If children with common vision problems receive and use eyeglasses, their educational performance rises. Without proper treatment, visually impaired children may not achieve educational gains and could suffer from poor mental health. We use a randomized controlled trial to study the impact of an eyeglasses promotion program in rural China on the mental health of myopic primary school students. Three measures of mental health are used: learning anxiety, physical anxiety, and scores on the Mental Health Test (MHT). Our empirical analysis showed that on average, the treatment has small and insignificant for learning anxiety and MHT, and a small but significant reduction in physical anxiety. However, subgroup analysis reveals that myopic students who study more intensively see their learning anxiety and physical anxiety reduced after being provided with eyeglasses. In contrast, students with the lower study intensity suffer a rise in learning anxiety after receiving eyeglasses. A potential mechanism for the differing impacts is the increase in teasing reported among low study-intensity students that does not occur for high study-intensity students. Care should be taken to maximize the benefits and minimize the costs of in-school vision programs.

To study the factors determining spectacle-wear compliance and reasons for non-wear among students in rural China.This study was based on a spectacle intervention trial among 162 schools in rural C...

Background: The gender gap remains a major impediment in the path toward equality, and it is especially wide in low-income countries. Gender differences in health-seeking behaviors may be a factor. Family size and childbirth order are two critical factors affecting family resource allocation. This study examines gender differences in healthcare-seeking behaviors among children with visual impairment in rural China across different family structures (birth order and family size).Methods: We draw on a dataset containing 19,934 observations constructed by combining data from 252 different school-level surveys spanning two provinces. The surveys were all conducted in 2012 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in grades from 4 to 5. Our analysis compares rural girls with rural boys regarding vision health outcome and behavior (vision examination and correction).Results: The findings revealed that girls have worse vision than boys. Regarding vision health behaviors, girls have a lower overall vision examination rate than boys. There is no gender difference when the sample student is the only child or the youngest child in the family, but there is still a gender difference when the sample student is the oldest child in the family or the middle child in the birth order. When it comes to vision correction behavior, boys are more likely to own eyeglasses than girls are for groups of students with mild visual impairment, even when the sample student is the only child in the family. However, when the sample student has another brother or sister (the sample student is the youngest, the oldest child in the family, or the middle child in the birth order), the gender difference disappears.Conclusions: Gender differences in vision health outcomes are correlated with gender differences in vision health-seeking behaviors among rural children. Depending on the birth order and family size, gender disparities in visual health practices vary. In the future, consideration should be given to providing medical subsidies to reduce the cost of vision health behaviors and to provide information interventions to change gender inequality in households and promote equality in children’s vision health behaviors.Trial registration: The trial was approved by the Stanford University Institutional Review Board (Protocol No. ISRCTN03252665). Permission was received from local Boards of Education in each region and the principals of all schools. The principles of the Declaration of Helsinki were followed throughout. Written informed consent was obtained from at least one parent for all child participants.

Background: Cataracts are highly prevalent in rural China, but patient utilization of eye care services is low. Cataract knowledge is regarded as an important factor in eye care utilization. Few studies, however, have been conducted to measure the level of cataract knowledge and its relationship with eye care utilization among older adults in rural China. Hence, we described cataract knowledge and investigated the relationships between cataract knowledge and eye care utilization among adults (≥50 years) in rural Western China.Methods: A large community-based cross-sectional study was conducted from October to December 2020 among adults aged 50 years and older in 73 rural villages in Qingcheng County, Western China. The participants underwent an eye examination at their village clinic to determine whether they had cataracts. Participants also answered a questionnaire about cataracts, eye care utilization status, and sociodemographic characteristics. The collected data underwent descriptive and multiple logistic regression analyses.Results: The eye examinations revealed that 45.15% (675/1,495) of participants had cataracts in at least one eye, yet 90.67% (612/675) were left untreated. The average score achieved by participants about cataract knowledge was 4.91 points (total score was eight points). Correct knowledge about cataracts was positively associated with cataract screening and cataract surgery. Elders with better cataract knowledge were 2.21 times more likely to undergo cataract screening (OR, 2.21; 95% CI, 1.54–3.16) and 5.61 times more likely to undergo cataract surgery (OR, 5.61; 95% CI, 2.87–10.98). More than half had three fundamental misconceptions about how cataracts should be treated, how much they should cost, and when they should be treated. Participants who did not have these misconceptions were more likely to receive cataract screening by 1.21–2.02 times and cataract surgery by 1.76–3.48 times.Conclusion: There are misunderstandings about cataract treatment methods, treatment costs and timing in the sample areas. A better understanding of cataracts was significantly positively associated with cataract screening and cataract surgery. Health education on cataracts and regular eye examinations are needed to improve eye care utilization in rural China.

