Spectacles utilization and its impact on health-related quality of life among rural Chinese adolescents

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The aims of the study were to assess the magnitude and predictors of the unmet need for spectacles utilization and to quantify its impact on health-related quality of life (HRQOL) among rural Chinese adolescents.


This school-based survey of 2346 grade-7 students (mean age: 13.8 years) was conducted in Southwestern China in 2016. Spectacles need was defined as uncorrected visual acuity (VA) of 20/40 or worse but correctable to 20/40 or better in the better-seeing eye, together with the presence of myopia of less than −0.5 diopters (D), hyperopia of more than +2.0 D, or astigmatism of more than 0.75 D in both eyes. The HRQOL was measured using self-reported versions of 23-item Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales (PedsQL 4.0).


Among 579 (24.7%) adolescents with an uncorrected VA of 20/40 or less, 483 (83.4%) needed vision corrections and 172 (35.6%) used them. Higher parental education levels (odds ratio (OR) = 2.73; 95% CI, 1.29–5.77), negative attitude regarding spectacles (OR = 0.49; 95% CI, 0.25–0.97), and poorer uncorrected VA (OR = 31.27; 95% CI, 3.76–260.23) were independent determinants for spectacles utilization. Adolescents not using spectacles had a lower HRQOL score compared to those using spectacles in terms of psychosocial health (65.91 vs. 70.59; P = 0.028), emotional health (56.85 vs. 63.24; P = 0.012), and social functioning (72.99 vs. 78.60; P = 0.036).


The rate of spectacles utilization in rural China was low. Adolescents were not accustomed to use spectacles had a worse HRQOL score.

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  1. 1.

    Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008;86:63–70.

  2. 2.

    Gordois A, Cutler H, Pezzullo L, Gordon K, Cruess A, Winyard S, et al. An estimation of the worldwide economic and health burden of visual impairment. Glob Public Health. 2012;7:465–81. https://doi.org/10.1080/17441692.2011.634815

  3. 3.

    Robaei D, Rose K, Ojaimi E, Kifley A, Huynh S, Mitchell P. Visual acuity and the causes of visual loss in a population-based sample of 6-year-old Australian children. Ophthalmology. 2005;112:1275–82. https://doi.org/10.1016/j.ophtha.2005.01.052

  4. 4.

    He M, Huang W, Zheng Y, Huang L, Ellwein LB. Refractive error and visual impairment in urban children in southern china. Invest Ophthalmol Vis Sci. 2004;45:793–9.

  5. 5.

    McCarty CA. Uncorrected refractive error. Br J Ophthalmol. 2006;90:521–2.

  6. 6.

    Roch-Levecq AC, Brody BL, Thomas RG, Brown SI. Ametropia, preschoolers’ cognitive abilities, and effects of spectacle correction. Arch Ophthalmol. 2008;126:252–8. https://doi.org/10.1001/archophthalmol.2007.36. quiz 161

  7. 7.

    Kumaran SE, Balasubramaniam SM, Kumar DS, Ramani KK. Refractive error and vision-related quality of life in South Indian children. Optom Vision Sci. 2015;92:272–8. https://doi.org/10.1097/OPX.0000000000000494

  8. 8.

    Ma X, Zhou Z, Yi H, Pang X, Shi Y, Chen Q, et al. Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial. BMJ. 2014;349:g5740 https://doi.org/10.1136/bmj.g5740

  9. 9.

    Rahi JS, Cable N, British Childhood Visual Impairment Study, G. Severe visual impairment and blindness in children in the UK. Lancet. 2003;362:1359–65. https://doi.org/10.1016/S0140-6736(03)14631-4

  10. 10.

    Varma R, Wu J, Chong K, Azen SP, Hays RD; Los Angeles Latino Eye Study Group. Impact of severity and bilaterality of visual impairment on health-related quality of life. Ophthalmology. 2006;113:1846–53. https://doi.org/10.1016/j.ophtha.2006.04.028

  11. 11.

    Li L, Song Y, Liu X, Lu B, Choi K, Lam DS, et al. Spectacle acceptance among secondary school students in rural China: the Xichang Pediatric Refractive Error Study (X-PRES)–report 5. Invest Ophthalmol Vis Sci. 2008;49:2895–902.

  12. 12.

    He M, Huang W, Zheng Y, Huang L, Ellwein LB. Refractive error and visual impairment in school children in rural southern China. Ophthalmology. 2007;114:374–82. https://doi.org/10.1016/j.ophtha.2006.08.020

  13. 13.

