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Spectacle Coverage among Urban Schoolchildren with Refractive Error Provided Subsidized Spectacles in North India

Gupta, Vivek, MD1; Saxena, Rohit, MD, PhD2*; Vashist, Praveen, MD, MSc(CEH)1; Bhardwaj, Amit, MSW1; Pandey, Ravindra Mohan, PhD3; Tandon, Radhika, MD2; Menon, Vimla, MD2

doi: 10.1097/OPX.0000000000001356
ORIGINAL INVESTIGATIONS
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SIGNIFICANCE Provision of subsidized spectacles to schoolchildren with refractive error in Delhi was associated with increased spectacle coverage.

PURPOSE Studies involving free spectacle distribution and self-purchase of spectacles often report poor compliance. We assessed 1-year spectacle coverage among schoolchildren with refractive error who were provided subsidized spectacles.

METHODS This was a study of a prospective cohort of 10,114 students from 20 randomly selected schools of Delhi. Children were presumed to have refractive error when unaided visual acuity was worse than or equal to 6/12 in either eye and a best-corrected visual acuity better than or equal to 6/9.5 in both eyes (n = 1503). Children with unmet need of spectacles (presenting with a visual acuity worse than 6/9.5 in the worse eye) were provided subsidized spectacles (n = 1191). Coverage was established by direct observation at baseline and after 1 year through unannounced visits.

RESULTS Mean age of cohort was 12.0 ± 2.0 years, and 566 (37.7%) were girls. Baseline spectacle coverage was 29.3% (95% confidence interval [CI], 27.1 to 31.7%), which improved to 65.9% (95% CI, 56.0 to 61.6%) among all children (n = 1470) and 58.8% (95% CI, 56.0 to 61.6%) among children with unmet need (n = 1163) at 1 year. Uptake of the subsidized spectacles was 98.6%. On multivariate regression, the odds of spectacle use were greatest when unaided vision was poor: 55.5% when visual acuity was better than or equal to 6/9.5, 74.8% when visual acuity was 6/19 to 6/60 (adjusted odds ratio, 2.5; 95% CI, 1.7 to 3.5), and 91.5% when visual acuity was worse than 6/60 (adjusted odds ratio, 3.1; 95% CI, 1.0 to 9.5). Sex (boys, 66.3%; girls, 65.3%) and socioeconomic status (lower, 58.6%; middle, 61.8%; upper middle, 70.7%) were not associated with coverage. Increasing maternal education and baseline spectacle use were associated with coverage. However, 38.0% were wearing spectacles prescribed by the project, and 61.9% of the spectacles being used at 1 year were purchased in the open market.

CONCLUSIONS Spectacle coverage after 1 year increased through a subsidized spectacle scheme, particularly for children with poor uncorrected vision.

1Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

2Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

3Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

* rohitsaxena80@yahoo.com

Submitted: December 12, 2017

Accepted: December 28, 2018

Funding/Support: Department of Science and Technology, Government of India (DST/TDD/2K12/182; to RS).

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Conceptualization: RS, PV, RMP, RT, VM; Data Curation: VG, RS, PV, AB, RMP, RT; Formal Analysis: VG, RS, PV, RMP, RT, VM; Funding Acquisition: RS, PV, RT; Investigation: VG, RS, PV, AB, RT, VM; Methodology: VG, RS, PV, AB, RMP, RT, VM; Project Administration: RS, PV, AB, VM; Resources: RS, PV, RT, VM; Software: RS, RMP; Supervision: RS, PV, AB, RT, VM; Validation: RS, AB, RMP; Writing – Original Draft: VG, RS, PV, AB, RMP, RT; Writing – Review & Editing: VG, RS, PV, AB, RMP, RT, VM.

© 2019 American Academy of Optometry