Plain English Summary
Background and study aims
Uncorrected refractive errors in children account for 90–95% of vision loss. The proportion of children aged 10–15 years with significant uncorrected refractive errors is less than 1% in Africa to over 70% in China. Shortsightedness (myopia) is the most common refractive error. Worldwide, more than 12 million children are visually impaired from uncorrected refractive errors. Many organisations support school vision testing initiatives, but there are gaps in the evidence about many aspects of these programmes. In most programmes, children are refracted by optometrists and those needing correction are given or sold prescription glasses (i.e., that fully correct the refractive error in both eyes), which are much more expensive than are ready-made spectacles (i.e., that have the same prescription in both eyes and do not correct astigmatism). The aim in this study is to investigate whether low-cost, high-quality, ready-made spectacles result in similar rates of wear than do more expensive prescription spectacles, and to assess the cost saving.
Who can participate?
Children at school with uncomplicated uncorrected refractive errors
What does the study involve?
Children will be randomly allocated to high-quality, low-cost ready-made spectacles or prescription spectacles. At 3–4 months, they will be classified as wearing or not wearing their spectacles. All children needing glasses will receive them free of charge from the project and will have an eye examination done for other pathology. If children require further tests or specialist referrals, then they will be referred to the Sankara Eye Hospital (Bangalore) where they will be seen free of charge.
What are the possible benefits and risks of participating?
Benefits not provided at time of registration. Children can occasionally take a little while to become accustomed to new spectacles, but eye strain and headache are uncommon.
Where is the study run from?
Sankara Eye Hospital (India)
When is the study starting and how long is it expected to run for?
December 2014 to June 2015
Who is funding the study?
L'Occitane Fondation (UK)
Who is the main contact?
Miss Priya Morjaria
Spectacle wearing among children in India given ready-made spectacles or prescription spectacles, and cost savings to programmes: a randomised controlled study
1. Several studies report that a high proportion of children given or who purchase spectacles do not wear them. One factor associated with spectacle wear is the degree of refractive error, with children having higher refractive errors being more likely to wear their spectacles. Other barriers to spectacle wear have been investigated, but few interventions have been assessed. To our knowledge there has only been one study of cost-effectiveness of screening for refractive errors and this study compared school-based programmes with primary health-care programmes (Frick, 2009). No studies have addressed cost effectiveness or cost savings of different approaches.
From a programmatic perspective prescribing ready-made spectacles has benefits for providers as well as parents and children as a supply of ready-made spectacles with a wide range of prescriptions and frame types can be taken to the school and dispensed immediately. By contrast, prescription spectacles have to be individually made up in optical laboratories, marked with the child’s name, and the spectacles taken back to the school and given to the correct child.
The value of ready-made spectacles compared with prescription spectacles are that they are far less expensive (i.e. US$ 2–3 compared with US$10–15 in most low-income countries. High-quality, low-cost, ready-made spectacles suitable for children are readily available and can be purchased in bulk. Ready-made spectacles are also far easier to dispense because they do not have to be made up by trained dispensing opticians for each individual child. The low cost of ready-made spectacles means that they can replaced at little extra cost, or children can be given two pairs to replace those that get broken, scratched or lost. In view of the very large number of children in low-income and middle-income countries who require spectacles at a cost saving of approximately US$10 per child would lead to huge cost savings either to those providing the service or to parents (in settings where they have to buy them).
There has been an earlier trial of ready-made versus prescription spectacles in school children but in this trial all children with uncorrected refractive errors were randomly allocated to ready-made or prescription spectacles irrespective of their refractive error. We feel this is not justifiable as some children have complex refractive errors and require prescription glasses. In our study children with complex refractive errors will be excluded. The earlier trial did not address cost savings.
2. Our study is powered to detect ≤10% difference in the proportion of children wearing ready-made spectacles compared with prescription spectacles. This margin of non-inferiority has been selected because a recently published superiority trial was powered to detect a 10% or greater difference in spectacle wear between intervention arms (Congdon, 2011).
3. Hypothesis: similar proportions of children will wear spectacles 3–4 months after they are dispensed irrespective of whether they are ready-made or prescription spectacles.
1. London School of Hygiene and Tropical Medicine (UK): Observational/interventions Research Ethics Committee, 09/01/2015, LSHTM Ethics Ref: 8827
2. Ethics Committee Institutional Review Board, Sankara Eye Hospital, Bangalore (India), 27/12/2014
Randomised non-inferiority double-blind study
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet.
Spectacle wearing in children with uncorrected refractive errors
Children will be randomly allocated to one of two arms:
1. Intervention: ready-made spectacles with the same prescription in each eye
2. Comparator: prescription spectacles (standard of care), made up by a dispensing optician in accordance with a prescription from a qualified optometrist; each eye can have a different prescription, including astigmatic correction.
Although ready-made spectacles are available for bulk purchase, in this study all spectacles will be made up in Sankara Eye Hospital (India), so that all children will have the same choice of frames and all spectacles will be delivered to the school at the same time. This will permit masking of students.
Primary outcome measures
Proportion of children in each arm of the trial who are wearing their spectacles at unannounced visits 3–4 months after refraction:
1. Children wearing spectacles at the time of the unannounced visit
2. Children not wearing spectacles at the time of the visit, but have them at school
3. Children not wearing spectacles at the time of the visit, but say they are at home
4. Children say they no longer have the spectacles because they are broken or lost
Categories 1 or 2 will be defined as spectacle wearing, and categories 3 or 4 as non-spectacle wearing (Wedner, 2008).
Secondary outcome measures
1. Cost savings to the programme of dispensing ready-made spectacles: this analysis will only be undertaken should the trial demonstrate non-inferiority
2. Reasons for not wearing spectacles, assessed at 8 weeks with a simple questionnaire
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Age 11–15 years
2. Visual acuity (i.e., with spectacles if usually worn) of less than 6/9 in one or both eyes
3. Visual acuity with full correction improves by two or more lines in the better seeing eye
4. Spherical equivalent (i.e., the sum of the myopic or hypermetropic prescription in dioptres (D) plus half the astigmatic cylindrical prescription) corrects the visual acuity to equal to or not more than one line less than best corrected visual acuity with a full prescription in the better eye
5. Difference between the spherical equivalents of the right and left eyes is not >1 D
6. Inter-pupillary distance matches that of ready-made spectacle frames
7. Spectacle frame is of acceptable size and fit
Target number of participants
Participant exclusion criteria
1. Other causes of visual loss
2. Visual acuity does not improve adequately with a spherical lens
3. >1 D of anisometropia
All these children will be dispensed prescription spectacles, but will not be recruited to the trial.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Sankara Eye Hospital
Varthur Main Road Marthahalli Kundalahalli Gate
L'Occitane Fondation (UK)
Funding Body Type
Funding Body Subtype
Vision Impact Institute
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
1. All results will be disseminated and a summary of findings will be reported to the head teachers and education officers.
2. The results of spectacle wear at the follow-up visit and cost savings will be published in peer reviewed journals at the end of the trial.
3. Reasons for non-spectacle wear will form a separate publication.
4. A report will be written for the websitse of both institutions, and presentation at national (UK and India) and international conferences; anticipated date for this is August 2015.
Intention to publish date
Participant level data
Available on request
Results - basic reporting
2016 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/26787016