    Paudel P, Ramson P, Naduvilath T, Wilson D, Phuong HT, Ho SM, et al. Prevalence of vision impairment and refractive error in school children in Ba Ria - Vung Tau province, Vietnam. Clin Exp Ophthalmol. 2014;42:217–26. https://doi.org/10.1111/ceo.12273

  14. 14.

    Mehari ZA, Yimer AW. Prevalence of refractive errors among schoolchildren in rural central Ethiopia. Clin Exp Optom. 2013;96:65–9. https://doi.org/10.1111/j.1444-0938.2012.00762.x

  15. 15.

    He J, Lu L, Zou H, He X, Li Q, Wang W, et al. Prevalence and causes of visual impairment and rate of wearing spectacles in schools for children of migrant workers in Shanghai, China. BMC Public Health. 2014;14:1312 https://doi.org/10.1186/1471-2458-14-1312

  16. 16.

    Wang X, Yi H, Lu L, Zhang L, Ma X, Jin L, et al. Population prevalence of need for spectacles and spectacle ownership among urban migrant children in Eastern China. JAMA Ophthalmol. 2015;133:1399–406. https://doi.org/10.1001/jamaophthalmol.2015.3513

  17. 17.

    Freedman BL, Jones SK, Lin A, Stinnett SS, Muir KW. Vision-related quality of life in children with glaucoma. J AAPOS. 2014;18:95–8. https://doi.org/10.1016/j.jaapos.2013.09.010

  18. 18.

    Wen G, McKean-Cowdin R, Varma R, Tarczy-Hornoch K, Cotter SA, Borchert M, et al. General health-related quality of life in preschool children with strabismus or amblyopia. Ophthalmology. 2011;118:574–80. https://doi.org/10.1016/j.ophtha.2010.06.039

  19. 19.

    Chadha RK, Subramanian A. The effect of visual impairment on quality of life of children aged 3-16 years. Br J Ophthalmol. 2011;95:642–5. https://doi.org/10.1136/bjo.2010.182386

  20. 20.

    Wong HB, Machin D, Tan SB, Wong TY, Saw SM. Visual impairment and its impact on health-related quality of life in adolescents. Am J Ophthalmol. 2009;147:505–11 e501. https://doi.org/10.1016/j.ajo.2008.09.025

  21. 21.

    Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–12.

  22. 22.

    Hochhausen L, Le HN, Perry DF. Community-based mental health service utilization among low-income Latina immigrants. Community Ment Health J. 2011;47:14–23. https://doi.org/10.1007/s10597-009-9253-0

  23. 23.

    Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s behavioral model of health services use: a systematic review of studies from 1998-2011. Psychosoc Med. 2012;9:Doc11. https://doi.org/10.3205/psm000089.

  24. 24.

    Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.

  25. 25.

    Yi H, Zhang H, Ma X, Zhang L, Wang X, Jin L, et al. Impact of free glasses and a teacher incentive on children’s use of eyeglasses: a cluster-randomized controlled trial. Am J Ophthalmol. 2015;160:889–96.e881. https://doi.org/10.1016/j.ajo.2015.08.006

  26. 26.

    Silva FG, Silva CR, Braga LB, Neto AS. Portuguese Children’s Sleep Habits Questionnaire - validation and cross-cultural comparison. J Pediatr. 2014;90:78–84. https://doi.org/10.1016/j.jped.2013.06.009

  27. 27.

    Odedra N, Wedner SH, Shigongo ZS, Nyalali K, Gilbert C. Barriers to spectacle use in Tanzanian secondary school students. Ophthalmic Epidemiol. 2008;15:410–7. https://doi.org/10.1080/09286580802399094

  28. 28.

    Seland JH, Vingerling JR, Augood CA, Bentham G, Chakravarthy U, deJong PT, et al. Visual impairment and quality of life in the older European population, the EUREYE study. Acta Ophthalmol. 2011;89:608–13. https://doi.org/10.1111/j.1755-3768.2009.01794.x

  29. 29.

    Daponte A, Bernal M, Bolívar J, Mateo I, Salmi LR, Barsanti S, et al. Criteria for implementing interventions to reduce health inequalities in primary care settings in European regions. Eur J Public Health. 2014;24:980–90. https://doi.org/10.1093/eurpub/cku044

  30. 30.

    Mangalore R, Knapp M, Jenkins R. Income-related inequality in mental health in Britain: the concentration index approach. Psychol Med. 2007;37:1037–45. https://doi.org/10.1017/S003329170600969X

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This work was supported by the National Natural Science Foundation of China under grant no. 81773449 and 81560169. The sponsor or funding organization had no role in the design or conduct of this research.

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Correspondence to Chen-Wei Pan.

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