title: Self correction of refractive error among young people in rural China: results of cross sectional investigation.
abstract: OBJECTIVE
  To compare outcomes between adjustable spectacles and conventional methods for refraction in young people.
  
  
  METHODS
  Cross sectional study.
  
  
  METHODS
  Rural southern China.
  
  
  METHODS
  648 young people aged 12-18 (mean 14.9 (SD 0.98)), with uncorrected visual acuity ≤ 6/12 in either eye.
  
  
  METHODS
  All participants underwent self refraction without cycloplegia (paralysis of near focusing ability with topical eye drops), automated refraction without cycloplegia, and subjective refraction by an ophthalmologist with cycloplegia.
  
  
  METHODS
  Uncorrected and corrected vision, improvement of vision (lines on a chart), and refractive error.
  
  
  RESULTS
  Among the participants, 59% (384) were girls, 44% (288) wore spectacles, and 61% (393/648) had 2.00 dioptres or more of myopia in the right eye. All completed self refraction. The proportion with visual acuity ≥ 6/7.5 in the better eye was 5.2% (95% confidence interval 3.6% to 6.9%) for uncorrected vision, 30.2% (25.7% to 34.8%) for currently worn spectacles, 96.9% (95.5% to 98.3%) for self refraction, 98.4% (97.4% to 99.5%) for automated refraction, and 99.1% (98.3% to 99.9%) for subjective refraction (P = 0.033 for self refraction v automated refraction, P = 0.001 for self refraction v subjective refraction). Improvements over uncorrected vision in the better eye with self refraction and subjective refraction were within one line on the eye chart in 98% of participants. In logistic regression models, failure to achieve maximum recorded visual acuity of 6/7.5 in right eyes with self refraction was associated with greater absolute value of myopia/hyperopia (P<0.001), greater astigmatism (P = 0.001), and not having previously worn spectacles (P = 0.002), but not age or sex. Significant inaccuracies in power (≥ 1.00 dioptre) were less common in right eyes with self refraction than with automated refraction (5% v 11%, P<0.001).
  
  
  CONCLUSIONS
  Though visual acuity was slightly worse with self refraction than automated or subjective refraction, acuity was excellent in nearly all these young people with inadequately corrected refractive error at baseline. Inaccurate power was less common with self refraction than automated refraction. Self refraction could decrease the requirement for scarce trained personnel, expensive devices, and cycloplegia in children's vision programmes in rural China.
authors.affiliation: Joint Shantou International Eye Centre, Shantou, People's Republic of China.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Zhang
authors.forename: Riping
authors.initials: R
authors.lastname: Zhang
authors.forename: Mingguang
authors.initials: M
authors.lastname: He
authors.forename: Wanling
authors.initials: W
authors.lastname: Liang
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Li
authors.forename: Lingbing
authors.initials: L
authors.lastname: She
authors.forename: Yunli
authors.initials: Y
authors.lastname: Yang
authors.forename: Graeme
authors.initials: G
authors.lastname: Mackenzie
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Silver
authors.forename: Leon
authors.initials: L
authors.lastname: Ellwein
authors.forename: Bruce
authors.initials: B
authors.lastname: Moore
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
mesh_terms: D000293:Adolescent; D002648:Child; D002681:China; D003430:Cross-Sectional Studies; D005139:Eyeglasses; D005260:Female; D006801:Humans; D008297:Male; D012030:Refractive Errors / Q000503:physiopathology / Q000628:therapy*; D012423:Rural Health; D012648:Self Care; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult