Interventions to improve school-based eye-care services in ... · School-based eye-care...

Bull World Health Organ 201896682ndash694D | doi httpdxdoiorg102471BLT18212332

Systematic reviews

682

IntroductionVision impairment and blindness in children can have nega-tive consequences on their health education and prospects1ndash4 which in turn can affect the nationrsquos broader economic pros-perity56 Globally an estimated 19 million children are blind or vision impaired7 with the majority of vision impairment being preventable or treatable8 The highest burden of blindness is experienced by children in low-income countries where the prevalence is estimated to be 09 per 1000 children compared with 07 per 1000 and 04 per 1000 children in middle- and high-income countries9 respectively this suggests there are fewer services or else increased barriers to accessing services in low-income countries8

School-based eye-care interventions have the potential to provide high-quality and costndasheffective services10 that allow the early detection of eye diseases and prevention of blindness particularly for children living in remote locations11 Identify-ing methods of improving and strengthening school-based eye-care interventions particularly in low- and middle-income countries is therefore important

We conducted a systematic review and qualitative analysis to identify and understand methods by which eye-care services for schoolchildren in low- and middle-income countries could be improved Our analysis was guided by the availability ac-cessibility acceptability and quality conceptual framework as presented in the United Nations Committee on Economic Social and Cultural Rights General Comment No 14 The Right to the Highest Attainable Standard of Health12

MethodsSystematic search

We registered our search on the International prospective register of systematic reviews (CRD42018090316) and fol-lowed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines13 when identifying studies as-sessing interventions that improve schoolchildrenrsquos access to eye-care services

This review set out to include all studies evaluating the impact of school-based eye-care interventions in countries that were categorized as low- and middle-income countries in 201714 Eligible studies were those that (i) evaluated the delivery of a school-based eye-care programme through vision screening refractive services or health promotion activities (ii) reported the evaluation results as either spectacle compli-ance rates quality of vision screening processes quality of vi-sion screening personnel or changes in knowledge or attitudes due to health promotion or (iii) provided other quantitative or qualitative results from follow-up evaluations of school-based eye-care interventions We included cross-sectional epidemiological surveys prospective observational studies qualitative studies economic evaluations and randomized controlled trials

Studies were excluded if (i) they were not conducted in low-and middle-income countries (ii) the described in-tervention did not include schoolchildren or (iii) they did not report data from follow-up evaluation We also excluded meeting abstracts conference papers editorial discussions books theses and studies without primary data collection Systematic reviews that we detected in the initial search were

a Brien Holden Vision Institute Level 4 North Wing RMB Gate 14 Barker St University of New South Wales Sydney 2052 AustraliaCorrespondence to Anthea M Burnett (email ABurnettbrienholdenvisionorg)(Submitted 14 March 2018 ndash Revised version received 28 June 2018 ndash Accepted 2 July 2018 ndash Published online 27 August 2018 )

Interventions to improve school-based eye-care services in low- and middle-income countries a systematic reviewAnthea M Burnetta Aryati Yashadhanaa Ling Leea Nina Serovaa Daveena Braina amp Kovin Naidooa

Objective To review interventions improving eye-care services for schoolchildren in low- and middle-income countriesMethods We searched online databases (CINAHL Embasereg ERIC MEDLINEreg ProQuest PubMedreg and Web of ScienceTM) for articles published between January 2000 and May 2018 Eligible studies evaluated the delivery of school-based eye-care programmes reporting results in terms of spectacle compliance rates quality of screening or attitude changes We considered studies to be ineligible if no follow-up data were reported Two authors screened titles abstracts and full-text articles and we extracted data from eligible full-text articles using the availability accessibility acceptability and quality rights-based conceptual frameworkFindings Of 24 559 publications screened 48 articles from 13 countries met the inclusion criteria Factors involved in the successful provision of school-based eye-care interventions included communication between health services and schools the willingness of schools to schedule sufficient time and the support of principals staff and parents Several studies found that where the numbers of eye-care specialists are insufficient training teachers in vision screening enables the provision of a good-quality and costndasheffective service As well as the cost of spectacles barriers to seeking eye-care included poor literacy misconceptions and lack of eye health knowledge among parentsConclusion The provision of school-based eye-care programmes has great potential to reduce ocular morbidity and developmental delays caused by childhood vision impairment and blindness Policy-based support while also attempting to reduce misconceptions and stigma among children and their parents is crucial for continued access

Systematic reviews

683Bull World Health Organ 201896682ndash694D| doi httpdxdoiorg102471BLT18212332

Systematic reviewsIntervention for school-based eye-care servicesAnthea M Burnett et al

screened to identify any studies initially missed they were not included in the analysis however

We searched the online databases CINAHL Embasereg ERIC MEDLINEreg ProQuest PubMedreg and Web of Sci-enceTM for articles published between January 2000 and May 2018 using the search terms in Box 1 No language re-strictions were placed on the search but since search terms were in English we only retrieved English abstracts We im-ported citations into Covidence software (Veritas Health Innovation Melbourne Australia) where two authors indepen-dently reviewed titles and abstracts If the article could not be excluded based on abstract or title it was included for full-text review Two authors indepen-dently reviewed the full text of potential articles Some article abstracts identified for full-text review did not have a full text in English and were translated in full by a native speaker of the language

Disagreements regarding inclusion or exclusion at either the title and ab-stract screening or full text review were resolved by discussion with a third re-viewer Two independent reviewers then appraised study quality using the Mixed Methods Appraisal Tool (v-2011 McGill University Montreal Canada)15 resolv-ing discrepancies through discussion We selected the appraisal tool as it has been used extensively in prior systematic reviews16 and allows for the critical ap-praisal of qualitative quantitative andor mixed methods studies This tool is preferable to the use of multiple tools which may not allow for inter-study comparisons

Analysis

We analyzed the extracted data quali-tatively using NVivo 11 (QSR Interna-tional Melbourne Australia) Thematic deductive coding1718 was applied to identify the a priori themes from the availability accessibility acceptability and quality conceptual framework12 This framework applies a rights-based approach to analyzing factors related to health system coverage and accessibility and the underlying determinants that shape them The framework identifies the systemic characteristics that inhibit or facilitate equitable eye-care outcomes for schoolchildren while also consider-ing determinants related to sex culture education and discrimination

ResultsOf the 24 559 articles initially captured we identified 48 describing school-based eye-care interventions (Fig 1)19ndash66 Identified articles were from 13 coun-

tries spanning five World Health Or-ganization (WHO) Regions including Africa (eight studies) the Americas (10 studies) the Eastern Mediterra-nean (one study) South-East Asia (18 studies) and the Western Pacific (11

Box 1 Search terms used for systematic review of eye-care services for schoolchildren in low- and middle-income countries

Eye-care services

(eye care OR blindness OR ocular OR optom OR ophthal OR refractive error OR myop OR visual acuit OR vision screening OR visual impairment OR vision impairment OR eye-care OR vision care OR visually impair OR amblyop OR cataract OR spectacle OR eyeglass OR glasses OR vision)

Education sector

(school OR health education OR service OR outreach OR school-based OR student)

Children

(child OR boy OR girl OR minor OR adolescen OR juvenile OR teen OR youth OR parent OR guardian OR student)

Accessibility

(access OR utiliz OR utilis OR availability OR appropriat OR acceptab OR approach OR adequ OR inadequate OR equity OR inequity OR capability OR health seeking OR health care seeking OR social determinant OR health literacy OR health beliefs OR barrier OR facilitator OR enabler OR adherence OR compliance OR afford OR willingness OR knowledge OR perception OR attitude OR socioeconomic OR participat OR predictor OR parental education OR key informant)

Fig 1 Flowchart used for the systematic review of eye-care services for schoolchildren in low- and middle-income countries

24 555 records identified through database search bull 5 418 from Web of ScienceTM

bull 1 920 from PubMedregbull 1 206 from CINAHLbull 4 444 from ProQuest Education and ERICbull 613 from ProQuest Arts Social Sciences and Sociologybull 10 954 from MEDLINEreg and EMBASEreg

24 559 records screened

16 761 abstracts assessed for eligibility

399 full-text articles assessed for eligibility

48 articles included

Four records identified through reference lists

7 798 duplicates removed

16 362 records excluded

351 full-text articles excluded bull 184 not an interventionbull 34 high-income countrybull 33 conference paperbull 30 duplicatesbull 24 not childrenbull 20 not an empirical studybull 13 unable to locate articlebull 7 no data on eye healthbull 4 book or thesisbull 2 methodology article

684 Bull World Health Organ 201896682ndash694D| doi httpdxdoiorg102471BLT18212332

Systematic reviewsIntervention for school-based eye-care services Anthea M Burnett et al

studies) Identified articles comprised 19 school-based eye-care programme evaluations19ndash3362ndash6466 16 studies inves-tigating spectacle compliance associa-tions34ndash4865 eight studies exploring the quality of various eye-care screening personnel49ndash56 four studies evaluating the effectiveness of eye health promo-tion57ndash60 and one study that included both spectacle compliance and the quality of screening personnel61 When appraised for quality15 we classified 18 studies as being of high quality 20 as medium quality and 10 as low quality Study characteristics are outlined in Table 1 (available at httpwwwwhointbulletinvolumes961018-212332)

Availability

School-based eye-care interventions

Recent guidelines for school-based eye-care recommend screening all primary schoolchildren for reduced visual acu-ity with annual screening thereafter for new students and those previously prescribed spectacles to maintain cor-rect prescriptions67 The same guidelines are recommended for secondary school-children in the first two years followed by a re-screening of all students in the third year67 However several studies noted that these guidelines were not being met by some school-based eye-care programmes27495562 with some children having never been screened52 Routine vision screening within schools can provide a solution to poor uptake of care external to education systems3337 A study that conducted mass vision screenings in 51 Indian schools at the start of each academic year was identi-fied as a costndasheffective intervention63 Many studies noted the availability of uncomplicated referral pathways be-tween education and health systems and clarity regarding referral processes as being crucial in successful follow-up provision of spectacles and continuity of care20222329323341516164 For example a study exploring children as potential vi-sion screeners found that despite being effective screeners they were not held with sufficient credibility when referring those they screened to other health ser-vices57 Inappropriate or overprescribing of spectacles was identified in studies from India and Mexico2643 suggesting that the prescribing of spectacles for moderate vision impairment should be balanced with cost and willingness to pay43 Overarching factors in the provi-

sion of successful school-based eye-care interventions included communication between health services and schools the willingness of schools to schedule suffi-cient time while minimizing impact5263 and the support of principals staff and parents232829

School-based eye-care resources

An insufficient number of eye-care spe-cialists created barriers to referrals and follow-ups in China62 India222364 and Peru30 As the availability of eye-care spe-cialists can be limited in school settings particularly in low- and middle-income countries studies have investigated the use of teachers nurses certified medi-cal assistants and key informants for the provision of screening and basic eye-care for children20212951ndash5456586062 Several studies found that training teachers in vision screening enabled the provision of a good-quality515356 and costndasheffective service53 while facilitating the oppor-tunity to motivate spectacle use among students54 Two studies reported that the use of teachers as vision screeners did not create significant burdens on normal workloads and in fact enhanced rapport with children and parents5056 Evidence from Brazil27 Nepal49 and Timor-Leste21 highlighted the benefits of school-based vision screening performed by trained nurses or certified medical assistants

Studies reported that the lack of facilities2023 and tools5155 such as ap-propriate charts for vision screening was a potential barrier to implementing school-based eye-care programmes The supply of low-cost spectacles was identi-fied as increasing spectacle acceptance in China24394546 Mexico26 and Timor-Leste21 However other studies reported that spectacle acceptance may be low with free or low-cost spectacles384243 which can be linked to parental concerns of poor quality65

Health plans and policies

A key policy-based facilitator to the prioritization of child eye-care is uptake and execution of a national eye-care plan505361 and the inclusion of eye-care in school health policy2829505558 Studies assessing the feasibility of school-based eye-care interventions such as the targeting of trachoma in the United Republic of Tanzania58 vision screening in Peru30 South Africa29 and Thailand56 and the provision of free spectacles in China39 noted that success was de-

pendent on multidisciplinary support from health and education ministries The level of collaboration between ministries may either facilitate20283058 or inhibit62 the coordination and suc-cess of interventions at the school level An example from a trachoma interven-tion in Tanzanian schools outlined that while elimination of trachoma was prioritized in health policies it also needed to be incorporated into education curriculums if progress was to be made58 Since achieving shared responsibility of the monitoring and execution of policies targeting eye health is considered important in the success of school-based eye-care interventions in low- and middle-income countries partnerships between ministries and nongovernmental or private organiza-tions are considered crucial2130525662

