To determine whether provision of free spectacles to rural-dwelling Chinese secondary school students with visually-significant refractive error, together with a teacher-based incentive to promote their use, increases the proportion of children going on to academic high school, as opposed to dropping out or pursuing a vocational track.
Year 1 students (about 12-15 years old) from schools in county-level cities and below in Liaoning Province
Uncorrected (self-glasses) visual acuity of ≤6/12 in both eyes
Refractive error meets cut-offs shown to be associated with significantly greater improvement in visual acuity when corrected7 (myopia ≤-0.75 diopters (D, or astigmatism (non-spherical refractive error) ≥1.00 D
Best corrected visual acuity ≥6/7.5 in either eye
Hyperopia ≥2.00 D
Presence of visually-significant ocular condition besides refractive error
Parallel
free spectacles
DeviceChildren will receive free spectacles
Attendance at academic high school
This will be assessed by systematically contacting parents, teachers and students to ascertain enrolment status, which REAP has used to obtain \> 97% follow-up in previous studies of high school accession. In the event of inconsistent responses, priority will be given to responses of parents, then teachers and finally students
Compliance with spectacle wear
Actual presence of spectacles on the child's face (rather than having glasses at school)at the time of an unannounced examination.
Classroom use of blackboards versus textbooks
Frequency of blackboard versus textbook use in the major subjects (Maths Chinese, English) on a questionnaire administered to teachers, and answered as "all", "most", "about half", little" or "none" of teaching.
Cost effectiveness of intervention.
Calculated as ratio of incremental cost to proportion of children who continue to academic high school as opposed to vocational high school or no schooling. Incremental cost is the difference of costs between implementation of intervention and control, Intervention costs will comprise the screening test glasses (including replacements).
Depression and Anxiety
Depression and anxiety score measured with Anxiety Stress Scale (DASS). The score range for depression, anxiety and stress are 0-42, with higher score indicates more severe mental health problems.
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