Can a county-based vision center increase eyeglasses use and improve school performance among primary schoolchildren in rural China? This cluster randomized clinical trial of 31 schools and 2613 participants showed that children who received eyeglasses earlier in the school year performed significantly better on an end-of-year mathematics test than children who received eyeglasses later in the year, equivalent to half a semester. Provision of free eyeglasses also improved children's use of spectacles.

Abstract: More than 60 million children in rural China are “left-behind”—both parents live and work far from their rural homes and leave their children behind. This paper explores differences in how left-behind and non-left-behind children seek health remediation in China’s vast but understudied rural areas. This study examines this question in the context of a program to provide vision health care to myopic rural students. The data come from a randomized controlled trial of 13,100 students in Gansu and Shaanxi provinces in China. The results show that without a subsidy, uptake of health care services is low, even if individuals are provided with evidence of a potential problem (an eyeglasses prescription). Uptake rises two to three times when this information is paired with a subsidy voucher redeemable for a free pair of prescription eyeglasses. In fact, left-behind children who receive an eyeglasses voucher are not only more likely to redeem it, but also more likely to use the eyeglasses both in the short term and long term. In other words, in terms of uptake of care and compliance with treatment, the voucher program benefitted left-behind students more than non-left-behind students. The results provide a scientific understanding of differential impacts for guiding effective implementation of health policy to all groups in need in developing countries.

Keywords: randomized controlled trial; rural China; left-behind children; healthcare

We present the results of a randomized trial testing the impact of providing free eyeglasses on academic outcomes of junior high school students in a poor rural area of western China. We find that providing free prescription eyeglasses approximately halves dropout rates over a school year among students who did not own eyeglasses at baseline. Effects on dropout are mirrored by improvements in student performance on standardized exams in math and aspirations for further schooling

Purpose: To study safety of children's glasses in rural China, where fear that glasses harm vision is an important barrier for families and policy makers.

Design: Exploratory analysis from a cluster-randomized, investigator-masked, controlled trial.

Methods: Among primary schools (n = 252) in western China, children were randomized by school to 1 of 3 interventions: free glasses provided in class, vouchers for free glasses at a local facility, or glasses prescriptions only (Control group). The main outcome of this analysis is uncorrected visual acuity after 8 months, adjusted for baseline acuity.

Results: Among 19 934 children randomly selected for screening, 5852 myopic (spherical equivalent refractive error ≤−0.5 diopters) eyes of 3001 children (14.7%, mean age 10.5 years) had VA ≤6/12 without glasses correctable to >6/12 with glasses, and were eligible. Among these, 1903 (32.5%), 1798 (30.7%), and 2151 (36.8%) were randomized to Control, Voucher, and Free Glasses, respectively. Intention-to-treat analyses were performed on all 1831 (96.2%), 1699 (94.5%), and 2007 (93.3%) eyes of children with follow-up in Control, Voucher, and Free Glasses groups. Final visual acuity for eyes of children in the treatment groups (Free Glasses and Voucher) was significantly better than for Control children, adjusting only for baseline visual acuity (difference of 0.023 logMAR units [0.23 vision chart lines, 95% CI: 0.03, 0.43]) or for other baseline factors as well (0.025 logMAR units [0.25 lines, 95% CI 0.04, 0.45]).

Conclusion: We found no evidence that spectacles promote decline in uncorrected vision with aging among children.

Importance: The number of urban migrants in China is 300 million and is increasing rapidly in response to government policies. Urban migrants have poor access to health care, but little is known about rates of correction of refractive error among migrant children. This is of particular significance in light of recent evidence demonstrating the educational impact of providing children with spectacles.

Objective: To measure prevalence of spectacle need and ownership among Chinese migrant children.

Design, Setting, and Participants: Population-based, cross-sectional study among children who failed vision testing (uncorrected visual acuity ≤6/12 in either eye) between September 15 and 30, 2013, at 94 randomly selected primary schools in predominantly migrant communities in Shanghai, Suzhou, and Wuxi, China.

Main Outcomes and Measures: Refractive error by cycloplegic refraction; spectacle ownership, defined as producing glasses at school, having been told to bring them; and needing glasses, defined as uncorrected visual acuity of 6/12 or less correctable to greater than 6/12 in either eye, with myopia of −0.5 diopters (D) or less, hyperopia of +2.0 D or greater, or astigmatism of 0.75 D or greater in both eyes.