Accessibility

Economic and physical accessibility

The cost of spectacles for children was identified as a significant barrier in many settings424566 Factors associated with a higher willingness to pay for spectacles included previous or current ownership of spectacles35 regular spectacle wear45 a recognized need for spectacles or an understanding that vision improves with spectacles3556 An additional economic factor that was reported to influence the demand of parents or guardians for eye-care services and spectacles was the loss of daily wages6466 due to a lack of a carer to accompany children to ad-ditional appointments33 Approaches to reduce programme costs were reported as sourcing instrumentation from local tertiary institutions63 and the use of costndasheffective personnel (eg school health counsellors23 or teachers54) and appropriate spectacle correction proto-cols Examples of correction protocols include only prescribing spectacles for moderate or severe refractive error3456 and the use of ready-made spectacles4047 The geographical inaccessibility of specialist eye-care services was also a barrier reported by parents3248

Information accessibility

Studies have identified misconcep-tions regarding the causes424856616466 and treatment363845486566 of eye disease and vision impairment as a significant barrier Poor literacy lack of aware-ness of eye health and misconceptions among parents were all reported as



having an impact on seeking care age of presentation and treatment choices for children285664 A prominent misun-derstanding regarding the wearing of spectacles is that they weaken or harm the eyes resulting in the reluctance of parents to obtain them3645486566

Gender inequity

Gender inequity in some countries presents barriers to school attendance among girls which can subsequently affect access to school-based eye-care A Nepalese study reported that irregu-lar school attendance among girls may affect access to eye-care49 However a programme providing outreach eye-care to schools in Timor-Leste resulted in greater gender equity among partici-pants21

Acceptability

Cultural appropriateness

The perspectives of children parents eye-care specialists teachers and the broader community all affect the success of school-based eye-care interventions Any intervention must be culturally appropriate as longstanding cultural practices can have a stronger influence than national health policy60 For in-stance a study from India identified how childrenrsquos participation in school-based eye-care programmes can be influenced by elderly family members hindering parental decision-making64 The plan-ning of school-based vision screening should also account for religious or cul-tural practices63 and understand emer-gent local beliefs For example a health promotion intervention in the United Republic of Tanzania was hindered by local beliefs that the services provided were linked to the recruitment of cult group followers through the outreach activities57

Sex

Sex-related factors associated with spectacle wear varied In India aesthetic norms that view spectacles as cosmeti-cally unappealing among girls64 were also linked to marriageability there-fore affecting uptake and utilization36 Similarly girls were more likely to refuse spectacles than boys in western China42 However studies evaluating spectacle compliance at unannounced follow-up visits found that boys were significantly less likely to be wearing spectacles (Ta-ble 2) in China4465 and South Africa35 no

differences between boys and girls were observed elsewhere however Sex also influenced the success of health promo-tion activities in the United Republic of Tanzania57 and Viet Nam59

Spectacle compliance

There were 17 studies either assessing interventions to increase spectacle pur-chase or compliance or investigating fac-tors associated with increased spectacle wear (Table 2) While an intervention designed to promote spectacle purchase was deemed ineffective in China65 one that included free spectacles was shown to increase spectacle wear in India41 Free spectacles also resulted in higher compliance compared with provision of a prescription only38 a prescription and a letter to the parents39 or when provided in conjunction with an edu-cation programme46 In observational studies following school-based eye-care programmes spectacle compliance ranged from 134 (66493) in Mexico34 to 871 (5462) in Brazil37

Due to variations in reporting it was not possible to identify which demographic factors were consistently associated with spectacle purchase and ongoing wear However girls children with higher maternal education and children with poorer visual acuity at presentation were generally more likely to be wearing spectacles at follow-up Many studies2833363741434548566466 re-ported that childrenrsquos experiences or perspectives of wearing spectacles were linked to stigma and discrimination or included verbal36374856 or physical abuse43 In Timor-Leste 181 (43237) of children surveyed believed that vision-impaired people could not attend school28 Other common reasons for not wearing prescribed spectacles included a lack of perceived need456566 fear of po-tential harm3645486566 affordability454866 and parental objections4266 Support net-works within schools including health promotion interventions284159 teacher training60 and curriculum-based eye health education2358 were key in cor-recting negative perceptions regarding spectacles or eye care

Quality

Spectacle quality and provision guidelines

Concerns about the quality of spec-tacles344365 or the inability to replace them4248 were reported as factors related to the unwillingness to purchase or wear

them Ready-made spectacles are often a costndasheffective and acceptable strategy for reducing the time of a clinicianrsquos visit and to dispense spectacles4047 and were acceptable to many children394447

As poorer visual acuity has been associated with increased spectacle ac-ceptance and compliance several studies have recommended only prescribing spectacles to children with more severe refractive error34475456 However a ran-domized controlled trial investigating the effect of various refractive cut-off protocols on compliance found no associations35 As small differences in refractive cut-offs are likely to have a significant impact on spectacle provision and programme costs further investiga-tions of spectacle prescribing guidelines are warranted

Quality of trained teachers as screeners

There are inherent benefits in using teachers to conduct initial screening as compared with visiting eye-care spe-cialists particularly in terms of costndashef-fectiveness Identified studies reported on the sensitivity (the percentage of children correctly identified with vision impairment) and specificity (the per-centage of children correctly identified as not having vision impairment) of var-ious school personnel (Table 3) While teachers have demonstrated adequate sensitivity and specificity in a variety of settings sensitivity was reduced with younger children56 and when screening cut-off thresholds were lower5455 The type of vision chart used was also sug-gested to affect teacher sensitivity and screening function55 Screening specific-ity is also critical due to the unnecessary burden placed on the limited numbers of eye-care specialists One study reported that teachers sometimes overestimate the risk and refer children who do not require visual correction20

Training can improve teacher per-formance as highlighted in examples from Peru where strategies to increase teacher engagement resulted in higher levels of teacher involvement and increased confidence in vision screen-ing3052 Elsewhere strategies used to increase teacher screening quality and engagement included involving all class teachers in the vision screen-ing programme as compared with selected teachers53 using adequate and structured training to increase knowl-edge and screening performance2958



Tabl

e 2

Sp

ecta

cle co

mpl

ianc

e an

d ac

cept

abili

ty fr

om sy

stem

atic

revi

ew o

f eye

-car

e se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySt

udy s

ampl

e an

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llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

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ase

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non-

wea

r

Rand

omiz

edn

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ando

miz

ed c

ontr

olle

d tr

ials

spe

ctac

le p

rom

otio

nCo

ngdo

n et

al

2011

65Sp

ecta

cle

prom

otio

na n

= 2

236

Co

ntro

l n

= 2

212

Anno

unce

d sin

gle

visit

6

mon

ths a

fter d

ispen

sing

spec

tacl

es

Spec

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e pr

omot

ion

162

2 (7

25)

Co

ntro

l 15

78 (7

13)

Spec

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e pr

omot

ion

pu

rcha

sed

25

7 (4

171

622)

w

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gin

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82

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424

17)

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purc

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40

(537

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wea

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in p

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537

)

Purc

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Non

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Wea

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Sign

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VA

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Non

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VA r

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Nar

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2018

41

Inte

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age

b n =

124

Co

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l n

= 1

14

Thre

e un

anno

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d sin

gle

visit

s at 1

and

4 m

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s afte

r di

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Inte

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01 (8

14)

4 m

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39)

Co

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l 1

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02 (8

95)

4

mon

ths

96 (8

42)

Inte

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wea

r at 1

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465

(4

710

1g ) w

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t 4 m

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9

(55

104g )

Cont

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r at 1

mon

th 1

76

(18

102)

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r at

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s 23

(2

296

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NR

NR

Rand

omiz

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olle

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fre

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purc

hase

d sp

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cles

Wed

ner e

t al

2008

38Fr

ee sp

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cles

n =

68

Pr

escr

iptio

n on

ly n

= 5

7 Si

ngle

visi

t 3 m

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s afte

r in

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n pr

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ed

Free

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58 (8

53)

Pr

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n on

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0 (8

77)

Free

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6 (2

758

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Sign

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Non

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Ma

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l 20

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Free

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= 5

27 F

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n n

= 6

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n =

492

Vou

cher

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= 4

96

Cont

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n =

510

Co

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l + e

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n =

526

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visi

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3 (9

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474

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61)

Co

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513

(97

5)

Free

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68

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ring

(194

527

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+ e

duca

tion

43

9

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(275

626

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r 37

6

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(185

492

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r +

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n 3

54

wea

ring

(176

496

) Co

ntro

l 25

3

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ring

(129

510

) Co

ntro

l + e

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tion

26

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earin

g (1

375

26)

Sign

ifica

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pro

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(contin

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)



Stud

ySt

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ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

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ts (

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ecta

cle co

mpl

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nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

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ease

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ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

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ase

or

non-

wea

r

Yi e

t al

2015

39Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

n =

358

Pre

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+

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nt le

tter

n =

370

U

nann

ounc

ed v

isits

at 6

wee

ks

and

6 m

onth

s

6 w

eek

follo

w-u

p

Free

spec

tacl

es +

teac

her

ince

ntiv

e 3

52 (9

83)

Pr

escr

iptio

n +

par

ent l

ette

r 36

3 (9

81)

6

mon

th fo

llow

-up

Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

341

(95

3)

Pres

crip

tion

+ p

aren

t let

ter

352

(95

1)

Free

spec

tacl

es +

teac

her i

ncen

tive

6

wee

ks w

earin

g 81

5

(287

352

) 6

mon

ths w

earin

g 6

83

(233

341

) Pr

escr

iptio

n +

par

ent l

ette

r 6

wee

ks

wea

ring

16

5 (6

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mon

ths

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ring

23

9 (8

435

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jaria

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l 20

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y-m

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232

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228

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nann

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t 3ndash

4 m

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s afte

r int

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n pr

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ed

Read

y-m

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choo

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184

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73

6 (1

311

78)

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nific

ante b

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d w

ith

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ing

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ram

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l 20

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n =

654

Si

ngle

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t at 4

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ths a

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disp

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ring

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125

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N

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ce

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sed

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erns

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166

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93)

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l 20

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n =

810

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ed si

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t at

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se

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Sing

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ided

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105

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ring

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chas

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134

210)

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200

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r res

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t

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t bas

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nt

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re g

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r

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r int

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108

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r saf

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l 20

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t 1

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fter d

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e

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ble

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nific

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t 3 m

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r di

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sing

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62 (7

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agi e

t al

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r di

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117

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ri et

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l 20

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me

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e re

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55Te

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involving ophthalmologists in training to increase motivation53 and greater emphasis on accurately measuring vi-sual acuity56 Financial incentives may encourage teachers to participate5156 and were shown to increase spectacle compliance through additional teacher motivation39

DiscussionThis systematic review revealed many factors that affect the delivery of eye-care services to children in schools The rights-based framework12 allowed us to explore the various dimensions of ser-vice delivery extending beyond physical availability to accessibility acceptability and service quality The consideration of culture discrimination and economic factors highlights the importance of social and systemic inequality and its impact on accessibility6869 Our review explored how school-based eye-care services function and connect with general health systems how stakehold-ers interact with school-based eye-care services and programmes and the possible paths to meeting population needs in a way that is equitable and responsive7071 School-based eye-care interventions (including vision screen-ings) are key to reducing morbidity and developmental delays associated with vision impairment while promoting early detection and prevention of eye diseases6772 Increasing the availability of school-based eye-care interventions in low- and middle-income countries can help to address the burden on poorly resourced secondary and tertiary eye-care7374 and enhance access for under-served rural children2130

Effective coordination between education and health systems is essential for appropriate referral pathways and

follow-up mechanisms22333452 At the policy level this requires cooperation be-tween the ministries of health and edu-cation and a national eye-care plan that includes school-based eye-care525658 Without a policy-based foundation programmes to provide high-quality and costndasheffective school-based eye-care including training teachers29505258 and school nurses21 in vision screening will face challenges in acquiring resources and achieving sustainable outcomes

Recent standard guidelines for comprehensive school-based eye-care programmes state that vision screening should use only one row of optotypes at the 69 visual acuity level67 Standardized assessment and equipment (using a tum-bling E chart) would reduce the current inconsistency in referral standards and allow improved monitoring of qual-ity and compliance We also identified teacher training strategies that could be applied to increase teacher engagement and the quality of screening

