilateral vision <= 0.3, 45.6% bought glasses. In multivariate models, presenting vision < 6/12 (P < 0.009), refractive error < -2.0 D (P < 0.001), and amount willing to pay for glasses (P = 0.01) were predictors of purchase.
Though half of children could benefit from spectacles, 60% of these were not wearing appropriate glasses. Significant uncorrected refractive errors are present among these children. Many families in rural China will pay for glasses, though uptake was < 50% even among children with poor vision.
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