Less than one-third of rural Chinese children with refractive error own or wear eyeglasses. To study the effect of teacher incentives on the acceptance of vision care offered to rural students with uncorrected refractive error, we conducted a cluster-randomized controlled trial in 18 townships in one county in Shaanxi Province. Primary and junior high schools within each township were assigned to either intervention (all teachers received an incentive) or control (no teacher incentives were offered) groups. A total of 42 schools were assigned to either the intervention group (13 schools) or the control group (29 schools). Teachers in the intervention group could elect to receive high-value (sunglasses worth USD 148), moderate-value (eyeglasses worth USD 89), or cash incentives (USD 35) if ≥70% of eligible students (uncorrected visual acuity (VA) ≤ 6/12 in both eyes and corrected VA ≤ 6/9.5 in both eyes) in the teacher’s class visited a program-affiliated vision center (VC) within 60 days after their vision screening. Among 8238 students, 3401 (41.2%, of which 53.0% were girls with a mean age of 12 (SD 1.75)) met the enrollment criteria and were randomly allocated to the intervention (n = 1645, 49.0%) and control groups (n = 1579, 51.0%). Among these, 3224 (94.8%) completed the study and underwent analysis. Nearly equal numbers of students had classroom teachers selecting the high-value (n = 524, 31.9%), moderate-value (n = 582, 35.4%), and cash incentives (n = 539, 32.8%). The rate of the acceptance of offered vision care was significantly higher in the intervention group (382/1645 = 23.2%) compared to the control group (172/1579 = 10.9%, 95% confidence interval for observed difference 12.3%, p < 0.001). Teacher incentives appeared effective in improving Chinese rural school-aged children’s uptake rate of vision services provided by county hospital-based VCs.

Background: Parental migration is an important factor affecting left-behind children’s health. However, few studies have addressed the effect of parental migration on children’s vision health in China. To fill the gap, this study aimed to assess the impact of parental migration on left-behind children’s vision health and to explore the possible mechanisms of the effect. Methods: Data were obtained from the baseline survey of the China Education Panel Survey (CEPS), which included over 10,000 junior high school students. This study used myopia, the most common vision problem among junior high school students, and tried to analyze whether myopia was corrected with eyeglasses as indicator variables of vision health. The impact of parental migration on vision health was assessed using an instrumental variables approach. Results: The results show that parental migration reduced the likelihood of myopia in left-behind children and decreased the possibility of myopic left-behind children being corrected. This result passed a series of robustness tests. The mechanism analysis indicated that compared to non-left-behind children, left-behind children spent more time on outdoor activities and less time on after-school classes, reducing their risk of being myopic. Further, because left-behind children live apart from their parents, their myopia problem is more difficult for parents to notice, and left-behind children are less likely to inform their parents of their myopia than non-left-behind children actively. This helps to explain why left-behind children have a lower correction rate with eyeglasses. Conclusions: Our findings suggest that parental migration, while not increasing the prevalence of myopia in left-behind children, has led to inequity in myopic left-behind children’s correction. Given the severe consequences of uncorrected myopia, action is required to enhance the correction rate of myopic left-behind children.