Because economic considerations are important in low- and middle-income countries the provision of low-cost or free spectacles can improve access However the costndasheffectiveness of screening and prescribed spectacles must be carefully considered to ensure sustainability Our review identified the need to improve perceptions and awareness of eye-care services and treat-ments (particularly spectacles) among parents and children we suggest health promotions that aim to (i) reduce mis-conceptions and stigma among parents children and the broader community and (ii) engage potential school-based eye-care providers such as teachers school nurses and community health workers A rights-based approach focus-ing on the link between good vision and childhood educational development is

recommended while also considering cultural factors

Our systematic review was executed according to recommended guidelines13 The literature consisted of a broad range of qualitative and quantitative studies and our use of the rights-based concep-tual framework12 enabled us to analyze the data in a well structured manner However data extraction and coding was only performed by a single reviewer due to time and resource constraints which may have resulted in the omission of some data

In conclusion providing school-based eye-care interventions is chal-lenging and reliant on economical sociocultural geographical and policy-based factors With these determinants considered school-based eye-care inter-ventions have great potential to reduce the morbidity and developmental delays caused by childhood vision impairment and blindness Teachers and nurses are well placed to provide school vision screenings particularly where there is a lack of eye-care specialists Policy-based support with a focus on health systems rather than a focus on a single disease is crucial for school-based eye-care in-terventions to be sustainable

AcknowledgementsWe thank Alison Poffley AB AY LL and KN are also affiliated to the School of Optometry and Vision Science Uni-versity of New South Wales Sydney Australia KN is also affiliated to the School of Health Sciences University of KwaZulu-Natal Durban South Africa

Funding The World Bank Group and the Global Partnership for Education (GPE) provided financial support

Competing interests None declared

ملخصالتدخالت لتحسني خدمات العناية بالعيون يف املدارس يف البلدان منخفضة ومتوسطة الدخل مراجعة منهجية

العناية خدمات لتحسني اهلادفة التدخالت مراجعة الغرض بالعيون ألطفال املدارس يف البلدان منخفضة ومتوسطة الدخل

CINAHL) الطريقة لقد بحثنا يف قواعد البيانات عىل اإلنرتنتو ProQuestو regMEDLINEو ERICو regEmbaseواملنشورة املقاالت عن (Web of ScienceTMو regPubMedبتقييم املؤهلة الدراسات قامت 2018 ومايو 2000 يناير بني تقارير وأعدت املدارس يف بالعيون العناية برامج تنفيذ كيفية أو الفحص جودة أو االمتثال معدالت حيث من النتائج عن فيها يرد مل إذا مؤهلة غري الدراسات واعتربنا املوقف تغريات

العناوين بفحص املؤلفني من اثنان قام املتابعة لبيانات ذكر أي باستخالص وقمنا للمقاالت الكاملة والنصوص وامللخصات البيانات من النصوص الكاملة للمقاالت املؤهلة وذلك باستخدام عليها االطالع وإمكانية البيانات هذه توافر ملفاهيم عمل إطار

وحقوق اجلودة 13 من مقالة 48 كانت مطبوعة 559 24 إمجايل من النتائج املتبعة يف العوامل التي تفي بمعايري االشتامل وشملت بلدا هي التوفري الناجح لتدخالت العناية بالعيون يف املدارس االتصال بني جلدولة املدارس واستعداد واملدارس الصحية اخلدمات مقدمي



摘要改善中低收入国家学校眼部护理服务的干预措施系统综述目的综述改善中低收入国家学校学生眼部护理服务的干预措施方法我们在线上数据库（CINAHLEmbaseregERICMEDLINEregProQuestPubMedreg 和 Web of Science trade ）中搜索了自 2000 年 1 月至 2018 年 5 月之间发表的文章符合入选标准的研究评估了学校开展的眼部护理课程从依从率筛查质量或态度改变几个方面报告结果如果没有上报后续数据我们就认为研究不符合入选标准两个作者筛选出标题摘要和全文然后我们利用基于可用性可得性可接受性和质量权利的概念框架从符合入选标准的全文中提取数据结果从 24559 个出版物中筛选出满足入选标准的来自 13 个国家的 48 篇文章学校成功提供眼部护理干

预措施所涉及的因素包括卫生服务与学校之间的沟通学校安排充足时间的意愿以及校长学校工作人员和父母的支持有几项研究发现在眼部护理专家人手不够时视力筛查的培训老师能够提供高质量且经济有效的服务除了眼镜的费用阻碍寻求眼部护理的因素还包括父母读写能力差误解和缺乏眼部健康知识结论学校提供眼部护理课程对减少眼部发病率和缓解由童年视力损伤和失明导致的发育迟滞现象有巨大的潜在作用在试图减少孩子和父母对此误解和污名化的同时政策支持对继续获取服务至关重要

Reacutesumeacute

Interventions visant agrave ameacuteliorer les services dophtalmologie en milieu scolaire dans les pays agrave revenu faible et intermeacutediaire une revue systeacutematiqueObjectif Examiner les interventions permettant drsquoameacuteliorer les services dophtalmologie pour les enfants scolariseacutes dans les pays agrave revenu faible et intermeacutediaireMeacutethodes Nous avons rechercheacute dans des bases de donneacutees en ligne (CINAHL Embasereg ERIC MEDLINEreg ProQuest PubMedreg et Web of ScienceTM) des articles publieacutes entre janvier 2000 et mai 2018 Les eacutetudes admissibles eacutevaluaient la mise en œuvre de programmes dophtalmologie en milieu scolaire et en preacutesentaient les reacutesultats en termes de taux de suivi des recommandations de qualiteacute du deacutepistage ou de changements dattitude Nous avons consideacutereacute comme non admissibles les eacutetudes qui ne comportaient pas de donneacutees de suivi Deux auteurs ont parcouru des titres des reacutesumeacutes et des articles inteacutegraux et nous avons extrait des donneacutees des articles inteacutegraux admissibles selon le cadre conceptuel de disponibiliteacute daccessibiliteacute dacceptabiliteacute et de qualiteacute fondeacute sur les droitsReacutesultats Sur les 24 559 publications examineacutees 48 articles provenant de 13 pays remplissaient les critegraveres dinclusion Les facteurs entrant en jeu dans la reacuteussite des interventions dophtalmologie en milieu

scolaire eacutetaient la communication entre les services de santeacute et les eacutetablissements scolaires la volonteacute de ces derniers dy accorder suffisamment de temps et le soutien des chefs deacutetablissement du personnel et des parents Plusieurs eacutetudes ont reacuteveacuteleacute que lorsque le nombre de speacutecialistes en ophtalmologie est insuffisant former les enseignants au deacutepistage des troubles visuels permet doffrir un service eacuteconomique et de bonne qualiteacute Outre le coucirct des lunettes un faible taux dalphabeacutetisation des ideacutees fausses et un manque de connaissances des parents en matiegravere de santeacute oculaire freinaient le recours aux soins dophtalmologieConclusion La mise en œuvre de programmes dophtalmologie en milieu scolaire peut permettre de reacuteduire sensiblement la morbiditeacute oculaire et les retards de deacuteveloppement dus agrave des deacuteficiences visuelles et agrave la ceacuteciteacute chez les enfants Il est crucial de beacuteneacuteficier dun soutien politique tout en tentant de combattre les ideacutees fausses et la stigmatisation chez les enfants et leurs parents pour maintenir laccegraves agrave ces services

Резюме

Меры по повышению качества оказания офтальмологической помощи на базе школ в странах с низким и средним уровнем дохода систематический обзорЦель Провести обзор мер направленных на повышение качества оказания медицинской помощи школьникам в странах с низким и средним уровнем доходаМетоды Авторы выполнили поиск в онлайн-базах данных (CINAHL Embasereg ERIC MEDLINEreg ProQuest PubMedreg и Web of ScienceTM)

по статьям опубликованным в период с января 2000 года по май 2018 года В удовлетворяющих критериям отбора исследованиях проводилась оценка реализации программ офтальмологической помощи на базе школ результатов отчетности с точки зрения степени приверженности качества скрининга или изменения

وأولياء العمل وفرق املدراء ودعم الغرض هلذا كاف وقت كفاية عدم حالة يف أنه الدراسات من العديد اكتشفت األمور فحص عىل املعلمني تدريب فإن بالعيون العناية أخصائيي عدد الرؤية يمكنه توفري خدمة جيدة النوعية وفعالة من حيث التكلفة وباإلضافة إىل تكلفة النظارات فإن عوائق العناية بالعيون شملت بني العيون بصحة املعرفة ونقص اخلاطئة واملفاهيم األمية شبه

اآلباء واألمهات

االستنتاج يمنح تقديم برامج العناية بالعيون يف املدرسة إمكانيات كبرية للحد من حدوث أمراض العيون والتأخر يف النمو الناجم الدعم حياول بينام األطفال لدى والعمى البرص ضعف عن العار ووصمة اخلاطئة املفاهيم من احلد السياسات عىل القائم الستمرار حاسم أمر أيضا أنه إال أمورهم وأولياء األطفال بني

احلصول عىل اخلدمة



отношения Мы исключили исследования в которых не сообщалось о проведении последующего наблюдения Два автора тщательно проверили заголовки выдержки и полнотекстовые статьи и из подходящих полнотекстовых статей мы извлекли данные пользуясь рамочными критериями приемлемости доступности и качестваРезультаты Из 24 559 публикаций критериям включения соответствовали 48 статей из 13 стран Факторы связанные с успешным проведением офтальмологических вмешательств на базе школ включали обмен информацией между службами здравоохранения и школами готовность школ выделить на это достаточное время а также поддержку руководства персонала и родителей В нескольких исследованиях было установлено что при нехватке специалистов-офтальмологов обучение

учителей проведению проверки зрения позволяет обеспечить качественное и экономически эффективное обслуживание Помимо стоимости очков препятствия для обращения к офтальмологу включали низкий уровень грамотности неверные представления и отсутствие знаний о здоровье глаз у родителейВывод Предоставление школьных программ офтальмологической помощи имеет большой потенциал для сокращения заболеваемости органов зрения и частоты случаев задержки в развитии вызванной нарушением зрения и слепотой у детей Поддержка на основе политики а также усилия по преодолению неверных представлений и социального отторжения среди детей и их родителей имеют решающее значение для постоянного доступа к медицинской помощи

Resumen

Intervenciones para mejorar los servicios de atencioacuten oftalmoloacutegica en escuelas de paiacuteses con ingresos entre bajos y medios una revisioacuten sistemaacuteticaObjetivo Revisar las intervenciones para mejorar los servicios de atencioacuten oftalmoloacutegica para los nintildeos en edad escolar en paiacuteses con ingresos entre bajos y mediosMeacutetodos Se realizaron buacutesquedas en bases de datos en liacutenea (CINAHL Embasereg ERIC MEDLINEreg ProQuest PubMedreg y Web of ScienceTM) para encontrar artiacuteculos publicados entre enero de 2000 y mayo de 2018 Los estudios admisibles evaluaron la ejecucioacuten de los programas de atencioacuten oftalmoloacutegica en las escuelas e informaron de los resultados en cuanto a las tasas de cumplimiento la calidad de los exaacutemenes de evaluacioacuten o los cambios de actitud Se consideroacute que los estudios no eran admisibles si no incluiacutean datos de seguimiento Dos autores seleccionaron los tiacutetulos los resuacutemenes y los artiacuteculos de texto completo y se extrajeron los datos de los artiacuteculos admisibles mediante el marco conceptual basado en derechos de disponibilidad accesibilidad aceptabilidad y calidadResultados De las 24 559 publicaciones examinadas 48 artiacuteculos de 13 paiacuteses cumplieron los criterios de inclusioacuten Los factores que intervienen en el eacutexito de las intervenciones de atencioacuten oftalmoloacutegica

en las escuelas incluyen la comunicacioacuten entre los servicios de salud y las escuelas la disposicioacuten de las escuelas a programar el tiempo suficiente y el apoyo de los directores el personal y los padres Varios estudios descubrieron que cuando el nuacutemero de especialistas en atencioacuten oftalmoloacutegica es insuficiente la formacioacuten de los profesores en la evaluacioacuten de la visioacuten permite la prestacioacuten de un servicio de buena calidad y rentable Ademaacutes del coste de las gafas las dificultades para obtener atencioacuten oftalmoloacutegica incluyen la alfabetizacioacuten deficiente los conceptos erroacuteneos y la falta de conocimientos sobre la salud ocular entre los padresConclusioacuten La provisioacuten de programas de atencioacuten oftalmoloacutegica en las escuelas tiene un gran potencial para reducir la morbilidad ocular y los retrasos en el desarrollo causados por el deterioro de la visioacuten y la ceguera infantiles Para mantener el acceso es fundamental contar con apoyo basado en poliacuteticas al tiempo que se intentan reducir los conceptos erroacuteneos y el estigma entre los nintildeos y sus padres

