Prevalence and associations of spectacle adherence among school children in a multicentre Indian study

Abstract

Background/aims: To assess adherence to spectacle wear among children attending public and private schools in urban and rural locations in Kerala, Maharashtra, Madhya Pradesh, Tamil Nadu and West Bengal.

Methods: All schools within a district served by one of six partner hospitals were invited to participate. Vision screening occurred in children aged 5 to 18 years using a pocket vision screener. Children unable to read 0.2 logMar letters (Snellen equivalent approximately 6/9) monocularly, able to read them through a +1.50 DS lens, already wearing spectacles or with ocular complaints or abnormalities were examined on-site by a vision professional. Glasses were provided according to age-specific guidelines and subjective improvement. Adherence was assessed by direct observation at an unannounced follow-up visit.

Results: Among 31 991 children prescribed glasses at 2145 schools, 29 667 (92.7%) were available at follow-up median of 5.6 months instead of a planned 3-month follow-up. Of these, 19 679 (66.3%) were adherent. Adherence was higher in children with poorer presenting vision, younger age, attending rural or government-supported schools, in areas with lower human development index or wearing spectacles for the first time (all p<0.001) but did not differ by sex (p=0.414). Adherence was higher in children with astigmatism than myopia (p<0.001) but not hyperopia (p=0.455), was similar in the latter two conditions (p=0.903) and decreased with longer follow-up intervals (p<0.05).

Conclusion: This large study covering a wide geographic area and variety of schools reveals higher wear among children in greatest need of free service: those living in rural, poorer areas, attending government schools and not previously owning glasses.

Keywords: Child health (paediatrics); Epidemiology; Optics and Refraction; Public health; Vision.