ProblemApproximately 10% of all primary school children in developing countries have problems with their eyesight.

World Bank studies suggest that approximately 10% of all primary school children in developing countries have problems with their eyesight. About 97% of children’s eye problems are caused by refraction errors, nearly all of which can be corrected with properly fitted eyeglasses. However, most children with refraction problems in low-income countries do not have glasses. Studies in urban and rural Southern China reveal up to 30% of children with uncorrected vision.

There is very little, if any, reliable data on the extent to which academic performance may be improved by providing eyeglasses to poor children who need them. Given the high incidence of uncorrected vision among children in developing countries, it is important to better understand the correlation between imperfect vision and educational outcomes. This is particularly true if the effects of addressing vision problems are comparable to other, more common (and more costly) educational interventions such as teacher training, scholarships, or reduced class sizes.

Poor vision may prevent better learning outcomes

Beginning in 2004, REAP conducted a randomized trial involving over 2,000 primary school students in rural Gansu Province to evaluate the impact of providing eyeglasses on educational performance.

Eyeglasses were offered to 1,319 students in the intervention schools, while 750 students in the control group were not offered glasses. In 2005, results indicated that students with poor vision increased their test performance by a statistically significant average of 0.20 standard deviations after their vision was corrected with eyeglasses. In other words, near-sighted students improved their average grades by half a letter grade or more by wearing glasses in the classroom.

However, of the 1,319 students who were offered glasses, 30% declined. Had they agreed to take the offer, it is possible that school performance on average could have improved by an estimated 0.30 standard deviations!

Why did the students to refuse eyeglasses? What types of incentives could convince them otherwise? This is the motivation behind a 2012 study among primary school students in rural Shaanxi and Gansu Provinces. 

Providing glasses may be a very cost-effective way to improve educational performance. Efforts can be made to promote the acceptance of wearing glasses.

Objectives

In order to address impaired vision among students in rural China, given the potential adverse consequences on education, REAP has the following objectives for the REAP/OneSight "Seeing is Learning" study:

1. Measure prevalence of myopia.

2. Understand how demand-side and supply-side barriers impact uptake of eyeglasses, delivery of eye care, and educational performance.

Approach

Using a randomized controlled trial approach, the study will randomly select 75 treatment schools and 75 control schools in rural Shaanxi province’s Yulin prefecture where 8 out of 11 counties are nationally designated poverty-stricken areas.

We will adopt a TWO BY THREE Factorial Design with “CROSS-CUTTING” vision care training. In other words, we will have 3 main effect groups (Free Glasses; Voucher Glasses; Vision Care Training). Given the factorial design, there were be a total of 6 interaction effects groups.

With this experimental design, we can study four questions of main effects on eyeglasses uptake and educational performance:

• Does offering Free eyeglasses work?
• Does offering a voucher for free eyeglasses work?
• Are impacts of Free eyeglasses larger than that of Voucher eyeglasses?
• Does Vision Care Training, in general, work?

Also, we can study three questions of interaction effects on eyeglasses uptake and educational performance:

• Are impacts of offering Free glasses larger when Vision Care training is also given?
• Are impacts of offering Voucher glasses larger when Vision Care training is also given?
• Are impacts of offering Free eyeglasses larger than Voucher when Vision Care training is also given?

Results

In the end of 2012, we organized much of our baseline data--tens of thousands of forms with screening and refraction data--to generate some numbers on prevalence. Here is a "snapshot" of what we've found so far: 

Number of schools in sample: 252

Counties: 18 (accross two provinces)

Students screened:19,977

Number of glasses prescribed: 4,344

Students in sample found to have low vision: 24 percent

Students in sample who had glasses prior to intervention: 4 percent (most with incorrect prescriptions)

Remember, we are just getting started with our analysis, and will be updating this page as we determine the effectiveness of the voucher and free glasses distribution models, rates of uptake, the effect of corrected vision on educational performance, and more.

Stay tuned!

Additional Information

A recipient of free glasses

Please click here to read a series of stories from the field. They include stories from:

• The children whom we've encountered along the way
• The staff and volunteers that have helped carry out our work
• There are also a series of updates that track our progress in this important project!

Please also take a look at our information intervention materials. These materials were part of a comprehensive educational intervention that targeted students, their caregivers, and school administrators. 

Thanks and check back soon for more updates!