|Year : 2013 | Volume
| Issue : 3 | Page : 199-202
The impact of spectacle wear compliance on the visual function related quality of life of Omani students: A historical cohort study
Rajiv B Khandekar1, Urmi P Gogri2, Saleh Al Harby2
1 Department of Non Communicable Disease Control, Eye Health Care Program, Directorate General of Health Affairs, Ministry of Health, Oman, Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
2 Department of Non Communicable Disease Control, Eye Health Care Program, Directorate General of Health Affairs, Ministry of Health, Oman
|Date of Web Publication||30-Nov-2013|
Rajiv B Khandekar
Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Eye screening and refractive services to students are part of a school health initiative in Oman. We evaluated the impact of the compliance of spectacle wear on the vision related quality of life (VFQ) among 12-13 years old and 15-16 years old Omani students with refractive error.
Materials and Methods: This historical cohort study was conducted in 2012. Students using spectacles and those not using spectacles after 1 year of prescribing/providing spectacles were interviewed to assess their VFQ. The VQ 20 questionnaire with 5 graded close-ended responses was adopted for this purpose. The responses for the VFQ related to different visual functions of students who were/were not spectacle wear compliant, were compared.
Results: Our cohort had 124 students in each group. The overall VFQ was significantly higher among the compliant spectacle wearers (compliant group) compared with the non-complaint wearers (non-compliant group) (relative risk [RR] =4.7% [95% of the confidence interval (CI): 2.8-6.6]). The association of gender and the grade level was not significant (P > 0.05). However, the variation of governorate was significantly associated to the difference of VFQ in both groups (χ2 = 16.6, degrees of freedom = 4, P = 0.0003). The VFQ related to the near work (RR = 1.3) and school related activities (RR = 1.3) was better in the compliant group.
Conclusion: VFQ was better among those students who were spectacle wear compliant compared with those who were not. VFQ related to near work and school related activities seem to be the most influenced by spectacle wear compliance.
Keywords: Compliance, myopia, school health, spectacles, vision screening, visual function related quality of life
|How to cite this article:|
Khandekar RB, Gogri UP, Al Harby S. The impact of spectacle wear compliance on the visual function related quality of life of Omani students: A historical cohort study. Oman J Ophthalmol 2013;6:199-202
|How to cite this URL:|
Khandekar RB, Gogri UP, Al Harby S. The impact of spectacle wear compliance on the visual function related quality of life of Omani students: A historical cohort study. Oman J Ophthalmol [serial online] 2013 [cited 2017 Dec 14];6:199-202. Available from: http://www.ojoonline.org/text.asp?2013/6/3/199/122278
| Introduction|| |
Uncorrected refractive error (RE) is the leading cause of visual disability in the world.  The World Health Organization (WHO) has therefore urged member countries to address this health issue.  Provision of low cost spectacles is a major challenge in developing world and it is the main cause of non-compliance of spectacle wear.  Spectacles improve eyesight and are an important component of refractive services for schoolchildren. One of the indicators suggested while planning a program aiming to improve the eye health care through school health is "Will providing refractive services make any difference to the child's life?"  To the best of our knowledge, little evidence about the impact of noncompliance of spectacle wear on the vision related quality of life among schoolchildren is available in the literature.
For the last two decades in Oman, health authorities have provided vision and eye screening and refractive services to schoolchildren on an annual basis.  This was considered a model for other in the region to adopt.  However, during an external evaluation of the eye health care program in Oman by an WHO expert, indicated that the impact of the school based eye care initiative should be reviewed. 
Accordingly this study was conducted to compare the visual function related quality of life (VFQ) among 7 th and 10 th grade school students with RE who were/were not spectacle wear compliant. Based on the findings suggestions to improve refractive services to schoolchildren was proposed.
| Materials and Methods|| |
The approval of the national eye health care committee was obtained to undertake this study in 2011-2012 in Oman. This study was part of the annual vision screening of school students of randomly selected students in some governorates of Oman. The consent for participation in the study was obtained from students with the help of the school principal.
This was a historical cohort study. The study population was comprised of students identified with significant RE (more than 0.75D myopia or more than + 1D hyperopia without asthenopia) in the previous school year who were provided spectacles. We randomly selected those who were spectacle wear complaint (complaint group) and those were non-compliant (non-complaint group) over the year after prescription and provision of spectacles.
The school health refractionist of each governorate had the list of students of 7 th and 10 th grades and was prescribed spectacles in previous school year. They were study population for the present study. During the visit to these schools/students in present academic year, refractionists evaluated the compliance of spectacle wear among these students. From the list of compliant and non-compliant students, they randomly selected required number of participants for their governorate. They also matched students of these two groups by school grade.