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3 Sommer A Tarwotjo I Hussaini G Susanto D Increased mortality in children with mild vitamin A deficiency Lancet 1983 Sep 10322(8350)585ndash8 doi httpdxdoiorg101016S0140-6736(83)90677-3 PMID 6136744

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11 Frick KD Riva-Clement L Shankar MB Screening for refractive error and fitting with spectacles in rural and urban India cost-effectiveness Ophthalmic Epidemiol 2009 Nov-Dec16(6)378ndash87 doi httpdxdoiorg10310909286580903312277 PMID 19995203

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16 Hong QN Gonzalez-Reyes A Pluye P Improving the usefulness of a tool for appraising the quality of qualitative quantitative and mixed methods studies the Mixed Methods Appraisal Tool (MMAT) J Eval Clin Pract 2018 0624(3)459ndash67 doi httpdxdoiorg101111jep12884 PMID 29464873

17 Pope C Ziebland S Mays N Qualitative research in health care Analysing qualitative data BMJ 2000 Jan 8320(7227)114ndash6 doi httpdxdoiorg101136bmj3207227114 PMID 10625273

18 Glaser BG Strauss AL The discovery of grounded theory strategies for qualitative research Abingdon Routledge 2017

19 de Melo KM Pessoa AT Rebouccedilas CB de A Silva MG da Almeida PC de Pagliuca LMF Blog for schoolchildren about people with disabilities evaluation of learning Rev Rene 2017 Mar-Apr18(2)187ndash94 Available from httpwwwperiodicosufcbrrenearticleview1924529962 [cited 2018 Jul 17]

20 Carvalho R de S Temporini ER Kara-Joseacute N Assessment of visual health campaign activities at schools teachersrsquo perception Arq Bras Oftalmol 2007 Mar-Apr70(2)239ndash45 doi httpdxdoiorg101590S0004-27492007000200011 PMID 17589694

21 Pereira SM Blignault I du Toit R Ramke J Improving access to eye health services in rural Timor-Leste Rural Remote Health 2012122095 PMID 22994876

22 Puri S Dang RS Akshay Singh A Sood S Vishal et al Evaluation of QOS (quality of services) by log frame analysis (LFA) and ocular morbidity in school children of Chandigarh Int J Pharm Pharm Sci 2014655ndash8

23 Rajaraman D Travasso S Chatterjee A Bhat B Andrew G Parab S et al The acceptability feasibility and impact of a lay health counsellor delivered health promoting schools programme in India a case study evaluation BMC Health Serv Res 2012 05 2512(1) PG-127127 doi httpdxdoiorg1011861472-6963-12-127 PMID 22630607

24 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 Dec133(12)1399ndash406 doi httpdxdoiorg101001jamaophthalmol20153513 PMID 26426113

25 Zhou Z Kecman M Chen T Liu T Jin L Chen S et al Spectacle design preferences among Chinese primary and secondary students and their parents a qualitative and quantitative study PLoS One 2014 03 39(3)e88857 doi httpdxdoiorg101371journalpone0088857 PMID 24594799

26 Esteso P Castanon A Toledo S Rito MAP Ervin A Wojciechowski R et al Correction of moderate myopia is associated with improvement in self-reported visual functioning among Mexican school-aged children Invest Ophthalmol Vis Sci 2007 Nov48(11)4949ndash54 doi httpdxdoiorg101167iovs07-0052 PMID 17962444

27 Fontenele RM Sousa AI de Faacutetima Almeida Lima E Characterization nurses working for the students eye health J Nurs UFPE 20159565ndash72 Available from wwwrepositoriosufpebrrevistasrevistaenfermagemarticledownload1037311111 [cited 2018 Jul 10]

28 Hobday K Ramke J Du Toit R Pereira SM Healthy eyes in schools an evaluation of a school and community-based intervention to promote eye health in rural Timor-Leste Health Educ J 201574(4)392ndash402 doi httpdxdoiorg1011770017896914540896

29 Juggernath YM Knight SE Knowledge and practices of visual acuity screening by primary school educators Afr Vis Eye Health 201574(1)a309 doi httpdxdoiorg104102avehv74i1309

30 Latorre-Arteaga S Gil-Gonzaacutelez D Bascaraacuten C Nuacutentildeez RH Morales MD Orihuela GC Visual health screening by schoolteachers in remote communities of Peru implementation research Bull World Health Organ 2016 Sep 194(9)652ndash9 doi httpdxdoiorg102471BLT15163634 PMID 27708470

31 Ma X Congdon N Yi H Zhou Z Pang X Meltzer ME et al Safety of spectacles for childrenrsquos vision a cluster-randomized controlled trial Am J Ophthalmol 2015 Nov160(5)897ndash904 doi httpdxdoiorg101016jajo201508013 PMID 26284747

32 Noma R Carvalho R de S Kara-Joseacute N Why are there defaulters in eye health projects Clinics (Sao Paulo) 201166(9)1585ndash9 PMID 22179164

33 Noma R Carvalho R de S Kara-Joseacute N Validity of recall absent schoolchildren to free eye health projects Arq Bras Oftalmol 2012 Jan-Feb75(1)16ndash9 doi httpdxdoiorg101590S0004-27492012000100003 PMID 22552411

34 Castanon Holguin AM Congdon N Patel N Ratcliffe A Esteso P Flores ST et al Factors associated with spectacle-wear compliance in school-aged Mexican children Invest Ophthalmol Vis Sci 2006 Mar47(3)925ndash8 doi httpdxdoiorg101167iovs05-0895 PMID 16505025

35 Congdon NG Patel N Esteso P Chikwembani F Webber F Msithini RB et al The association between refractive cutoffs for spectacle provision and visual improvement among school-aged children in South Africa Br J Ophthalmol 2008 Jan92(1)13ndash8 doi httpdxdoiorg101136bjo2007122028 PMID 17591673

36 Rustagi N Uppal Y Taneja DK Screening for visual impairment outcome among schoolchildren in a rural area of Delhi Indian J Ophthalmol 2012 May-Jun60(3)203ndash6 doi httpdxdoiorg1041030301-473895872 PMID 22569381

37 Santos MJ Alves MR Netto AL Santos RR Fioravanti Lui GA Fioravanti Lui TA et al [Acceptance of initial spectacle prescription for children in their first-year at primary school] Rev Bras Oftalmol 201170(3)157ndash61 [Portuguese] doi httpdxdoiorg101590S0034-72802011000300005

38 Wedner S Masanja H Bowman R Todd J Bowman R Gilbert C Two strategies for correcting refractive errors in school students in Tanzania randomised comparison with implications for screening programmes Br J Ophthalmol 2008 Jan92(1)19ndash24 doi httpdxdoiorg101136bjo2007119198 PMID 18156372

39 Yi H Zhang H Ma X Zhang L Wang X Jin L et al Impact of free glasses and a teacher incentive on childrenrsquos use of eyeglasses A cluster-randomized controlled trial Am J Ophthalmol 2015 Nov160(5)889ndash896e1 doi httpdxdoiorg101016jajo201508006 PMID 26275472

40 Zeng Y Keay L He M Mai J Munoz B Brady C et al A randomized clinical trial evaluating ready-made and custom spectacles delivered via a school-based screening program in China Ophthalmology 2009 Oct116(10)1839ndash45 doi httpdxdoiorg101016jophtha200904004 PMID 19592103

41 Narayanan A Ramani KK Effectiveness of interventions in improving compliance to spectacle wear and referral in school vision screening Clin Exp Optom 2018 May 16 doi httpdxdoiorg101111cxo12797 PMID 29770493

42 Glewwe P Park A Zhao M A better vision for development eyeglasses and academic performance in rural primary schools in China J Dev Econ 2016122170ndash82 doi httpdxdoiorg101016jjdeveco201605007

43 Gogate P Mukhopadhyaya D Mahadik A Naduvilath TJ Sane S Shinde A et al Spectacle compliance amongst rural secondary school children in Pune district India Indian J Ophthalmol 2013 Jan-Feb61(1)8ndash12 doi httpdxdoiorg1041030301-473899996 PMID 23275214

44 Keay L Zeng Y Munoz B He M Friedman DS Predictors of early acceptance of free spectacles provided to junior high school students in China Arch Ophthalmol 2010 Oct128(10)1328ndash34 doi httpdxdoiorg101001archophthalmol2010215 PMID 20938003

45 Li L Song Y Liu X Lu B Choi K Lam DSC et al Spectacle acceptance among secondary school students in rural China the Xichang pediatric refractive error study (X-PRES)ndashreport 5 Invest Ophthalmol Vis Sci 2008 Jul49(7)2895ndash902 doi httpdxdoiorg101167iovs07-1531 PMID 18223245

46 Ma X Zhou Z Yi H Pang X Shi Y Chen Q et al Effect of providing free glasses on childrenrsquos educational outcomes in China cluster randomized controlled trial BMJ 2014 09 23349g5740 doi httpdxdoiorg101136bmjg5740 PMID 25249453

47 Morjaria P Evans J Murali K Gilbert C Spectacle wear among children in a school-based program for ready-made vs custom-made spectacles in India a randomized clinical trial JAMA Ophthalmol 2017 Jun 1135(6)527ndash33 doi httpdxdoiorg101001jamaophthalmol20170641 PMID 28426857

48 Odedra N Wedner SH Shigongo ZS Nyalali K Gilbert C Barriers to spectacle use in Tanzanian secondary school students Ophthalmic Epidemiol 2008 Nov-Dec15(6)410ndash7 doi httpdxdoiorg10108009286580802399094 PMID 19065434

49 Adhikari S Shrestha U Validation of performance of certified medical assistants in preschool vision screening examination Nepal J Ophthalmol 2011 Jul-Dec3(2)128ndash33 doi httpdxdoiorg103126nepjophv3i25264 PMID 21876585

50 Kaur G Koshy J Thomas S Kapoor H Zachariah JG Bedi S Vision screening of school children by teachers as a community based strategy to address the challenges of childhood blindness J Clin Diagn Res 2016 Apr10(4)NC09ndash14 PMID 27190849

51 Khandekar R Parast N Arabi A Evaluation of lsquovision screeningrsquo program for three to six-year-old children in the Republic of Iran Indian J Ophthalmol 2009 Nov-Dec57(6)437ndash42 doi httpdxdoiorg1041030301-473857151 PMID 19861745



52 Latorre-Arteaga S Gil-Gonzaacutelez D Enciso O Phelan A Garciacutea-Muntildeoz A Kohler J Reducing visual deficits caused by refractive errors in school and preschool children results of a pilot school program in the Andean region of Apurimac Peru Glob Health Action 2014 02 137(1)22656 doi httpdxdoiorg103402ghav722656 PMID 24560253

53 Priya A Veena K Thulasiraj R Fredrick M Venkatesh R Sengupta S et al Vision screening by teachers in southern Indian schools testing a new ldquoall class teacherrdquo model Ophthalmic Epidemiol 2015 Feb22(1)60ndash5 doi httpdxdoiorg103109092865862014988877 PMID 25495755

54 Saxena R Vashist P Tandon R Pandey RM Bhardawaj A Menon V Accuracy of visual assessment by school teachers in school eye screening program in delhi Indian J Community Med 2015 Jan-Mar40(1)38ndash42 doi httpdxdoiorg1041030970-0218149269 PMID 25657511

55 Tabansi PN Anochie IC Nkanginieme KE Pedro-Egbe CN Evaluation of teachersrsquo performance of vision screening in primary school children in Port Harcourt Niger J Ophthalmol 200917(1)27ndash31 doi httpdxdoiorg104314njov17i146759

56 Teerawattananon K Myint CY Wongkittirux K Teerawattananon Y Chinkulkitnivat B Orprayoon S et al Assessing the accuracy and feasibility of a refractive error screening program conducted by school teachers in pre-primary and primary schools in Thailand PLoS One 2014 06 139(6)e96684 doi httpdxdoiorg101371journalpone0096684 PMID 24926993

57 Chan VF Minto H Mashayo E Naidoo KS Improving eye health using a child-to-child approach in Bariadi Tanzania Afr Vis Eye Health 2017 Jan 3076(1)6 doi httpdxdoiorg104102avehv76i1406

