Cluster-randomized controlled trial of the effects of free glasses on glasses purchase in China: the PRICE (Potentiating Rural Investment in Children’s Eyecare) study

Abstract

Purpose : To assess the effect of providing free spectacles on purchase and wear of glasses in rural Chinese children.

Methods : Design: Cluster-randomized, investigator-masked, controlled trial.
One 4^th or 5^th grade class was chosen randomly at randomly selected 138 primary schools from 9 counties in Guangdong and Yunnan provinces, China. Children with uncorrected visual acuity (VA) <=6/12 in either eye correctable to >6/12 in both eyes were randomized by school to one of four groups: glasses prescription only (Control); Free Glasses; Free Glasses + offer of $15 Upgrade Glasses; Free Glasses + offer of $30 Upgrade Glasses. Spectacle purchase (main outcome) and observed glasses wear (secondary outcome) were assessed 6 months later. We hypothesized that providing free glasses would not decrease glasses purchase rates, comparing children given prescriptions only with those offered free glasses together with “upgrade spectacles” (having stylish designs and scratch-free coatings) at the point of distribution at county hospitals.

Results : Among 10,234 children screened, 890 (8.70%, mean age 10.6 years, 45.4% boys) were eligible and randomized: 259 (29.1%) at 37 schools to Control; 253 (28.4%) at 32 schools to Free Glasses; 192 (21.6%) at 31 schools to Free Glasses + $15 Upgrade; and 186 (20.9%) at 27 schools to Free Glasses +$30 upgrade. Baseline ownership among these children needing glasses was 11.8% (105/890), and 874 (98.2%) children completed follow-up. Glasses purchase did not differ between Control and the Free Glasses + Upgrade Groups: Control: 60/259=23.2%; Free + $15 Upgrade: 39/192=20.3%, adjusted Odds Ratio (OR) 0.83 (0.45-1.55), P = 0.563; Free + $30 Upgrade: 38/186=20.4%, OR 0.87 (0.48, 1.55), P=0.63.

Conclusions : Providing free glasses while offering upgrade glasses for purchase can deliver services to poorer children and families while maintaining high rates of spectacle sales needed to sustain programs.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.