Why Children Do—and Don’t—Wear Their Eyeglasses
JAMA Ophthalmology, April 2019
Nearly 13 million children worldwide have visual impairment resulting from uncorrected refractive errors. Although eyeglasses are a simple and cost-effective solution, low adherence to spectacle wear can occur in any income setting. Morjaria et al. looked at predictors of spectacle adherence among students aged 11 to 15 years. They found that the greatest predictors of spectacle wear were “poorer presenting visual acuity [VA]” and “greater improvement in VA with correction.” The main reason for nonwear was bullying or teasing by peers. The predictors of adherence support using prescribing guidelines such as those in this study.
The study was a planned analysis of secondary objectives from a noninferiority study among students who fulfilled eligibility criteria, including correction improvement of at least 2 lines in the better eye. Participants were recruited from government schools in Bangalore, India. Masked observers documented the rate of compliance to spectacle wear during unannounced visits to the schools several months after the spectacles had been distributed.
Of the 460 participants, follow-up information was available on 362 (78.7%). At that time, 92 (25.4%) were not wearing their eyeglasses. The main reason for nonwear was teasing or bullying by peers (48.9%), followed by lost, forgotten, or stolen spectacles (26.1%). Headaches and parental disapproval also had an impact, with headaches and discomfort reported by more boys than girls (10.4% vs. 4.5%, respectively), and parental disapproval directed more at girls than boys (11.4% vs. 4.2%, respectively).
Students with poorer presenting VA and greater correction of VA were more likely to be wearing their eyeglasses: Those whose uncorrected VA was less than 6/18 (20/60) in the better eye were nearly three times more likely to be wearing their spectacles than were those whose VA ranged from less than 6/9 to 6/12 (20/30 to 20/40; adjusted odds ratio [OR], 2.84). Compared with correction resulting in improvement of 3 lines or less, correction of 3 to 6 lines was associated with an adjusted OR of 2.31, and correction of at least 6 lines had an adjusted OR of 2.57.
The fact that most students were wearing their eyeglasses at follow-up supports the use of prescribing guidelines in this study. (Spectacles are provided for students who require correction of at least 2 lines in the better eye.)
The authors emphasized the importance of interventions to reduce teasing and bullying. However, they also acknowledged that it would be difficult to address the issues underlying parental disapproval. (Also see related commentary by Vivian Manh, OD, MS, in the same issue.)
The original article can be found here.