58 Lewallen S Massae P Tharaney M Somba M Geneau R Macarthur C et al Evaluating a school-based trachoma curriculum in Tanzania Health Educ Res 2008 Dec23(6)1068ndash73 doi httpdxdoiorg101093hercym097 PMID 18209114

59 Paudel P Yen PT Kovai V Naduvilath T Ho SM Giap NV et al Effect of school eye health promotion on childrenrsquos eye health literacy in Vietnam Health Promot Int 2017 Oct 6 doi httpdxdoiorg101093heaprodax065 PMID 29040581

60 Thummalapalli R Williams JD Khoshnood K Salchow DJ Forster SH Effect of education sessions of a structured school eye screening programme on Indian schoolteachersrsquo knowledge and responsibility for childrenrsquos eye health Health Educ J 201372(4)375ndash85 doi httpdxdoiorg1011770017896912446550

61 Rewri P Kakkar M Raghav D Self-vision testing and intervention seeking behavior among school children a pilot study Ophthalmic Epidemiol 2013 Oct20(5)315ndash20 doi httpdxdoiorg103109092865862013823506 PMID 24070103

62 Bai Y Yi H Zhang L Shi Y Ma X Congdon N et al An investigation of vision problems and the vision care system in rural China Southeast Asian J Trop Med Public Health 2014 Nov45(6)1464ndash73 PMID 26466433

63 Anuradha N Ramani K Role of optometry school in single day large scale school vision testing Oman J Ophthalmol 2015 Jan-Apr8(1)28ndash32 doi httpdxdoiorg1041030974-620X149861 PMID 25709271

64 Balasubramaniam SM Kumar DS Kumaran SE Ramani KK Factors affecting eye care-seeking behavior of parents for their children Optom Vis Sci 2013 Oct90(10)1138ndash42 doi httpdxdoiorg101097OPX0000000000000010 PMID 24037060

65 Congdon N Li L Zhang M Yang A Gao Y Griffiths S et al Randomized controlled trial of an educational intervention to promote spectacle use in rural China the see well to learn well study Ophthalmology 2011 Dec118(12)2343ndash50 doi httpdxdoiorg101016jophtha201106016 PMID 21889800

66 Ebeigbe JA Factors influencing eye-care seeking behaviour of parents for their children in Nigeria Clin Exp Optom 2018 Jul101(4)560ndash4 PMID 27990681

67 Gilbert C Minto H Morjaria P Khan I Standard guidelines for comprehensive school eye health programs Sightsavers International London London School of Hygiene and Tropical Medicine Brien Holden Vision Institute 2016

68 Marmot M Friel S Bell R Houweling TAJ Taylor S Commission on Social Determinants of Health Closing the gap in a generation health equity through action on the social determinants of health Lancet 2008 Nov 8372(9650)1661ndash9 doi httpdxdoiorg101016S0140-6736(08)61690-6 PMID 18994664

69 Closing the gap in a generation health equity through action on the social determinants of health Commission on Social Determinants of Health Final Report Geneva World Health Organization 2008 p 33

70 Blanchet K Gilbert C de Savigny D Rethinking eye health systems to achieve universal coverage the role of research Br J Ophthalmol 2014 Oct98(10)1325ndash8 doi httpdxdoiorg101136bjophthalmol-2013-303905 PMID 24990874

71 Blanchet K Gilbert C Lindfield R Crook S Eye health systems assessment (EHSA) How to connect eye care with the general health system London London School of Hygiene Tropical Medicine 2012

72 Gilbert C Muhit M Eye conditions and blindness in children priorities for research programs and policy with a focus on childhood cataract Indian J Ophthalmol 2012 Sep-Oct60(5)451ndash5 doi httpdxdoiorg1041030301-4738100548 PMID 22944758

73 Resnikoff S Felch W Gauthier T-M Spivey B The number of ophthalmologists in practice and training worldwide a growing gap despite more than 200000 practitioners Br J Ophthalmol 2012 Jun96(6)783ndash7 doi httpdxdoiorg101136bjophthalmol-2011-301378 PMID 22452836

74 Palmer JJ Chinanayi F Gilbert A Pillay D Fox S Jaggernath J et al Mapping human resources for eye health in 21 countries of sub-Saharan Africa current progress towards VISION 2020 Hum Resour Health 2014 08 1512(1)44 doi httpdxdoiorg1011861478-4491-12-44 PMID 25128163

Bull World Health Organ 201896682ndash694D| doi httpdxdoiorg102471BLT18212332 694A


Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

ic re

view

of i

nter

vent

ions

to im

prov

e ey

e-ca

re se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

Hol

gui e

t al

2006

34M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

493

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

5ndash1

8 ye

ars

Asse

ss sp

ecta

cle

com

plia

nce

Low

Carv

alho

et a

l 20

0720

Braz

ilCr

oss-

sect

iona

l (p

rosp

ectiv

e)15

17 e

lem

enta

ry sc

hool

teac

hers

or p

rinci

pals

Asse

ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

Low

Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n (m

ean

age

12 y

ears

)As

sess

the

impa

ct o

f spe

ctac

les o

n se

lf-re

port

ed v

ision

hea

lthM

ediu

m

Cong

don

et a

l 20

0835

Sout

h Af

rica

Pros

pect

ive

obse

rvat

iona

l85

20 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n ag

ed 6

ndash19

year

sEv

alua

te re

fract

ive

erro

r cut

-offs

for

spec

tacl

e pr

ovisi

on to

mor

e eff

ectiv

ely

iden

tify

child

ren

with

impr

oved

visi

on

and

incr

ease

com

plia

nce

Low

Lew

alle

n et

al

2008

58U

nite

d Re

publ

ic o

f Tan

zani

aM

ixed

met

hods

20 sc

hool

s (10

inte

rven

tion

10

cont

rol)

139

6 sc

hool

child

ren

(gra

des 3

and

4)

Eval

uate

trac

hom

a ed

ucat

ion

outc

omes

in

clud

ing

know

ledg

e an

d hy

gien

e pr

actic

es

Hig

h

Li e

t al

2008

45Ch

ina

Pros

pect

ive

coho

rt18

92 se

cond

ary

scho

olch

ildre

n ag

ed 1

3ndash16

yea

rsAs

sess

the

dete

rmin

ants

of s

pect

acle

co

mpl

ianc

eM

ediu

m

Ode

dra

et a

l 20

0848

Uni

ted

Repu

blic

of T

anza

nia

Mix

ed m

etho

ds10

8 se

cond

ary

scho

ol st

uden

ts (a

vera

ge a

ge

15 y

ears

) 58

inte

rven

tion

grou

p 5

0 co

ntro

l gr

oup

Asse

ss re

ason

s for

poo

r com

plia

nce

follo

win

g in

-sch

ool p

rovi

sion

of

spec

tacl

es

Med

ium

Wed

ner e

t al

2008

38U

nite

d Re

publ

ic o

f Tan

zani

aRa

ndom

ized

cont

rolle

d tri

al12

5 se

cond

ary

scho

olch

ildre

n ag

ed 1

1ndash19

yea

rsAs

sess

com

plia

nce

of fr

ee sp

ecta

cles

Hig

h

Khan

deka

r et a

l 20

0951

Islam

ic R

epub

lic o

f Ira

nM

ixed

met

hods

15 p

aren

ts a

nd 1

5 te

ache

rsEv

alua

te sc

hool

visi

on sc

reen

ing

in

kind

erga

rten

inc

ludi

ng c

ost a

nd v

alid

ity

of te

ache

r use

Med

ium

Taba

nsi e

t al

2009

55N

iger

iaCr

oss-

sect

iona

l (p

rosp

ectiv

e)13

0 te

ache

rs 1

300

prim

ary

scho

olch

ildre

n ag

ed 6

ndash11

year

sAs

sess

acc

urac

y of

teac

her s

cree

ning

s co

mpa

red

with

rese

arch

team

doc

tors

Hig

h

Zeng

et a

l 20

0940

Chin

aRa

ndom

ized

cont

rolle

d tri

al74

3 se

cond

ary

scho

olch

ildre

n ag

ed 1

2ndash15

yea

rsEv

alua

te c

hild

renrsquo

s visi

on a

nd

satis

fact

ion

with

read

y-m

ade

spec

tacl

esM

ediu

m

Keay

et a

l 20

1044

Chin

aPr

ospe

ctiv

e ob

serv

atio

nal

428

seco

ndar

y sc

hool

child

ren

aged

12ndash

15 y

ears

Det

erm

ine

wha

t infl

uenc

es re

ady-

mad

e an

d cu

stom

-mad

e sp

ecta

cle

com

plia

nce

Hig

h

Adhi

kari

amp Sh

rest

ha 2

01149

Nep

alCr

oss-

sect

iona

l (p

rosp

ectiv

e)20

cer

tified

med

ical

ass

istan

tsAs

sess

relia

bilit

y of

cer

tified

med

ical

as

sista

nts i

n sc

hool

-bas

ed v

ision

sc

reen

ing

com

pare

d w

ith p

aedi

atric

op

htha

lmol

ogist

s

Med

ium

Cong

don

et a

l 20

1165

Chin

aRa

ndom

ized

cont

rolle

d tri

al11

423

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

12ndash

17 y

ears

Effec

tiven

ess o

f an

educ

atio

nal

inte

rven

tion

to p

rom

ote

spec

tacl

e pu

rcha

se

Low

Nom

a et

al

2011

32Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

767

pare

nts

Det

erm

ine

reas

ons f

or n

on-a

dher

ence

to

oph

thal

mic

exa

min

atio

ns fo

llow

ing

scho

ol sc

reen

ing

Low

(contin

ues

)

Bull World Health Organ 201896682ndash694D| doi httpdxdoiorg102471BLT18212332694B


Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Sant

os e

t al

2011

37Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

62 p

rimar

y sc

hool

child

ren

aged

6ndash1

1 ye

ars

with

refra

ctiv

e er

ror

Asse

ss c

ompl

ianc

e of

chi

ldre

n to

thei

r fir

st p

air o

f gla

sses

Low

Nom

a et

al

2012

33Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

14 6

51 p

rimar

y sc

hool

child

ren

aged

7ndash1

0 ye

ars

Det

erm

ine

reas

ons f

or n

on-a

dher

ence

to

oph

thal

mic

exa

min

atio

ns fo

llow

ing

scho

ol sc

reen

ing

Hig

h

Pere

ira e

t al

2012

21Ti

mor

-Les

teCr

oss-

sect

iona

l (p

rosp

ectiv

e)21

scho

ol h

ealth

nur

ses

1819

chi

ldre

n sc

reen

edEv

alua

te e

ffica

cy o

f eye

hea

lth o

utre

ach

serv

ices

Med

ium

Raja

ram

an e

t al

2012

23In

dia

Mix

ed m

etho

ds52

chi

ldre

n ag

ed 9

ndash17

year

s 35

scho

ol st

aff

13 sc

hool

hea

lth c

ouns

ello

rs 4

par

ents

and

3

clin

icia

ns

Eval

uate

the

effec

tiven

ess o

f del

iver

y of

sc

hool

hea

lth p

rom

otio

n by

lay

scho

ol

heal

th c

ouns

ello

rs

Hig

h

Rust

agi e

t al

2012

36In

dia

Mix

ed m

etho

ds51

seco

ndar

y sc

hool

child

ren

aged

11ndash

18 y

ears

sa

mpl

ed fo

r ref

ract

ion

out

of 1

075

scre

ened

Asse

ss th

e m

agni

tude

of v

ision

im

pairm

ent a

mon

g ch

ildre

n an

d th

eir

spec

tacl

e co

mpl

ianc

e

Med

ium

Bala

subr

aman

iam

et a

l 20

1364

Indi

aQ

ualit

ativ

e35

par

ents

with

scho

ol-a

ged

child

ren

and

16

eye-

care

spec

ialis

tsEff

ectiv

enes

s of s

choo

l visi

on sc

reen

ing

Med

ium

Gog

ate

et a

l 20

1343

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

e)10

18 se

cond

ary

scho

olch

ildre

n ag

ed

8ndash16

yea

rsAs

sess

spec

tacl

e co

mpl

ianc

e am

ong

rura

l chi

ldre

nH

igh

Rew

ri et

al

2013

61In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

7411

seco

ndar

y sc

hool

child

ren

aged

11ndash

19 y

ears

Eval

uate

stud

ents

rsquo abi

lity

to se

lf-ex

amin

e th

eir v

ision

and

seek

inte

rven

tion

such

as

spec

tacl

es

Hig

h

Thum

mal

apal

li et

al

2013

60In

dia

Pros

pect

ive

obse

rvat

iona

l10

4 pr

imar

y sc

hool

teac

hers

Eval

uate

effe

ctiv

enes

s of e

ye h

ealth

pr

omot

ion

and

scre

enin

g in

terv

entio

n am

ong

teac

hers

Low

Bai e

t al

2014

62Ch

ina

Cros

s-se

ctio

nal

(retro

spec

tive)

