Need and Challenges of Refractive Correction in Urban Chinese School Children

PURPOSE: Uncorrected refractive error is recognized as the principal cause of visual impairment in school-aged children. Although correction of refractive error is easy, safe, and effective, many children are without the necessary spectacles. Empiric research on barriers to refractive correction remains limited, precluding the formulation of effective remedial actions. The aims of this study were to characterize parental awareness and other barriers to spectacle use among children considered to be in need of refractive correction and to determine the proportion undercorrected for those already with spectacles. METHODS: A population-based sample of children 5 to 15 years of age was examined in Guangzhou, China. Visual acuity was measured followed by cycloplegic refraction and best-corrected vision. Parental awareness of the child's vision difficulties, spectacle use, and frequency of vision checkups were collected by questionnaire. Associations between these variables and demographic and socioeconomic characteristics were investigated with multiple logistic regression. RESULTS: Among the 4359 examined children, 919 (21.1%) were found to be in need of refractive correction. Need was defined as uncorrected visual acuity < or = 0.50 in both eyes correctable by at least two lines in the better eye. Parental awareness was apparent for 85% of cases; 74% had spectacles. Awareness of vision difficulties was associated with older child age, greater visual impairment, and higher parental education. The purchase of spectacles was associated with greater visual impairment; the child's age, gender, parental education, and family income were not significant factors. Undercorrection by two lines or more in the better eye was found in 30% of those already with spectacles; undercorrection was associated with greater visual impairment and less frequent refraction checkups. CONCLUSIONS: Half of the children in need of first-time or updated spectacles are without them, an unacceptably high proportion. Younger children with moderate visual impairment are at particular risk for uncorrected refractive error. Parental education and enhanced school-based screening programs may be necessary to address the unfilled need for refractive correction among school-aged children.