Results: Among 4409 children, 4376 (99.3%) completed vision screening (mean [SD] age, 11.0 [0.81] years; 55.3% boys; 4225 [96.5%] migrant and 151 [3.5%] local). Among 1204 children failing vision testing (total, 27.5%; 1147 migrant children [27.1%] vs 57 local children [37.7%]; P = .003), 850 (70.6%) completed refraction. Spectacle ownership in migrant children needing glasses (147 of 640 children [23.0%]) was less than among local children (12 of 34 children [35.3%]) (odds ratio = 0.55; 95% CI, 0.32-0.95; P = .03). Having uncorrected visual acuity less than 6/18 in both eyes was associated positively with baseline spectacle ownership (odds ratio = 5.73; 95% CI, 3.81-8.62; P < .001), but parental education and family wealth were not.

Conclusions and Revelance: Among urban migrant children, there was a high prevalence of need for spectacles and a very low rate of spectacle ownership. Spectacle distribution programs are needed specifically targeting migrant children.

Using a survey of 19,977 children in two provinces, this paper explores the prevalence, correlates and potential consequences of poor vision among children in China's vast but understudied rural areas. We find that 24% of sample students suffer from reduced uncorrected visual acuity in either eye and 16% in both eyes. Poor vision is significantly correlated with individual, parental and family characteristics, with modest magnitudes for all correlates but home province and grade level. The results also suggest a possible adverse impact of poor vision on academic performance and mental health, particularly among students with severe poor vision.

Currently available data on myopia and spectacle wear are drawn largely from China’s richer and middle-income areas, and little is known about refractive error and spectacle wear in the lowest income provinces. Studies from China and elsewhere suggest that large differences in myopia prevalence may exist between areas of different socioeconomic status within countries, but reasons for these differences are not well understood. The current report details the prevalence and predictors of myopia measured using the identical protocols and equipment in adjoining provinces of western China, middle-income Shaanxi and low-income Gansu. Study methods including institutional review board approvals and consent have been described elsewhere.

This paper examines the prevalence of vision problems and accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveryed had ever had a vision exam. Among those who self-reported vision problems, 34% did not wear eyeglasses. Fifty-four percent of those with vision problems who had eyeglasses did not have a vision exam prior to receiving glasses. However, having a vision exam did not always guarantee access to quality vision care. Four channels of vision care service were assessed. The school vision examination program did not increase the usage rate of eyeglasses. Each county-hospital was staffed with three eye-doctors having one year of education beyond high school, serving more than 400,000 residents. Private optometrists often had low levels of education and professional certification. In conclusion, our findings shows that the vision care system in rural China is inadequate and ineffective in meeting the needs of the rural population sampled.

Objective: To study for the first time using a clinical trial the effect of free glasses on academic performance in rural Chinese children, among whom uncorrected myopia is the leading cause of visual impairment.

Participants: Among 19,934 children in grades 4 and 5 randomly selected for visual acuity screening, 3177 (15.9%, mean age 10.5 years) had visual acuity < 6/12 in either eye without glasses correctable to > 6/12 with glasses, and were eligible for allocation. Among these, 3052 (96.0%) completed the study.

Interventions: Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: free glasses provided in class, vouchers for free glasses at a local facility or glasses prescriptions only (Control group).

Results: Among 3177 eligible children, 1036 (32.6%), 988 (31.1%) and 1153 (36.3%) were randomized to Control, Voucher and Free Glasses respectively. All eligible children would benefit from glasses, but only 15% had them at baseline. Intention-to-treat analyses were performed on all 1002 (96.8%), 946 (95.9%) and 1104 (95.8%) children completing final testing in Control, Voucher and Free Glasses groups. Effect on test score was 0.11 SD (95% Confidence Interval [CI] 0.01 to 0.21, p = 0.03) comparing the Free Glasses and Control groups. Adjusted effect of providing free glasses (0.10 SD, 95% CI 0.01 to 0.20; p = 0.04) was greater than parental education (0.03, 95% CI -0.03 to 0.10) or family wealth (0.002, 95% CI -0.07 to 0.07). Closeout glasses wear was 41% (observed), 68% (self-reported) in the Free Glasses group.

Conclusions: Providing free glasses improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance. Myopia is common and rarely corrected in this setting.

PURPOSE. We assessed the prevalence and predictors of inaccurate refractive error among rural refractionists in western China.