19 9

77 p

rimar

y sc

hool

stud

ents

(in

grad

es 4

an

d 5)

Effec

tiven

ess o

f sch

ool v

ision

scre

enin

gM

ediu

m

Lato

rre-A

rtea

ga e

t al

2014

52Pe

ruCr

oss-

sect

iona

l (p

rosp

ectiv

e)21

teac

hers

Eval

uate

the

effec

tiven

ess o

f tea

cher

vi

sion

scre

enin

g an

d es

timat

e ch

ildho

od

refra

ctiv

e er

ror p

reva

lenc

e

Med

ium

Ma

et a

l 20

1446

Chin

aRa

ndom

ized

cont

rolle

d tri

al31

77 p

rimar

y sc

hool

child

ren

aged

8ndash1

3 ye

ars

in 2

51 sc

hool

sAs

sess

the

effec

t of f

ree

spec

tacl

e pr

ovisi

on o

n ac

adem

ic p

erfo

rman

ceM

ediu

m

Puri

et a

l 20

1422

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

e)54

04 c

hild

ren

aged

8ndash1

5 ye

ars s

cree

ned

and

71 te

ache

rs su

rvey

edEv

alua

te sc

hool

visi

on p

rogr

amm

eM

ediu

m

Teer

awat

tana

non

et a

l 20

1456

Thai

land

Mix

ed m

etho

ds58

85 st

uden

ts 1

335

pre-

prim

ary

child

ren

aged

4ndash6

yea

rs 4

550

prim

ary

child

ren

aged

7ndash

12 y

ears

Asse

ss a

ccur

acy

and

feas

ibili

ty o

f te

ache

r scr

eeni

ngM

ediu

m

Zhou

et a

l 20

1425

Chin

aM

ixed

met

hods

136

urba

n pr

imar

y sc

hool

child

ren

aged

9ndash

11 y

ears

290

rura

l sec

onda

ry sc

hool

child

ren

aged

11ndash

17 y

ears

16

pare

nts

Asse

ss th

e ta

ke-u

p of

adj

usta

ble-

lens

sp

ecta

cles

am

ong

child

ren

and

pare

nts

Hig

h

Anur

adha

amp R

aman

i 20

1563

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

e)12

3 op

tom

etris

ts o

r opt

omet

ry st

uden

tsEff

ectiv

enes

s of o

ptom

etry

stud

ents

in

cond

uctin

g sc

hool

-bas

ed si

ngle

-day

vi

sion

scre

enin

g

Hig

h

( continued)

(contin

ues

)

Bull World Health Organ 201896682ndash694D| doi httpdxdoiorg102471BLT18212332 694C


Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Font

enel

e et

al

2015

27Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

94 sc

hool

hea

lth n

urse

s age

d 20

ndash29

year

sAs

sess

the

invo

lvem

ent o

f nur

ses i

n ch

ildre

nrsquos e

ye h

ealth

Med

ium

Hob

day

et a

l 20

1528

Tim

or-L

este

Mix

ed m

etho

ds38

4 pr

imar

y sc

hool

child

ren

aged

10ndash

17 y

ears

te

ache

rs a

nd p

aren

ts (n

umbe

r und

isclo

sed)

Eval

uate

an

in-s

choo

l hea

lth

prom

otio

nal i

nter

vent

ion

Med

ium

Jugg

erna

th amp

Kni

ght

2015

29So

uth

Afric

aRa

ndom

ized

cont

rolle

d tri

al37

teac

hers

or p

rinci

pals

19

in in

terv

entio

n gr

oup

(age

d 23

ndash67

year

s) 1

8 in

con

trol g

roup

(a

ged

21ndash5

9 ye

ars)

Asse

ss te

ache

r visu

al a

cuity

scre

enin

g fo

llow

ing

train

ing

Med

ium

Ma

et a

l 20

1531

Chin

aRa

ndom

ized

cont

rolle

d tri

al28

40 p

rimar

y sc

hool

child

ren

aged

8ndash1

3 ye

ars

in 2

49 sc

hool

sAs

sess

the

safe

ty o

f spe

ctac

les i

n ru

ral

cont

ext w

here

a fe

ar th

at sp

ecta

cles

ha

rm th

e ey

es is

an

impo

rtan

t bar

rier

Hig

h

Priy

a et

al

2015

53In

dia

Case

ndashcon

trol

917

teac

hers

Asse

ss c

ost a

nd e

ffect

iven

ess o

f sc

reen

ing

prog

ram

me

invo

lvin

g al

l te

ache

rs c

ompa

red

with

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Bull World Health Organ 201896682ndash694D| doi httpdxdoiorg102471BLT18212332694D


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Figure 1

Table 2

Table 1



screened to identify any studies initially missed they were not included in the analysis however

We searched the online databases CINAHL Embasereg ERIC MEDLINEreg ProQuest PubMedreg and Web of Sci-enceTM for articles published between January 2000 and May 2018 using the search terms in Box 1 No language re-strictions were placed on the search but since search terms were in English we only retrieved English abstracts We im-ported citations into Covidence software (Veritas Health Innovation Melbourne Australia) where two authors indepen-dently reviewed titles and abstracts If the article could not be excluded based on abstract or title it was included for full-text review Two authors indepen-dently reviewed the full text of potential articles Some article abstracts identified for full-text review did not have a full text in English and were translated in full by a native speaker of the language

Disagreements regarding inclusion or exclusion at either the title and ab-stract screening or full text review were resolved by discussion with a third re-viewer Two independent reviewers then appraised study quality using the Mixed Methods Appraisal Tool (v-2011 McGill University Montreal Canada)15 resolv-ing discrepancies through discussion We selected the appraisal tool as it has been used extensively in prior systematic reviews16 and allows for the critical ap-praisal of qualitative quantitative andor mixed methods studies This tool is preferable to the use of multiple tools which may not allow for inter-study comparisons

Analysis

We analyzed the extracted data quali-tatively using NVivo 11 (QSR Interna-tional Melbourne Australia) Thematic deductive coding1718 was applied to identify the a priori themes from the availability accessibility acceptability and quality conceptual framework12 This framework applies a rights-based approach to analyzing factors related to health system coverage and accessibility and the underlying determinants that shape them The framework identifies the systemic characteristics that inhibit or facilitate equitable eye-care outcomes for schoolchildren while also consider-ing determinants related to sex culture education and discrimination

ResultsOf the 24 559 articles initially captured we identified 48 describing school-based eye-care interventions (Fig 1)19ndash66 Identified articles were from 13 coun-

tries spanning five World Health Or-ganization (WHO) Regions including Africa (eight studies) the Americas (10 studies) the Eastern Mediterra-nean (one study) South-East Asia (18 studies) and the Western Pacific (11

Box 1 Search terms used for systematic review of eye-care services for schoolchildren in low- and middle-income countries

Eye-care services

(eye care OR blindness OR ocular OR optom OR ophthal OR refractive error OR myop OR visual acuit OR vision screening OR visual impairment OR vision impairment OR eye-care OR vision care OR visually impair OR amblyop OR cataract OR spectacle OR eyeglass OR glasses OR vision)

Education sector

(school OR health education OR service OR outreach OR school-based OR student)

Children

(child OR boy OR girl OR minor OR adolescen OR juvenile OR teen OR youth OR parent OR guardian OR student)

Accessibility

(access OR utiliz OR utilis OR availability OR appropriat OR acceptab OR approach OR adequ OR inadequate OR equity OR inequity OR capability OR health seeking OR health care seeking OR social determinant OR health literacy OR health beliefs OR barrier OR facilitator OR enabler OR adherence OR compliance OR afford OR willingness OR knowledge OR perception OR attitude OR socioeconomic OR participat OR predictor OR parental education OR key informant)

Fig 1 Flowchart used for the systematic review of eye-care services for schoolchildren in low- and middle-income countries

24 555 records identified through database search bull 5 418 from Web of ScienceTM

bull 1 920 from PubMedregbull 1 206 from CINAHLbull 4 444 from ProQuest Education and ERICbull 613 from ProQuest Arts Social Sciences and Sociologybull 10 954 from MEDLINEreg and EMBASEreg

24 559 records screened

16 761 abstracts assessed for eligibility

399 full-text articles assessed for eligibility

48 articles included

Four records identified through reference lists

7 798 duplicates removed

16 362 records excluded

351 full-text articles excluded bull 184 not an interventionbull 34 high-income countrybull 33 conference paperbull 30 duplicatesbull 24 not childrenbull 20 not an empirical studybull 13 unable to locate articlebull 7 no data on eye healthbull 4 book or thesisbull 2 methodology article




Availability










Accessibility








Gender inequity


Acceptability



Sex






Quality










Tabl

e 2

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dle-

inco

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coun

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s

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d fo

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4) P

artic

ipan

ts a

ged

ge 1

9 ye

ars w

ere

excl

uded

Wea

ring

13

4 (6

649

3)

in p

osse

ssio

n 3

43

(169

493

)Si

gnifi

cant

c old

er a

ge r

ural

resid

ence

m

othe

rrsquos e

duca

tion

myo

pia

lt ndash

125

D

hype

ropi

a gt

+0

50 D

N

on-s

igni

fican

tc sex

leng

th o

f tim

e sin

ce

spec

tacl

es d

ispen

sed

Conc

erns

abo

ut a

ppea

ranc

e an

d be

ing

teas

ed (1

66

82

493)

for

got (

166

824

93)

use

only

occ

asio

nally

(14

2

704

93)

Cong

don

et a

l 20

0835

n =

810

U

nann

ounc

ed si

ngle

visi

t at

4ndash11

mon

ths a

fter d

ispen

sing

spec

tacl

es

483

(59

6)W

earin

g 3

08

(149

483

) in

pos

sess

ion

13

9 (6

748

3)Si

gnifi

cant

c fem

ale

shor

ter t

ime

to

follo

w-u

p N

on-s

igni

fican

t ag

e p

rese

ntin

g VA

wor

se

eye

NR

Li e

t al

2008

45n

= 6

74

Sing

le v

isit 3

mon

ths a

fter

inte

rven

tion

prov

ided

597

(88

6)Pu

rcha

sed

35

2 (2

105

97)

wea

ring

63

9

(of t

hose

that

pur

chas

ed

134

210)

Sign

ifica

ntc w

orse

VA

at b

asel

ine

sp

heric

al e

quiv

alen

t lt ndash

200

D w

illin

g to

pa

y m

ore

for s

pect

acle

s N

on-s

igni

fican

tc age

sex

par

ents

rsquo ed

ucat

ion

bas

elin

e vi

sual

fiel

d sc

ore

ho

me

floor

spac

e pe

r res

iden

t

Ow

ned

spec

tacl

es a

t bas

elin

e c

urre

nt

spec

tacl

es a

re g

ood

enou

gh (7

79

10

914

0) s

pect

acle

s too

exp

ensiv

e (1

14

16

140

) ha

ve sy

mpt

oms f

rom

cur

rent

sp

ecta

cles

(64

9

140

) D

id n

ot o

wn

spec

tacl

es a

t bas

elin

e

spec

tacl

es n

ot n

eede

d (4

87

110

226

) pr

ice

(17

7 4

022

6) h

arm

ful e

ffect

s of

spec

tacl

es o

n vi

sion

(12

8 2

922

6)

( continued)

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Ode

dra

et a

l 20

0848

n =

not

stat

ed

Una

nnou

nced

sing

le v

isit

3 m

onth

s afte

r int

erve

ntio

n

108

Wea

ring

37

0 (4

010

8)N

on-s

igni

fican

tc sex

Nam

e-ca

lling

con

cern

s ove

r saf

ety

of

spec

tacl

es (h

arm

) co

st

Keay

et a

l 20

1044

n =

428

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter d

ispen

sing

spec

tacl

es

415

(97

0)W

earin

g 4

65

(193

415

) in

po

sses

sion

27

(1

141

5)Si

gnifi

cant

c fem

ale

low

er in

com

e

spec

tacl

es V

A lt

66

pup

il siz

e ge

4 m

m

less

trou

ble

with

app

eara

nce

Non

-sig

nific

antc a

ge h

avin

g cu

stom

-m

ade

spec

tacl

es

NR

Sant

os e

t al

2011

37n

= 7

9 Si

ngle

visi

t 3 m

onth

s afte

r di

spen

sing

spec

tacl

es

62 (7

85)

