Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with...

Area of Science:

• Ophthalmology
• Public Health
• Global Health

Background:

• Refractive error (RE) is a significant cause of visual impairment globally.
• School vision screening programs aim to identify and correct RE in students.
• Understanding factors influencing spectacle adherence is crucial for program effectiveness.

Purpose of the Study:

• To compare the impact of free spectacles versus spectacle prescriptions on wearing rates among Tanzanian students with uncorrected RE.
• To evaluate the effectiveness of different intervention strategies for spectacle adherence.

Main Methods:

• A cluster randomized trial was conducted in 37 secondary schools in Dar es Salaam, Tanzania.
• 6,904 students were screened for distance visual acuity; 135 had RE requiring correction.
• Schools were randomized to receive either free spectacles or only a prescription.

Main Results:

• The prevalence of uncorrected RE was 1.8%.
• At 3 months, 47% of students receiving free spectacles wore them compared to 26% receiving only a prescription (adjusted OR 2.4).
• Free spectacles and myopia were independently associated with increased spectacle use.

Conclusions:

• While free spectacles improved adherence, overall uptake remained low, questioning the value of current vision screening programs in this setting.
• Policy decisions for school vision screening in low- and middle-income countries must consider cost-effectiveness and resource allocation.
• Further research is needed to optimize interventions for spectacle wear in resource-limited environments.