Visual Morbidity Due to Inaccurate Spectacles among School Children in Rural China: The See Well to Learn Well Project, Report 1

Purpose: Inadequately corrected refractive error is the leading cause of visual disability among children in China; inaccurate spectacles are a potential cause. The prevalence and visual impact of spectacle inaccuracy were studied among rural, secondary-school children, to determine the optimal timing for updating of refraction.

Methods: A random sample of children from years 1 and 2 in all junior and senior high schools in Fuyang Township, Guangdong Province, underwent ocular examination. All children who reported wearing glasses received cycloplegic refraction, vision assessment, and measurement of current spectacles.

Results: Among 3226 examined children, 733 (22.7%) reported owning spectacles. Refractive error and spectacle power were assessed for 588 (80.2%) children. They had a mean age of 15.0 ± 1.6 years; 70.2% were girls, 83.3% had more than −1.5 D of myopia, and 17.9% had presenting vision ≤ 6/12 in the better eye. The glasses of 48.8% of children were inaccurate by ≥1 D; inaccuracy was ≥2 D in 17.7%. Children with inaccurate glasses (≥1 D) had presenting vision in the better eye significantly (P < 0.001) worse than that of children with accurate glasses, and 30.3% had presenting acuity ≤ 6/12. In multivariate models, younger age (P = 0.004), more myopic refractive error (P < 0.001), and having glasses ≥ 1 year old (P = 0.04) were associated with inaccurate spectacles.

Discussion: Inaccurate spectacles are common and are associated with significant visual impairment among children in rural China. Reducing outdated glasses could lessen the visual burden, although refractive services may have to be offered on an annual basis for optimal benefit.