Wea

ring

87

1 (5

462

)N

on-s

igni

fican

te sex

age

pre

sent

ing

VAPo

or fr

ame

to fa

ce a

djus

tmen

t pr

ejud

ice

from

col

leag

ues

Rust

agi e

t al

2012

36n

= 5

1 Si

ngle

visi

t 8 m

onth

s afte

r di

spen

sing

spec

tacl

es

48 (9

41)

Purc

hase

d 7

08

(34

48)

wea

ring

20

8

(10

48)

Non

-sig

nific

ante se

xH

arm

ful e

ffect

of s

pect

acle

s on

visio

n (5

79

22

38)

antic

ipat

ion

of te

asin

g fro

m

othe

r stu

dent

s (52

6

20

38)

diffi

culty

in

gett

ing

mar

ried

(50

0 1

938

)G

ogat

e et

al

2013

43n

= 2

312

Una

nnou

nced

sing

le v

isit a

t 6ndash

12 m

onth

s afte

r disp

ensin

g sp

ecta

cles

1018

(44

0)W

earin

g 2

95

(300

101

8) i

n po

sses

sion

21

o

f tho

se n

ot w

earin

g sp

ecta

cles

(15

718)

g

Sign

ifica

ntcf

myo

pia

lt ndash

200

D V

A lt

61

8 to

36

0 at

bas

elin

e h

ighe

r aca

dem

ic

perfo

rman

ce

Non

-sig

nific

antcf

sex

age

VA

612

to

618

Teas

ed a

bout

spec

tacl

es (1

98

142

718

) sp

ecta

cles

bro

ken

(17

4 1

257

18)

spec

tacl

es a

t hom

e (1

63

117

718

)

Rew

ri et

al

2013

61n

= 7

42

Sing

le v

isit 9

wee

ks a

fter s

econ

d vi

sion

scre

enin

g

493

(66

4)Pu

rcha

sed

40

2 (1

984

93)

wea

ring

81

3

(of t

hose

who

pur

chas

ed)

(161

198

)

NR

NR

Glew

we

et a

l 20

1642

n =

197

8 As

sess

ed a

ccep

tanc

e of

re

ceiv

ing

spec

tacl

es ra

ther

than

w

earin

g

NR

Acce

pted

spec

tacl

es 7

00

(1

384

1978

)Si

gnifi

cant

d mal

e w

orse

VA

hou

seho

ld

head

is a

teac

her

high

er to

wns

hip

per

capi

ta in

com

e N

on-s

igni

fican

t ha

ving

spec

tacl

es a

t ba

selin

e h

ouse

hold

hea

d is

a vi

llage

le

ader

hea

d ye

ars o

f sch

oolin

g te

st

scor

es c

ount

y lo

catio

n T

ibet

an s

choo

l le

vel

Hou

seho

ld h

ead

refu

sed

(31

5 1

875

94)

child

refu

sed

(15

0 8

959

4) c

anno

t ad

just

to sp

ecta

cles

(10

3 6

159

4)

D d

iopt

re N

R n

ot re

porte

d VA

visu

al a

cuity

a S

pect

acle

s wer

e re

com

men

ded

to b

e pu

rcha

sed

afte

r pro

visio

n of

a p

resc

riptio

n b

ut n

ot p

rovi

ded

b Int

erve

ntio

n pa

ckag

e co

nsist

ed o

f 23

com

pone

nts r

elat

ed to

spec

tacl

e fra

me

and

fit e

duca

tion

and

mot

ivat

ion

and

con

duct

of t

he sc

reen

ing

c Mul

tivar

iate

ana

lysis

d P

robi

t est

imat

e as

soci

ated

with

acc

eptin

g sp

ecta

cles

e U

niva

riate

ana

lysis

f M

yopi

a sa

mpl

e on

lyg P

erce

ntag

es h

ave

been

reca

lcul

ated

as d

iscre

panc

ies e

xist

ed b

etw

een

the

repo

rted

valu

es a

nd re

porte

d pe

rcen

tage

s Co

mpl

ianc

e ra

tes m

ay n

ot b

e re

liabl

e

( continued)



Tabl

e 3

Ab

ility

of v

ario

us ca

dres

to id

entif

y visi

on im

pairm

ent f

rom

revi

ew o

f sch

ool-b

ased

eye

-car

e pr

ogra

mm

es in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySc

reen

ing

cadr

ePo

pula

tion

scre

ened

Gold

stan

dard

Outc

ome

Perc

enta

ge

sens

itivi

ty

(95

CI)

Perc

enta

ge

spec

ificit

y (9

5 CI

)

PPV

(95

CI)

NPV

(95

CI)

Khan

deka

r et a

l 20

0951

Kind

erga

rten

te

ache

rs77

68 c

hild

ren

aged

3ndash6

yea

rsO

ptom

etris

tVA

lt 2

040

(61

2)

corre

ctab

le b

y sp

ecta

cles

of

gt plusmn

05

D

745

(72

7ndash76

3)

972

(96

7ndash97

6)

966

866

Taba

nsi e

t al

2009

55Te

ache

rs13

00 c

hild

ren

aged

6ndash1

1 ye

ars

Stud

y in

vest

igat

ors a

nd

doct

ors

VA lt

61

8 in

eith

er o

r bot

h ey

es53

398

479

394

7

Adhi

kari

amp Sh

rest

ha 2

01149

Cert

ified

med

ical

as

sista

nts

528

child

ren

aged

3ndash7

yea

rsPa

edia

tric

opht

halm

olog

istVA

lt 6

12

(HO

TVa c

hart

)80

099

0ndash

ndashAb

norm

al re

d re

flex

test

160

970

ndashndash

Scre

enin

g pa

ssf

ail

580

960

304

988

Rew

ri et

al

2013

6174

11 c

hild

ren

aged

10

ndash19

year

s81

7 ch

ildre

n w

ith se

lf-as

sess

ed im

paire

d vi

sion

aged

10

ndash19

year

s

Opt

omet

rist

VA le

61

2 (s

elf-

exam

inat

ion)

962

(94

5ndash97

4)

902

(87

8ndash92

2)

908

(88

6ndash92

7)

960

(94

1ndash97

2)

Lato

rre-A

rtea

ga

et a

l 20

1452

Teac

hers

33 c

hild

ren

aged

3ndash5

yea

rsO

phth

alm

ic a

ssist

ants

VA lt

69

in o

ne o

r bot

h ey

esndash

958

(92

8ndash98

7)

591

(36

3ndash81

9)

ndash

30 c

hild

ren

aged

5ndash1

1 ye

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VA le

69

in o

ne o

r bot

h ey

esndash

930

(89

0ndash96

9)

478

(25

2ndash70

4)

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Teer

awat

tana

non

et a

l 20

1456

Pre-

prim

ary

teac

hers

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ldre

n p

re-p

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ogist

Pres

entin

g VA

lt 2

040

(lt

61

2) (lsquo

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art)

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Prim

ary

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ldre

n p

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entin

g VA

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040

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llen

char

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0 (5

70ndash

610

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a et

al

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53Se

lect

ed te

ache

rs62

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aged

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7 ye

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mic

team

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20

30 (6

95

) in

eith

er

eye

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ndash bndash b

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each

ers

3806

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ldre

n ag

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ndash17

year

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030

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n ei

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2015

54Te

ache

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Prim

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care

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ker

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70ndash

812

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3 (9

27ndash

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1ndash79

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7ndash97

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41ndash

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rs12

9 ch

ildre

n ag

ed le

16

year

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phth

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ists

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69

in e

ither

eye

980

(88

0ndash99

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(18

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6ndash56

1)c

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(76

0ndash99

8)c

D d

iopt

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PV p

ositi

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redi

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lue

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neg

ativ

e pr

edic

tive

valu

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visu

al a

cuity

a A

n HO

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ision

test

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char

t con

tain

s the

lette

rs H

O T

and

Vb S

ensit

ivity

and

spec

ifici

ty re

sults

not

pro

vide

d st

udie

s are

incl

uded

in th

e ta

ble

for c

ompl

eten

ess

c S

ensit

ivity

spe

cific

ity a

nd 9

5 c

onfid

ence

inte

rval

s wer

e ca

lcul

ated

from

repo

rted

valu

es o

f tru

e po

sitiv

e tr

ue n

egat

ive

false

pos

itive

and

false

neg

ativ

e
























Reacutesumeacute



Резюме











Resumen




















































































Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

ic re

view

of i

nter

vent

ions

to im

prov

e ey

e-ca

re se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

Hol

gui e

t al

2006

34M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

493

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

5ndash1

8 ye

ars

Asse

ss sp

ecta

cle

com

plia

nce

Low

Carv

alho

et a

l 20

0720

Braz

ilCr

oss-

sect

iona

l (p

rosp

ectiv

e)15

17 e

lem

enta

ry sc

hool

teac

hers

or p

rinci

pals

Asse

ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

Low

Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n (m

ean

age

12 y

ears

)As

sess

the

impa

ct o

f spe

ctac

les o

n se

lf-re

port

ed v

ision

hea

lthM

ediu

m

Cong

don

et a

l 20

0835

Sout

h Af

rica

Pros

pect

ive

obse

rvat

iona

l85

20 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n ag

ed 6

ndash19

year

sEv

alua

te re

fract

ive

erro

r cut

-offs

for

spec

tacl

e pr

ovisi

on to

mor

e eff

ectiv

ely

iden

tify

child

ren

with

impr

oved

visi

on

and

incr

ease

com

plia

nce

Low

Lew

alle

n et

al

2008

58U

nite

d Re

publ

ic o

f Tan

zani

aM

ixed

met

hods

20 sc

hool

s (10

inte

rven

tion

10

cont

rol)

139

6 sc

hool

child

ren

(gra

des 3

and

4)

Eval

uate

trac

hom

a ed

ucat

ion

outc

omes

in

clud

ing

know

ledg

e an

d hy

gien

e pr

actic

es

Hig

h

Li e

t al

2008

45Ch

ina

Pros

pect

ive

coho

rt18

92 se

cond

ary

scho

olch

ildre

n ag

ed 1

3ndash16

yea

rsAs

sess

the

dete

rmin

ants

of s

pect

acle

co

mpl

ianc

eM

ediu

m

Ode

dra

et a

l 20

0848

Uni

ted

Repu

blic

of T

anza

nia

Mix

ed m

etho

ds10

8 se

cond

ary

scho

ol st

uden

ts (a

vera

ge a

ge

15 y

ears

) 58

inte

rven

tion

grou

p 5

0 co

ntro

l gr

oup

Asse

ss re

ason

s for

poo

r com

plia

nce

follo

win

g in

-sch

ool p

rovi

sion

of

spec

tacl

es

Med

ium

Wed

ner e

t al

2008

38U

nite

d Re

publ

ic o

f Tan

zani

aRa

ndom

ized

cont

rolle

d tri

al12

5 se

cond

ary

scho

olch

ildre

n ag

ed 1

1ndash19

yea

rsAs

sess

com

plia

nce

of fr

ee sp

ecta

cles

Hig

h

Khan

deka

r et a

l 20

0951

Islam

ic R

epub

lic o

f Ira

nM

ixed

met

hods

15 p

aren

ts a

nd 1

5 te

ache

rsEv

alua

te sc

hool

visi

on sc

reen

ing

in

kind

erga

rten

inc

ludi

ng c

ost a

nd v

alid

ity

of te

ache

r use

Med

ium

Taba

nsi e

t al

2009

55N

iger

iaCr

oss-

sect

iona

l (p

rosp

ectiv

e)13

0 te

ache

rs 1

300

prim

ary

scho

olch

ildre

n ag

ed 6

ndash11

year

sAs

sess

acc

urac

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teac

her s

cree

ning

s co

mpa

red

with

rese

arch

team

doc

tors

Hig

h

Zeng

et a

l 20

0940

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aRa

ndom

ized

cont

rolle

d tri

al74

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cond

ary

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olch

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ed 1

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yea

rsEv

alua

te c

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s visi

on a

nd

satis

fact

ion

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read

y-m

ade

spec

tacl

esM

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m

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et a

l 20

1044

Chin

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serv

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Det

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cer

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1165

Chin

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ears

Effec

tiven

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rven

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rom

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rcha

se

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al

2011

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ctio

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ine

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yCo

untr

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ampl

ePu

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ality

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la

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t al

2011

37Br

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Cros

s-se

ctio

nal

(pro

spec

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62 p

rimar

y sc

hool

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ars

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ctiv

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ror

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ss c

ompl

ianc

e of

chi

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n to

thei

r fir

st p

air o

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sses

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a et

al

2012

33Br

azil

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s-se

ctio

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(pro

spec

tive)

