Predictors of Spectacle Wear and Reasons for Nonwear in Students Randomized to Ready-made or Custom-made Spectacles: Results of Secondary Objectives From a Randomized Noninferiority Trial

  • Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential.

  • The objective of this study is to investigate predictors of spectacle wear and reasons for nonwear in students’ ages 11 to 15 years randomized to ready-made or custom-made spectacles in Bangalore, India.

  • Of 460 students, recruited and randomized, 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles.

  • Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12.

  • The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]).

  • Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%).

  • The main conclusions of this study were:

  • Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial.

  • Programs for the correction of REs in school students should address the most important reasons for nonadherence with spectacle wear.

  • 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.

  • 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.

Publication date

February 1, 2019


JAMA Ophthalmology

Sponsor Institution

L’Occitane Foundation (Prof Gilbert) and the Vision Impact Institute (Dr Morjaria)


Priya Morjaria, PhD; Jennifer Evans, PhD; Clare Gilbert, MD
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