Randomized, Controlled Trial of an Educational Intervention to Promote Spectacle Use among Secondary School Children in Islamabad, Pakistan

Uncorrected refractive errors among school age children can adversely affect the school performance and quality of life.Provision of spectaclesis the simple solution to correct refractive errors and improve school performance. Unfortunately, adherence to spectacle wear is a big issue among school age children. Lack of understanding about benefits of spectacles wear is the main reason for non-adherence. There is a crucial need to increase awareness among children, parents and teachers about importance of spectacle use for academic performance. This study

Objective: To test an educational intervention to promote spectacle wear among secondary school children of Islamabad Pakistan.

Design: Randomized Controlled Trial.

Participants: Children of age group 11- 16 years from public sector secondary schools of Islamabad Pakistan.

Methods: Vision screening of children was done in both intervention and control arms by a trained optometrist. Autorefraction and subjective refraction of Children with visual acuity ≤ 6/12 was performed and prescription of spectacles was given. At 3 months follow up purchase and use of spectacles was assessed and at 6 months follow up compliance to spectacle wear was observed before intervention. After 6 months follow up educational intervention was given in intervention arm. At 12 months follow up compliance to spectacle wear was observed after intervention.

Analysis was done on SPSS version 23 and percentage compliance between two arms was compared. Compliance to spectacle wear before and after intervention within intervention arm was also compared. To predict spectacle wear compliance logistic regression was performed.

Main Outcome Measures:Compliance to spectacle wear.

Results:  Follow up after intervention shows 47% compliance in control arm while 62% compliance in intervention arm. Mathematically there is 15% difference of spectacle compliance among control and intervention arms and this difference is also statistically significant difference with p- value 0.02 < 0.1and OR was calculated as 1.89 with 95% CI as 1.0 – 3.25.

Spectacle compliance before intervention within the intervention arm was recorded as 46% and after intervention in the same group was measured as 62%. There is 16% difference in spectacle compliance before and after intervention in this arm. This difference is statistically significant with p-value 0.00 < 0.1, OR 3 and 95% CI as 2.16 – 4.16

Logistic regression to predict spectacle wear compliance find out that children in the intervention arm were 2 times more compliant to spectacle wear as compared to children in control arm.

Conclusion: A comprehensive educational intervention to educate teachers, parents and children about the importance of wearing spectacles has the potential to increase spectacle wear among secondary school children.