Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China: A Cluster Randomized Clinical Trial

  • Visual impairment is common among children in rural China, but fewer than one-third of children with poor vision own and wear eyeglasses.

  • The objective is to study the effect of hospital-based vision centers on academic performance, ownership of eyeglasses, and eyeglasses-wearing behavior in rural Chinese children.

  • All 31 rural primary schools in Yongshou County participated; participants were all children in grades 4 through 6 (aged approximately 10-12 years) with uncorrected visual acuity of Snellen 6/12 or worse in either eye (2613 children). Data analysis was conducted March through May 2016, and data were analyzed by the intention-to-treat principle.

  • After teacher-led vision screening early in the school year (September-October 2014), schools were randomly assigned to either early referral (December 2014-February 2015) to the vision center for refraction and free eyeglasses if needed or late referral (March-June 2015) for the identical intervention.

  • The primary outcome was score on a study-administered mathematics test (June 2015) adjusted for baseline score. Secondary outcomes were self-reported eyeglasses ownership and wear at final examination (June 2015).

  • All 2613 children evaluated were of Han Chinese race/ethnicity, and 1209 (46.3%) were female. Twelve hundred children (45.9%) met the vision criteria. Among these, 543 (45.3%) were randomized to early screening and 657 (54.7%) to late screening; 433 (79.7%) of the early screening group and 516 (78.5%) of the late screening group completed the study.

  • Of eligible children, 120 (27.7%) owned eyeglasses at baseline. The adjusted effect on test scores comparing early and late groups was 0.25 SD (95% CI, 0.01-0.48; 1-sided P = .04), with the point estimate equivalent to half a semester of additional learning.

  • At the end of the study, 347 of the 433 participants in the early group (80%) reported owning eyeglasses and 326 (75%) reported wearing eyeglasses; among the 516 participants in the late group, 371 (61%) reported owning and 286 (55%) reported wearing eyeglasses.

  • In this study, early provision of free eyeglasses was seen to improve children’s academic performance and wearing of spectacles. These findings suggest that a county hospital–based vision center may be an effective way to improve children’s educational opportunities in rural China.

Publication date

July 1, 2021


JAMA Ophthalmology

Sponsor Institution

The 111 Project (grant B16031) (Drs Shi and Ma). The eyeglasses frames used in this study were supplied free by OneSight, Luxottica-China, Brien Holden Vision Institute, and CLSA.


Yue Ma, PhD; Nathan Congdon, MD, MPH; Yaojiang Shi, PhD; Ruth Hogg, PhD; Alexis Medina, MA; Matthew Boswell, MA; Scott Rozelle, PhD; Mony Iyer, MBA
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