The Fred Hollows Foundation Vietnam
Survey on the effect of wearing spectacles in secondary school students
From 2013 to 2015 the SiB5 project provided refractive error screening for 470,178 students, 13,312 of those were diagnosed with RE and were advised to wear/change spectacles. 3,182 spectacles were provided to students from poor households to help them to have good visual acuity (VA). However, the project lacked technical evidence to demonstrate if the visual acuity of students wearing spectacles had improved and, if so, the impact of better vision on students’ education and life.
Therefore, to answer these concerns, the project staff and project partner conducted a survey on the effect of wearing spectacles in secondary school students in April 2016. 42 students wearing subsidized spectacles and 42 corresponding students wearing self-purchased spectacles were randomly selected from 21 of the 36 secondary schools in Tien Giang province. In addition to interviews, both student groups had their visual acuity assessed and their lens capacity was also measured
a) To assess the visual acuity of school students wearing spectacles,
b) To explore the difference in VA between students wearing spectacles provided by the project and students wearing self-purchased spectacles, and
c) To assess the impact of better vision on students’ education outcomes.
The survey findings:
a. A substantial majority of students wearing spectacles have good visual acuity
In Tien Giang 85% of students wearing spectacles have good visual acuity. This is much higher than the findings from SCB4 project Mid-term review in November 2011 in Ha Noi (41%) and Ho Chi Minh (75%). The reasons for this result are:
i. The majority of students had relatively new glasses which were more likely to correct their current refractive error. 55% of students having good visual acuity have had their spectacles for less than 6 months.
ii. The optical workshops contracted by the project paid more attention to the quality of RE assessment and correction; and
iii. The students wearing self-purchased spectacles were introduced to quality optical workshops. 53% of students having good visual acuity of self-purchased group were introduced to the well-known optical workshops in Tien Giang.
The Tien Giang visual acuity results confirm the reported experience of the students, 95% of whom stated that they saw the letters on the blackboard more clearly since wearing spectacles.
There are still 15% students with a VA below 6/9. The reasons are: lost spectacles (1.2%); high refractive error capacity with amblyopia symptom (5% from -3.25 diopters to -17.5 diopters) and don’t know (8/84=11%).
- The visual acuity of students wearing subsidized spectacles is higher than the visual acuity of students wearing self-purchased spectacles.
The rate of students having good vision in the project funded spectacles group (88%) is higher than the self-purchased spectacles group (81%). This difference is due mainly to the fact that those self-purchasing had had their spectacles for longer. Only 26% of students wearing self-purchased spectacles had had their spectacles for less than six months, while 97% of students wearing project provided spectacles had theirs for less than six months.
c. More than half the students had higher study results after wearing spectacles.
Compared with the time before wearing spectacles, after wearing spectacles the study results of students were higher for 52%, unchanged for 46% and lower for 1%. The reasons for the higher study results were that:
i. The students could see the letters on the blackboard more clearly and
ii. They could write more quickly and accurately.
The student who had a lower study result has retinal detachment in her right eye and she only uses her left eye with myopia to see.
d. Students are very aware of the importance of wearing spectacles.
83/84 students in the sample are wearing spectacles of whom 60% wear spectacles when reading or studying, and the remaining 40% wear spectacles all the time. The students wear spectacles because the spectacles help the students have clear vision and prevent refractive error increasing (54%) and the students are following the doctors’ advice (6%). Those students who do not wear spectacles all the time were afraid of breaking their spectacles (23%), engaged in other activities that do not require good vision (11%) and because their eyes are weary when wearing spectacles (6%). Only one student did not wear spectacles because of spectacles loss. This result showed that students have good awareness of the importance of spectacles.
Most of the students knew that they should get their vision re-checked every 6 months (70%) at the optical workshops or eye hospitals, and the remaining students did not know when and where they should have their vision re-checked.
87% of students said that their family could afford to buy new spectacles to help them have good vision for study and better health, and avoid refractive error increasing and worse study results. However, 13% of students said their family will not buy new spectacles for them because their families are too poor and the price of spectacles is quite high (around 15-40 USD).
- Students are positive about wearing spectacles
77.4% of interviewed students said that they like wearing spectacles; reasons were due to better vision (60.7%); more beautiful/handsome or more intelligent appearance (16.7%). Meanwhile 22.6% disliked wearing spectacles (discomfort or unfamiliarity or ugliness were reasons mentioned by students).
The school refractive error program in Tien Giang province improved students’ vision and study results through the provision of spectacles and advice on purchasing spectacles. Students wearing project provided spectacles were significantly more likely to have good visual acuity compared to students wearing self-purchased spectacles. However this may be a reflection of the accuracy of the current prescription as those self-purchasing had had their spectacles for a longer time. The majority of students found their spectacles very acceptable and useful, and expected that their families could afford to and would buy them new spectacles as needed.
The results from this survey will inform the project partners in the four project provinces. It is recommended that:
i) Project partners should work with schools to remind students with RE to go for periodic eye checks and
ii) Project partners should introduce the project contracted spectacles suppliers to schools so that students’ families can access the low cost spectacles.
It is also recommended that the same survey be conducted in other provinces where school eye care program are conducted. Further research is required to ascertain whether there is substantial variation in the quality of optical shops throughout Vietnam and if so, what factors affect the provision of appropriate spectacles.
Phan Thi Trang
The Fred Hollows Foundation Vietnam