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Original Investigation |

Population Prevalence of Need for Spectacles and Spectacle Ownership Among Urban Migrant Children in Eastern China

Xiuqin Wang, MD1,2; Hongmei Yi, PhD3; Lina Lu, MM4; Linxiu Zhang, PhD3; Xiaochen Ma, PhD5,6; Ling Jin, MS1; Haiqing Zhang, PhD7; Kovin S. Naidoo, OD, MPH8,9; Hasan Minto, DipOpt9; Haidong Zou, MD4,10; Scott Rozelle, PhD6; Nathan Congdon, MD, MPH1,11,12
[+] Author Affiliations
1Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Division of Preventive Ophthalmology, Sun Yat-sen University, Guangzhou, China
2Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
3Center for Chinese Agricultural Policy, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
4Shanghai Ophthalmic Treatment and Prevention Hospital, Shanghai, China
5China Center for Health Development Studies, Peking University, Beijing, China
6Stanford Center for International Development, Stanford University, Stanford, California
7Shanghai Ocean University, Shanghai, China
8African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
9Brien Holden Vision Institute, Durban, South Africa
10Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
11Translational Research for Equitable Eyecare, Queen’s University Belfast, Belfast, Northern Ireland
12Orbis International, New York, New York
JAMA Ophthalmol. 2015;133(12):1399-1406. doi:10.1001/jamaophthalmol.2015.3513.
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Importance  The number of urban migrants in China is 300 million and is increasing rapidly in response to government policies. Urban migrants have poor access to health care, but little is known about rates of correction of refractive error among migrant children. This is of particular significance in light of recent evidence demonstrating the educational impact of providing children with spectacles.

Objective  To measure prevalence of spectacle need and ownership among Chinese migrant children.

Design, Setting, and Participants  Population-based, cross-sectional study among children who failed vision testing (uncorrected visual acuity ≤6/12 in either eye) between September 15 and 30, 2013, at 94 randomly selected primary schools in predominantly migrant communities in Shanghai, Suzhou, and Wuxi, China.

Main Outcomes and Measures  Refractive error by cycloplegic refraction; spectacle ownership, defined as producing glasses at school, having been told to bring them; and needing glasses, defined as uncorrected visual acuity of 6/12 or less correctable to greater than 6/12 in either eye, with myopia of −0.5 diopters (D) or less, hyperopia of +2.0 D or greater, or astigmatism of 0.75 D or greater in both eyes.

Results  Among 4409 children, 4376 (99.3%) completed vision screening (mean [SD] age, 11.0 [0.81] years; 55.3% boys; 4225 [96.5%] migrant and 151 [3.5%] local). Among 1204 children failing vision testing (total, 27.5%; 1147 migrant children [27.1%] vs 57 local children [37.7%]; P = .003), 850 (70.6%) completed refraction. Spectacle ownership in migrant children needing glasses (147 of 640 children [23.0%]) was less than among local children (12 of 34 children [35.3%]) (odds ratio = 0.55; 95% CI, 0.32-0.95; P = .03). Having uncorrected visual acuity less than 6/18 in both eyes was associated positively with baseline spectacle ownership (odds ratio = 5.73; 95% CI, 3.81-8.62; P < .001), but parental education and family wealth were not.

Conclusions and Relevance  Among urban migrant children, there was a high prevalence of need for spectacles and a very low rate of spectacle ownership. Spectacle distribution programs are needed specifically targeting migrant children.

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Flowchart for Enrollment of Children in the Study

aThe total number of baseline observations was 4409. Among these, 15 children with missing baseline screening data and 18 children with unknown residential status (a total of 33 [0.75%]) were excluded.

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