Safety of Spectacles for Children's Vision: A Cluster-Randomized Controlled Trial.
OBJECTIVE
To study safety of children's glasses in rural China, where fear that glasses harm vision is an important barrier for families and policy makers.


METHODS
Exploratory analysis from a cluster-randomized, investigator-masked, controlled trial.


METHODS
Among primary schools (n = 252) in western China, children were randomized by school to 1 of 3 interventions: free glasses provided in class, vouchers for free glasses at a local facility, or glasses prescriptions only (Control group). The main outcome of this analysis is uncorrected visual acuity after 8 months, adjusted for baseline acuity.


RESULTS
Among 19 934 children randomly selected for screening, 5852 myopic (spherical equivalent refractive error ≤-0.5 diopters) eyes of 3001 children (14.7%, mean age 10.5 years) had VA ≤6/12 without glasses correctable to >6/12 with glasses, and were eligible. Among these, 1903 (32.5%), 1798 (30.7%), and 2151 (36.8%) were randomized to Control, Voucher, and Free Glasses, respectively. Intention-to-treat analyses were performed on all 1831 (96.2%), 1699 (94.5%), and 2007 (93.3%) eyes of children with follow-up in Control, Voucher, and Free Glasses groups. Final visual acuity for eyes of children in the treatment groups (Free Glasses and Voucher) was significantly better than for Control children, adjusting only for baseline visual acuity (difference of 0.023 logMAR units [0.23 vision chart lines, 95% CI: 0.03, 0.43]) or for other baseline factors as well (0.025 logMAR units [0.25 lines, 95% CI 0.04, 0.45]).


CONCLUSIONS
We found no evidence that spectacles promote decline in uncorrected vision with aging among children.
China Center for Health Development Studies, Peking University, Beijing, China; Stanford Center For International Development, Stanford University, Stanford, California.
Xiaochen
X
Ma
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; ORBIS International, New York, New York; Center for Public Health and TREE Center, Queen's University Belfast, Belfast, United Kingdom. Electronic address: ncongdon1@gmail.com.
Nathan
N
Congdon
Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
Hongmei
H
Yi
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Zhongqiang
Z
Zhou
School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China.
Xiaopeng
X
Pang
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Mirjam E
ME
Meltzer
Center for Experimental Economics for Education, Shaanxi Normal University, Xi'an, China.
Yaojiang
Y
Shi
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Mingguang
M
He
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Yizhi
Y
Liu
Freeman Spogli Institute of International Studies, Stanford University, Stanford, California.
Scott
S
Rozelle
D002648:Child; D002681:China / Q000453:epidemiology; D005139:Eyeglasses / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012424:Rural Population; D012574:Schools; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000534:rehabilitation*