To calculate the sample size of our cohort study, we assumed that the VFQ score of 75% percentile among students compliant to the spectacle wear was 90% and among those who were not compliant to the spectacle wear was 75%.  To achieve 95% of the confidence intervals (CI) and 80% power of the study of a cohort with 1:1 ratio of students in the compliant and non-compliant groups, we required 113 students with RE in each group. To compensate for the loss of data, we increased the sample by 10%. Thus the final minimum sample required for this study was 124 students in each group.
The governorate school health refractionists and Arabic speaking nurses were the field staff. Students were interviewed to generate information about the status of their current VFQ.
Data were collected on gender, grade level, location of school (Governorate), type of RE and ocular comorbidity by reviewing the school health book of each student. We adapted the National Eye Institute Visual functioning Questionnaire (VFQ-25) to assess VFQ of students with RE. , Arabic translation and adaptation of this questionnaire was tested using reverse translation. It was piloted to test its validity and understanding among Arabic speaking Omani students. We also referred an Arabic VFQ questionnaire that was prepared to study cataract patients.  The student responses student were graded on a 5-point Likert scale.  A summary of the questionnaire used in our study is presented in [Figure 1]. A strongly positive response was allotted two points while strong disagreement was given - two points. If a participant chose not to answer to a question, it was omitted for calculating the overall score. The sum of scores for different VFQ responses (distance vision, near vision, field of vision, vision for computer work, vision for communication, vision for social activities, vision for mobility, perception of change in school performance and self-esteem due to better vision quality) were graded as: Excellent (>75%), very good (50-75%) poor (25-50%) and very poor (<25%).
|Figure 1: Summary of questionnaire for vision related quality of life among students with refractive error|
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The data were collected on pretested data collection forms and then entered into computer using EpiData (Lauritsen JM and Bruus M. Epi Data Entry (version). A comprehensive tool for validated entry and documentation of data. The EpiData Association, Odense Denmark). The final data were transferred into a spreadsheet for statistical package for social studies version 16 (IBM Corp., New York, NY, USA) (Chicago, USA). The number and percent of participants with an excellent score of VFQ in the complaint and non-complaint groups were compared. The difference in percentage proportion and the 95% CI were calculated for statistical validation.
| Results|| |
There were 124 students in the compliant group and 124 students in the non-compliant group. In the non-compliant group, one member chose not to respond to the questions. The comparison of their profile is presented in [Table 1]. The participants in both group gender and age matched, but school location (governorate) varied.
The strongly positive responses to the questions related to different types of VFQ were compared between groups [Table 2]. The relative risk (RR) of overall response for VFQ was significantly higher in the compliant group compared with non-complaint group (RR = 4.7% [95% CI: 2.8-6.6]). However, while comparing subgroups of VFQ among two groups, element of chance cannot be ruled out.
|Table 2: Responses to the VQL by type of work among students with refractive error|
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The association of the compliance to VFQ by gender (RR = 0.8), type of RE (P = 0.4), comorbidity and level of school (RR = 1) was not significant. However, the variation of the governorate was significantly associated to the difference in compliance to spectacle wear among those having high VQL [Table 3].
|Table 3: Association of non-compliance of spectacle wear and VQL among students with refractive error|
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| Discussion|| |
VFQ was significantly better among students who were spectacle wear compliant compared to those who were not spectacle wear compliant. This association was influenced by the location of the school (governorate of Oman), but did not vary by gender, type of RE and preparatory versus secondary school levels. The positive impact of compliance of spectacle wear on the VFQ that was found in our study could be an important advocacy tool for motivating parents and children to improve compliance of spectacle wear.
In our study, we had a noted positive and significant impact of correcting RE on VFQ. In contrast, Nutheti et al. found that VFQ among those provided and using RE correction among adults and those not provided RE correction was not significantly different.  The differing age group of the study participants between studies could be the reason for the variation. It should be noted that adults could have age related ocular morbidities affecting the visual functioning.  Owing to a small numbers of ocular comorbidities an association with VFQ could not be performed in our study.
Myopia corrected with spectacles had a differential impact on VFQ related to stress of injuries, coping with the demands of daily life and difficulties in fulfilling roles.  We did not find differences in VFQ among myopic children.
There are some limitations to this study. There were a limited number of children with hyperopia and high astigmatism. Hence, the influence of the type of RE on the association of compliance and VFQ could not be studied effectively. None of the participants were contact lens wearers. Hence, the impact of compliance of contact lens that is more common among urban adolescents with myopia could not be evaluated. The VFQ of a student with high myopia could differ from that of moderate myopia. Thus, association of compliance of spectacle wear to the VFQ could be confounded by the severity of myopia. Thus overall VFQ of students with moderate and severe myopia might have been influenced by grade of myopia in our study.
