Impact of Free Glasses and a Teacher Incentive on Children's Use of Eyeglasses : A Cluster-Randomized Controlled Trial

PURPOSE: To study the effect of free glasses combined with teacher incentives on in-school glasses wear among Chinese urban migrant children.DESIGN: Cluster-randomized controlled trial.METHODS: Children with visual acuity (VA) £6/12 in either eye owing to refractive error in 94 randomly chosen primary schools underwent randomization by school to receive free glasses, education on their use, and a teacher incentive (Intervention), or glasses prescriptions only(Control). Intervention group teachers received a tablet computer if ‡80% of children given glasses wore them during unannounced visits 6 weeks and 6 months (main outcome) after intervention.RESULTS: Among 4376 children, 728 (16.7%, mean age 10.9 years, 51.0% boys) met enrollment criteria and were randomly allocated, 358 (49.2%, 47 schools) to Intervention and 370 (50.8%, 47 schools) to Control. Among these, 693 children (95.2%) completed the study and underwent analysis. Spectacle wear was significantly higher at 6 months among Intervention children (Observed [main outcome]: 68.3% vs 23.9%, adjusted odds ratio [OR] [ 11.5, 95% confidence interval [CI]5.91–22.5, P < .001; Self-reported: 90.6% vs 32.1%, OR [ 43.7, 95% CI [ 21.7–88.5, P < .001). Other predictors of observed wear at 6 months included baseline spectacle wear (P < .001), uncorrected VA <6/18 (P [ .01), and parental spectacle wear (P [ .02). The 6-month observed wear rate was only 41% among similar-aged children provided free glasses in our previous trial without teacher incentives.CONCLUSIONS: Free spectacles and teacher incentives maintain classroom wear in the large majority of children needing glasses over a school year. Low wear among Control children demonstrates the need for interventions