Abstract

BackgroundOffering free glasses can be important to increase children’s wear. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China.MethodsIn this cluster-randomized, controlled trial, children with uncorrected visual acuity (VA)< = 6/12 in either eye correctable to >6/12 in both eyes at 138 randomly-selected primary schools in 9 counties in Guangdong and Yunnan provinces, China, 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) was assessed 6 months after randomization.ResultsAmong 10,234 children screened, 882 (8.62%, mean age 10.6 years, 45.5% boys) were eligible and randomized: 257 (29.1%) at 37 schools to Control; 253 (28.7%) at 32 schools to Free Glasses; 187 (21.2%) at 31 schools to Free Glasses + $15 Upgrade; and 185 (21.0%) at 27 schools to Free Glasses +$30 Upgrade. Baseline ownership among these children needing glasses was 11.8% (104/882), and 867 (98.3%) children completed follow-up. Glasses purchase was significantly less likely when free glasses were given: Control: 59/250 = 23.6%; Free glasses: 32/252 = 12.7%, P = 0.010. Offering Upgrade Glasses eliminated this difference: Free + $15 Upgrade: 39/183 = 21.3%, multiple regression relative risk (RR) 0.90 (0.56–1.43), P = 0.65; Free + $30 Upgrade: 38/182 = 20.9%, RR 0.91 (0.59, 1.42), P = 0.69.ConclusionsUpgrade glasses can prevent reductions in glasses purchase when free spectacles are provided, providing important program income.Trial registrationClinicalTrials.gov Identifier: NCT02231606. Registered on 31 August 2014.

Highlights

  • Under-corrected refractive error (URE) accounts for 90% of visual disability among rural Chinese children [1,2,3,4,5,6], and among the 13 million children in the world visually impaired from URE, some half live in China [7]

  • A model combining the advantages of free glasses and glasses sales is needed

  • At the time of our initial screening visit to all schools, we discovered the prevalence of refractive error was lower than expected, requiring an increase in the number of schools in order to achieve adequate power for the study

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Summary

Introduction

Under-corrected refractive error (URE) accounts for 90% of visual disability among rural Chinese children [1,2,3,4,5,6], and among the 13 million children in the world visually impaired from URE, some half live in China [7]. Despite the fact that glasses wear is a safe and effective means of correcting refractive error [8], and is associated with significant, trial-proven increases in educational outcomes [9], only 15–20% of Chinese children in rural [9, 10] and urban migrant [11, 12] population studies who need glasses have them. School vision screening programs needed to identify children requiring glasses depends on profits from glasses sales for entities such as rural county hospitals in order to sustain them. A model combining the advantages of free glasses (lack of financial barriers) and glasses sales (sustainability) is needed. We sought to assess whether “Upgrade glasses” could avoid reduced glasses sales when offering free glasses to children in China

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