That’s the question that Priya Morjaria, Research Fellow in Public Health Optometry at the International Centre for Eye Health (ICEH) based at the London School of Hygiene & Tropical Medicine (LSHTM), set out to answer in a study recently published in JAMA Ophthalmology.
We caught up with Priya to get her perspective on the study and to get the answer. Here are her thoughts:
Why did you decide to pursue this topic? There are many ways that school eye health programs for uncorrected refractive errors can be more efficient and effective. One way is to consider the spectacles that are dispensed. Most programs dispense custom-made spectacles regardless of the prescription or severity of the refractive error. Dispensing ready-made spectacles has many advantages. These spectacles are less expensive and can be dispensed immediately in the school, thus decreasing travel and opportunity costs for parents.
How did you choose your study participants? The children in the study were 11-15 years old, as there is evidence of refractive errors progressing during these years. They were randomly selected from rural and semi-urban government schools in and around Bangalore, India. We obtained a list of schools from the District Education Officer and got permission from school authorities and parents before we did any screening. And, children were only eligible to be recruited into the study if they met strict criteria with regards to their prescription for ready-made spectacles.
Is there any stigma about wearing spectacles in the area where the study was conducted? There is a lot of stigma surrounding spectacle wear, not just in the area where the study was conducted, but also in different settings in India, and globally. There are common reasons in all these settings why children do not wear their spectacles, including bullying and teasing by peers, and name calling. Parental disapproval is also cited as an important reason for spectacle non-wear. This is especially true for female children where they are told ‘they will not get married’ if they wear spectacles.
Tell us how you went about your study. The study was a randomized clinical trial that took place in Bangalore, India, in collaboration with Sankara Eye Hospital. The field teams, including optometrists, field staff, vehicles, equipment and spectacle dispensing was all undertaken by the team at Sankara. We obtained a list of rural and urban government schools from the District Education Officer and filtered out those that had undergone school screening within the past 24 months. We screened more than 23,000 children over a six-month period and dispensed spectacles to 460 children who met the inclusion criteria. Follow-up of spectacle wear and reasons for non-wear were obtained at the three-to-four month unannounced visits.
What was the outcome of the study? The first outcome is that 86 percent of children who underwent assessment have prescriptions that are suitable for ready-made spectacles.
At three to four months after the children received them, follow-up rates and spectacle wear are similar in both arms [of the study] and the proportions are ‘not inferior.’ 75 percent of students who received ready-made spectacles and 73 percent of those who received custom-made spectacles were still wearing them.
This finding is very important. It tells us that not only are most children with uncorrected refractive errors suitable for ready-made spectacles, but that we would not be compromising spectacle wear by dispensing ready-made spectacles. This has the potential to be considerable cost-savings to school eye health programs.
Did the results surprise you and, if so, in what way? The most important discovery is the significantly higher rate of spectacle wear compared to other studies in children of similar ages. The low rate of spectacle compliance is not unique to low-and-middle income settings. It’s a challenge in high income settings, too. That’s why it’s very promising to have spectacle compliance as high as 75 percent.
Why do you think spectacle-wear rate was so high? There are a couple of factors that I would like to draw attention to in this study that we believe influence spectacle wear:
The child chose the frame he/she was given.
Every child recruited to the study had the opportunity to select the frames they preferred from a range of six ‘trendy’ plastic or metallic frames. This is important as other studies have shown that a child may not wear their spectacles if they don’t like the way they look. Although it would seem obvious in many settings that a child should be able to choose the frame he prefers, it’s not the norm in many programs.
Screening failure and prescribing guidelines were defined.
These two factors are linked. If children do not perceive an improvement in their vision, they are less likely to wear their spectacles. When a child already has good vision in one eye, they are less motivated to wear their spectacles. We prescribed spectacles to children with significant refractive error where the vision improved by two or more lines in the better-seeing eye. Combining these two, we only prescribed spectacles to children if they had the potential to benefit from spectacles.
How do you think the local government or those working on eye health in this community can use these results? These results can be used by any stakeholder involved in the provision of school eye health programs. It’s an opportunity for all programs to critically evaluate the prescriptions that are being dispensed and calculate the potential cost savings to their programs by prescribing ready-made spectacles. It’s also an opportunity to ensure that monitoring and evaluation of programs include spectacle compliance as a mark of a successful program.Priya Morjaria is a Research Fellow in Public Health Optometry at the International Centre for Eye Health (ICEH) based at the London School of Hygiene & Tropical Medicine (LSHTM). She trained as an Optometrist from City University, UK and is a member of the College of Optometrists and the European Academy of Optometry & Optics. She completed the MSc in Public Health for Eye Care at LSHTM and joined ICEH as a researcher and is currently a PhD candidate there. Her PhD research focuses on improving the efficiency of school programs for uncorrected refractive error with a regional focus in India where she is undertaking two randomized controlled trials. One of them involving ready-made spectacles and the other uses Peek (Portable Eye Examination Kit). She has a breadth of experience in eye research in developing countries including Kenya, Malawi, Mozambique, Ethiopia, Zambia, Bangladesh and Nepal. She is a member of the Refractive Error Working Group (IAPB) and the Public Health Committee of the WCO.