The compliance rate varied from as low as 64.4% in preparatory students and as high as 80% in secondary students in Oman.  In spite of offering free and periodic refractive services to the schoolchildren in Oman, the low compliance rate is a matter of concern. Newer tools for advocacy - the positive impact on VFQ could improve spectacle wear compliance and thus strengthen the eye care through school health programs. 
| Acknowledgments|| |
The authors would like to thank the administrators and staff of school health, Ministry of Education and eye health care to extend support for this study. The Sincere and hard work of field teams was key to the success of this study especially, S. Karunanithy, N. Sarvanan, Satheesh P, A. Sattar, A. Othman, Ahmed M, Lilamani B, R. Gupta, M. Pathan, K. Hadrami. We express our sincere gratitude to the students who actively participated in this study.
| References|| |
|1.||Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-8. |
|2.||World Health Organization. Refractive Errors; Approaches to Prevention of Visual Impairment in Global Initiative for the Elimination of Avoidable Blindness-Action Plan 2006-2011. Geneva, Switzerland: WHO; 2007. p. 15-6. |
|3.||Sharma A, Congdon N, Patel M, Gilbert C. School-based approaches to the correction of refractive error in children. Surv Ophthalmol 2012;57:272-83. |
|4.||Eastern Mediterranean Regional Offi ce of the International Agency for the Prevention of Blindness (EMR-IAPB). Guidelines for School Eye Health for the Eastern Mediterranean Region (EMR). 2009. p. 12-4. http://www.pbunion.org/IMPACT-EMR-Guidelines-1.pdf last visited on 6th November 2013. |
|5.||Mohammed AJ, editor. Community Health and Disease Surveillance Newsletter, Vol. 17. Ministry of Health, Sultanate of Oman, Sep. 2008. p. 15. Available from: http://www.moh.gov.om/en/reports/publications/Newsletter17-7.pdf [Last cited 2013 Oct 12]. |
|6.||Thulsiraj RD, Mohideen. A Executive Summary in World Health Organization Report on Assessment of Vision 2020 in Oman. Ministry of Health, Oman 2009. p. 4. |
|7.||McClure TM, Choi D, Wooten K, Nield C, Becker TM, Mansberger SL. The impact of eyeglasses on vision-related quality of life in American Indian/Alaska Natives. Am J Ophthalmol 2011;151:175-1822. |
|8.||Berry S, Mangione CM, Lindblad AS, McDonnell PJ. Development of the National Eye Institute refractive error correction quality of life questionnaire: Focus groups. Ophthalmology 2003;110:2285-91. |
|9.||Toker E, Onal S, Eraslan M, Eyriparmak M. The Turkish version of the National Eye Institute Refractive Error Quality of Life Instrument: Translation, validity and reliability. Qual Life Res 2008;17:1269-76. |
|10.||Mousa A, Al Ghamdi AH, Kalantan H, Al Muammar AR. Development and validation of an Arabic version of the visual functioning index VF-14 for cataract patients. Middle East Afr J Ophthalmol 2012;19:309-13. |
|11.||Siengle D. University of Connecticut, USA. Likert Scale. Available from: http://www.gifted.uconn.edu/siegle/research/instrument%20reliability%20and%20 validity/likert.html. [Last accessed on 2013 Jun 9]. |
|12.||Nutheti R, Shamanna BR, Nirmalan PK, Keeffe JE, Krishnaiah S, Rao GN, et al. Impact of impaired vision and eye disease on quality of life in Andhra Pradesh. Invest Ophthalmol Vis Sci 2006;47:4742-8. |
|13.||Chen CY, Keeffe JE, Garoufalis P, Islam FM, Dirani M, Couper TA, et al. Vision-related quality of life comparison for emmetropes, myopes after refractive surgery, and myopes wearing spectacles or contact lenses. J Refract Surg 2007;23:752-9. |
|14.||Nirmalan PK, Tielsch JM, Katz J, Thulasiraj RD, Krishnadas R, Ramakrishnan R, et al. Relationship between vision impairment and eye disease to vision-specific quality of life and function in rural India: The Aravind Comprehensive Eye Survey. Invest Ophthalmol Vis Sci 2005;46:2308-12. |
|15.||Khandekar R, Mohammed AJ, Al Raisi A. Compliance of spectacle wear and its determinants among schoolchildren of Dhakhiliya region of Oman: A descriptive study. J Sci Res Med Sci 2002;4:39-43. |
[Table 1], [Table 2], [Table 3]