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The challenge
Refractive error has particular significance for school-going children as an inability to see well may have a dramatic impact on a child's learning capability, educational potential and career prospects. Fortunately, the vast majority of people with refractive error will require little more than a pair of eyeglasses to improve their vision: a treatment that is at once safe, affordable, and easy to apply. Unfortunately, there is a tremendous shortage of eyeglasses in the world's developing regions. The reason for this is simple: the eye is ubiquitous; the eye care professional, not. This problem begs the question: Is there some way to address the need for vision correction in the absence of adequate access to eye care professionals?
A promising technology
Adjustable eyeglasses allow users to correct their own vision and thereby access eyeglasses without the need for expensive equipment or eye-care specialists. The eyeglasses offer the user the ability to change the power of each lens independently to improve vision in each eye: a process known as self-refraction. Adjustable eyeglasses thus have the potential to provide a means of both measuring and correcting refractive error in regions underserved by eye-care professionals. While eyeglasses of this sort are being used by some 30,000 adults in various parts of the developing world, there is currently little evidence that self-refraction can be used reliably as a means of correcting refractive error amongst children.
The objective of the study
The primary objective of this study is to compare the accuracy of self-refraction to the 'gold standard' refraction technique used by eye-care professionals in clinical practice. This study represents a first step in designing a programme to provide affordable vision correction to children through existing models of service delivery such as PCD's school health programmes. The advantages of doing this study within the education sector are:
- schools provide a strong link between healthcare, education and the community
- schools offer unprecedented access to children in the care of a skilled workforce with extensive ties to the local community
- it is possible to utilise existing distribution channels, providing corrective eyewear alongside reading and study materials
Testing the technology
At a PCD funded meeting held at the University of Oxford in July 2007, experts in child vision, optics, education and government development policy unanimously agreed that self-refraction should be tested in the school setting. The purpose of the Child Self Refraction Study is to determine whether school-going children can correct their own vision under the supervision of their teachers.
Participants
The study will be carried out in Boston (USA), Shantou and Guangzhou (both in China). The study's methodology is designed to conform to, and be integrated with, the existing school-based vision programmes offered at each site. Children attending schools that are scheduled to undergo routine vision screening will be invited to take part in this study and a sample of 1,800 children, 600 at each site, aged 13 to 16 years will be selected from within these schools using grades as the sampling frame.
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Study Partners
The Child Self Refraction Study is commissioned and supported by the Partnership for Child Development, Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London, UK, a World Bank resource centre for school health programmes.
This project is designed and coordinated by the Centre for Vision in the Developing World and will be conducted by eye specialists involved in the study and treatment of refractive error.
Contributing centres include:
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong.
- Department of Specialty and Advanced Care, New England College of Optometry, Boston, MA, USA.
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, PRC.
Please see our list of partners for more details.
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