Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses: A Cluster-Randomized Controlled Trial.
OBJECTIVE
To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children.


METHODS
Cluster-randomized controlled trial.


METHODS
Children with visual acuity (VA) ≤6/12 in either eye owing to refractive error in 94 randomly chosen primary schools underwent randomization by school to receive free glasses, education on their use, and a teacher incentive (Intervention), or glasses prescriptions only (Control). Intervention group teachers received a tablet computer if ≥80% of children given glasses wore them during unannounced visits 6 weeks and 6 months (main outcome) after intervention.


RESULTS
Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomly allocated, 358 (49.2%, 47 schools) to Intervention and 370 (50.8%, 47 schools) to Control. Among these, 693 children (95.2%) completed the study and underwent analysis. Spectacle wear was significantly higher at 6 months among Intervention children (Observed [main outcome]: 68.3% vs 23.9%, adjusted odds ratio [OR] = 11.5, 95% confidence interval [CI] 5.91-22.5, P < .001; Self-reported: 90.6% vs 32.1%, OR = 43.7, 95% CI = 21.7-88.5, P < .001). Other predictors of observed wear at 6 months included baseline spectacle wear (P < .001), uncorrected VA <6/18 (P = .01), and parental spectacle wear (P = .02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives.


CONCLUSIONS
Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions.
Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, Beijing, China.
Hongmei
H
Yi
College of Economics and Management, Shanghai Ocean University, Shanghai, China.
Haiqing
H
Zhang
China Center for Health Development Studies, Peking University, Beijing, China; Stanford Center for International Development, Stanford University, Stanford, California.
Xiaochen
X
Ma
Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, Beijing, China.
Linxiu
L
Zhang
State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Affiliated Hospital of Guangdong Medical College, Zhanjiang, China.
Xiuqin
X
Wang
State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Ling
L
Jin
Brien Holden Vision Institute, Durban, South Africa; AVRI, University of KwaZulu-Natal, Durban, South Africa.
Kovin
K
Naidoo
Brien Holden Vision Institute, Durban, South Africa.
Hasan
H
Minto
Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China.
Haidong
H
Zou
Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China.
Lina
L
Lu
China Center for Health Development Studies, Peking University, Beijing, China.
Scott
S
Rozelle
State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; ORBIS International, New York, New York; Queen's University Belfast, Belfast, United Kingdom. Electronic address: ncongdon1@gmail.com.
Nathan
N
Congdon
D002648:Child; D002681:China / Q000453:epidemiology; D005139:Eyeglasses / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009042:Motivation / Q000502:physiology*; D016017:Odds Ratio; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012424:Rural Population; D014792:Visual Acuity