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Predictors of Spectacle Wear and Reasons for Nonwear in Students Randomized to Ready-made or Custom-made Spectacles: Results of Secondary Objectives From a Randomized Noninferiority Trial


Priya Morjaria, PhD; Jennifer Evans, PhD; Clare Gilbert, MD


L’Occitane Foundation (Prof Gilbert) and the Vision Impact Institute (Dr Morjaria)




JAMA Ophthalmology


  • Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential.

  • The objective of this study is to investigate predictors of spectacle wear and reasons for nonwear in students’ ages 11 to 15 years randomized to ready-made or custom-made spectacles in Bangalore, India.

  • Of 460 students, recruited and randomized, 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles.

  • Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12.

  • The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]).

  • Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%).

  • The main conclusions of this study were:

  • Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial.

  • Programs for the correction of REs in school students should address the most important reasons for nonadherence with spectacle wear.

  • Adherence might have improved by increasing awareness of the benefits of spectacle wear among teachers and parents and by giving a spare pair of spectacles to classroom teachers and asking them to encourage spectacle wear.

  • Interventions to reduce teasing and bullying and disapproval among parents, particularly of girls, is more challenging because interventions would need to address societal norms and attitudes.