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Spectacle wear increases due to vision correction, decreases due to bullying
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Adherence to spectacle wear is higher in students with poor presenting visual acuity and greater improvement in visual acuity with correction.
Additionally, researchers found that teasing and bullying by peers was the most frequently reported reason for nonwear in children, according to a study published in JAMA Ophthalmology.
“Our findings support the use of prescribing guidelines, which in this study was that the corrected visual acuity (VA) had to improve by two or more lines in the better eye, meaning that only students likely to perceive a benefit are prescribed spectacles,” the authors wrote.
This randomized noninferiority trial collected data from 460 students 11 to 15 years old from government schools in Bangalore, India. Students were eligible for recruitment if their vision improved by at least two lines in the better eye with correction and their eyes were suitable for ready-made spectacles.
A total of 362 students were assessed during unannounced visits to schools 3 to 4 months after distribution of spectacles. Participants were categorized as wearing or nonwearing. Students not wearing spectacles were asked an open-ended question to explain their nonwear.
At follow-up, 92 students were not wearing spectacles (25.4%). Students with uncorrected visual acuity of less than 6/18 in the better eye were nearly three times more likely to wear their spectacles than those with less than 6/9 to 6/12 (adjusted odds ratio, 2.84).
Descriptive analyses found that strongest predictors for spectacle use were poor presenting visual acuity and stronger improvement in visual acuity with correction. The main reason for nonwear was teasing and bullying (48.9%). Female students reported parental disapproval as an explanation for nonwear more frequently than their male cohorts (difference of 7.2%).
“In our study, adherence might have improved by increasing awareness of the benefits of spectacle wear among teachers and parents and by giving a spare pair of spectacles to classroom teachers and asking them to encourage spectacle wear,” researchers wrote. “Interventions to reduce teasing and bullying and disapproval among parents, particularly of girls, is more challenging because interventions would need to address societal norms and attitudes.” – by Julia Lowndes
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Kelly Frantz, OD, FCOVD, FAAO
Although this study was conducted in India, its findings can apply in many cultures. Sadly, teasing/bullying among children and teens is common and sometimes associated with spectacle wear. It can be heartbreaking to discover that a pediatric patient is not complying with spectacle wear when the optometrist knows it could significantly impact the child’s academic performance.
Not surprisingly, this study found better spectacle wear compliance in children with poorer unaided visual acuity. The authors recommend use of their prescribing guidelines, which require an acuity improvement of at least two lines in the better-seeing eye. However, many children with moderate hyperopia have adequate unaided acuity and thus would not receive spectacles based on this guideline. In my opinion, a guideline that provides spectacles only for patients who would experience at least a two-line acuity improvement neglects the potential benefits of moderate hyperopic correction on accommodative and binocular function. Granted, children with hyperopia may not be inclined to use their glasses if they notice little acuity improvement.
Thus, thorough education of parents and teachers regarding the need for spectacle (or contact lens) compliance is essential if we hope to serve our pediatric patients fully.
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