14 6

51 p

rimar

y sc

hool

child

ren

aged

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ars

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ine

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or n

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ns fo

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ol sc

reen

ing

Hig

h

Pere

ira e

t al

2012

21Ti

mor

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teCr

oss-

sect

iona

l (p

rosp

ectiv

e)21

scho

ol h

ealth

nur

ses

1819

chi

ldre

n sc

reen

edEv

alua

te e

ffica

cy o

f eye

hea

lth o

utre

ach

serv

ices

Med

ium

Raja

ram

an e

t al

2012

23In

dia

Mix

ed m

etho

ds52

chi

ldre

n ag

ed 9

ndash17

year

s 35

scho

ol st

aff

13 sc

hool

hea

lth c

ouns

ello

rs 4

par

ents

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clin

icia

ns

Eval

uate

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effec

tiven

ess o

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iver

y of

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hool

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lth p

rom

otio

n by

lay

scho

ol

heal

th c

ouns

ello

rs

Hig

h

Rust

agi e

t al

2012

36In

dia

Mix

ed m

etho

ds51

seco

ndar

y sc

hool

child

ren

aged

11ndash

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ears

sa

mpl

ed fo

r ref

ract

ion

out

of 1

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scre

ened

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ss th

e m

agni

tude

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g ch

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spec

tacl

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e

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ium

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aman

iam

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l 20

1364

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aQ

ualit

ativ

e35

par

ents

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ol-a

ged

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eye-

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spec

ialis

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ectiv

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choo

l visi

on sc

reen

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ium

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ate

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l 20

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rsAs

sess

spec

tacl

e co

mpl

ianc

e am

ong

rura

l chi

ldre

nH

igh

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ri et

al

2013

61In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

7411

seco

ndar

y sc

hool

child

ren

aged

11ndash

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ears

Eval

uate

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ents

rsquo abi

lity

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lf-ex

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ision

and

seek

inte

rven

tion

such

as

spec

tacl

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Hig

h

Thum

mal

apal

li et

al

2013

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dia

Pros

pect

ive

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rvat

iona

l10

4 pr

imar

y sc

hool

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hers

Eval

uate

effe

ctiv

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ealth

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omot

ion

and

scre

enin

g in

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tiven

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Eval

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ium

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et a

l 20

1446

Chin

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Chin

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2015

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Eval

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2015

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h

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h

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Det

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ality

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Figure 1

Table 2

Table 1




Availability










Accessibility








Gender inequity


Acceptability



Sex






Quality










Tabl

e 2

Sp

ecta

cle co

mpl

ianc

e an

d ac

cept

abili

ty fr

om sy

stem

atic

revi

ew o

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low

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mid

dle-

inco

me

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trie

s

Stud

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ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

spe

ctac

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rom

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nCo

ngdo

n et

al

2011

65Sp

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cle

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otio

na n

= 2

236

Co

ntro

l n

= 2

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Anno

unce

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gle

visit

6

mon

ths a

fter d

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sing

spec

tacl

es

Spec

tacl

e pr

omot

ion

162

2 (7

25)

Co

ntro

l 15

78 (7

13)

Spec

tacl

e pr

omot

ion

pu

rcha

sed

25

7 (4

171

622)

w

earin

gin

pos

sess

ion

82

0 (3

424

17)

Cont

rol

purc

hase

d 3

40

(537

157

8)

wea

ring

in p

osse

ssio

n 8

72

(468

537

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Purc

hasin

g sp

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cles

c Si

gnifi

cant

fem

ale

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rer u

ncor

rect

ed V

A at

bas

elin

e h

ighe

r ref

ract

ive

erro

r sh

orte

r fo

llow

-up

afte

r spe

ctac

le p

rovi

sion

Non

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nific

ant

age

bes

t cor

rect

ed

VA h

avin

g sp

ecta

cles

at b

asel

ine

ra

ndom

ized

to in

terv

entio

n gr

oup

Wea

ring

in p

osse

ssio

n of

spec

tacl

esc

Sign

ifica

nt f

emal

e p

oore

r unc

orre

cted

VA

at b

asel

ine

Non

-sig

nific

ant

age

bes

t cor

rect

ed

VA r

efra

ctiv

e er

ror m

agni

tude

hav

ing

spec

tacl

es a

t bas

elin

e ra

ndom

ized

to

inte

rven

tion

grou

p

Lack

of p

erce

ived

nee

d (3

40

738

217

0)

satis

fied

with

cur

rent

spec

tacl

es (3

05

66

221

70)

fear

s tha

t spe

ctac

les w

ill h

arm

ey

es (1

32

287

217

0)

Nar

ayan

an amp

Ram

ani

2018

41

Inte

rven

tion

pack

age

b n =

124

Co

ntro

l n

= 1

14

Thre

e un

anno

unce

d sin

gle

visit

s at 1

and

4 m

onth

s afte

r di

spen

sing

spec

tacl

es

Inte

rven

tion

pack

age

1

mon

th 1

01 (8

14)

4 m

onth

s 10

4 (8

39)

Co

ntro

l 1

mon

th 1

02 (8

95)

4

mon

ths

96 (8

42)

Inte

rven

tion

pack

age

wea

r at 1

mon

th

465

(4

710

1g ) w

ear a

t 4 m

onth

s 52

9

(55

104g )

Cont

rol

wea

r at 1

mon

th 1

76

(18

102)

wea

r at

4 m

onth

s 23

(2

296

)

NR

NR

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

fre

e sp

ecta

cles

ver

sus

purc

hase

d sp

ecta

cles

Wed

ner e

t al

2008

38Fr

ee sp

ecta

cles

n =

68

Pr

escr

iptio

n on

ly n

= 5

7 Si

ngle

visi

t 3 m

onth

s afte

r in

terv

entio

n pr

ovid

ed

Free

spec

tacl

es

58 (8

53)

Pr

escr

iptio

n on

ly 5

0 (8

77)

Free

spec

tacl

es

wea

ring

or in

pos

sess

ion

46

6 (2

758

) Pr

escr

iptio

n on

ly w

earin

g or

in

poss

essio

n 2

60

(13

50)

Sign

ifica

ntc w

orse

VA

myo

pia

(refra

ctiv

e er

ror s

tatu

s)

Non

-sig

nific

antc p

rovi

ded

with

free

sp

ecta

cles

NR

Ma

et a

l 20

1446

Free

spec

tacl

es n

= 5

27 F

ree

spec

tacl

es +

edu

catio

n n

= 6

26

Vouc

her

n =

492

Vou

cher

+

educ

atio

n n

= 4

96

Cont

rol

n =

510

Co

ntro

l + e

duca

tion

n =

526

U

nann

ounc

ed si

ngle

visi

t 8

mon

ths a

fter i

nter

vent

ion

prov

ided

Free

spec

tacl

es 5

06 (9

60)

Fr

ee sp

ecta

cles

+ e

duca

tion

59

8 (9

55)

Vo

uche

r 47

3 (9

61)

Vo

uche

r + e

duca

tion

474

(9

56)

Co

ntro

l 49

0 (9

61)

Co

ntro

l + e

duca

tion

513

(97

5)

Free

spec

tacl

es 3

68

wea

ring

(194

527

) Fr

ee sp

ecta

cles

+ e

duca

tion

43

9

wea

ring

(275

626

) Vo

uche

r 37

6

wea

ring

(185

492

) Vo

uche

r +

educ

atio

n 3

54

wea

ring

(176

496

) Co

ntro

l 25

3

wea

ring

(129

510

) Co

ntro

l + e

duca

tion

26

0 w

earin

g (1

375

26)

Sign

ifica

ntc p

rovi

ded

spec

tacl

es v

ouch

er

(with

out e

duca

tion)

pro

vide

d sp

ecta

cles

(w

ith e

duca

tion)

pro

vide

d fre

e sp

ecta

cles

(w

ithou

t edu

catio

n) p

rovi

ded

free

spec

tacl

es (w

ith e

duca

tion)

NR

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Yi e

t al

2015

39Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

n =

358

Pre

scrip

tion

+

pare

nt le

tter

n =

370

U

nann

ounc

ed v

isits

at 6

wee

ks

and

6 m

onth

s

6 w

eek

follo

w-u

p

Free

spec

tacl

es +

teac

her

ince

ntiv

e 3

52 (9

83)

Pr

escr

iptio

n +

par

ent l

ette

r 36

3 (9

81)

6

mon

th fo

llow

-up

Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

341

(95

3)

Pres

crip

tion

+ p

aren

t let

ter

352

(95

1)

Free

spec

tacl

es +

teac

her i

ncen

tive

6

wee

ks w

earin

g 81

5

(287

352

) 6

mon

ths w

earin

g 6

83

(233

341

) Pr

escr

iptio

n +

par

ent l

ette

r 6

wee

ks

wea

ring

16

5 (6

036

3) 6

mon

ths

wea

ring

23

9 (8

435

2)

At th

e 6-

mon

th v

isit

Sign

ifica

ntc in

terv

entio

n gr

oup

VA lt

61

8

at le

ast o

ne p

aren

t wea

rs sp

ecta

cles

ha

ving

spec

tacl

es a

t bas

elin

e N

on-s

igni

fican

tc sex

age

loc

atio

n

pare

nts e

duca

tion

bei

ng o

nly

child

be

lieve

s wea

ring

spec

tacl

es h

arm

s visi

on

mat

hem

atic

s sco

re p

aren

ts e

mpl

oyed

fa

mily

wea

lth b

lack

boar

d us

e

NR

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

rea

dy- v

ersu

s cu

stom

-mad

e sp

ecta

cles

Zeng

et a

l 20

0940

Read

y-m

ade

n =

250

cus

tom

-m

ade

n =

245

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter s

pect

acle

s di

spen

sed

Read

y-m

ade

208

(83

2)

cust

om-m

ade

206

(84

1)W

earin

g re

ady-

mad

e 4

69

(98

209)

cu

stom

-mad

e

514

(1

062

06)

Non

-sig

nific

antc b

eing

pro

vide

d w

ith

cust

om- c

ompa

red

with

read

y-m

ade

spec

tacl

es

NR

Mor

jaria

et a

l 20

1747

Read

y-m

ade

n =

232

cus

tom

-m

ade

n =

228

U

nann

ounc

ed si

ngle

visi

t 3ndash

4 m

onth

s afte

r int

erve

ntio

n pr

ovid

ed

Read

y-m

ade

184

(79

3)

cust

om-m

ade

178

(78

1)W

earin

g or

had

them

at s

choo

l re

ady-

mad

e 7

55

(139

184

) cu

stom

-m

ade

73

6 (1

311

78)

Non

-sig

nific

ante b

eing

pro

vide

d w

ith

cust

om- c

ompa

red

with

read

y-m

ade

spec

tacl

es

NR

Obs

erva

tion

al s

tudi

es fo

llow

ing

scho

ol e

ye-c

are

prog

ram

mes

Cast

anon

Hol

guin

et a

l 20

0634

n =

654

Si

ngle

visi

t at 4

ndash18

mon

ths a

fter

disp

ensin

g sp

ecta

cles

493

(75

4) P

artic

ipan

ts a

ged

ge 1

9 ye

ars w

ere

excl

uded

Wea

ring

13

4 (6

649

3)

in p

osse

ssio

n 3

43

(169

493

)Si

gnifi

cant

c old

er a

ge r

ural

resid

ence

m

othe

rrsquos e

duca

tion

myo

pia

lt ndash

125

D

hype

ropi

a gt

+0

50 D

N

on-s

igni

fican

tc sex

leng

th o

f tim

e sin

ce

spec

tacl

es d

ispen

sed

Conc

erns

abo

ut a

ppea

ranc

e an

d be

ing

teas

ed (1

66

82

493)

for

got (

166

824

93)

use

only

occ

asio

nally

(14

2

704

93)

Cong

don

et a

l 20

0835

n =

810

U

nann

ounc

ed si

ngle

visi

t at

4ndash11

mon

ths a

fter d

ispen

sing

spec

tacl

es

483

(59

6)W

earin

g 3

08

(149

483

) in

pos

sess

ion

13

9 (6

748

3)Si

gnifi

cant

c fem

ale

shor

ter t

ime

to

follo

w-u

p N

on-s

igni

fican

t ag

e p

rese

ntin

g VA

wor

se

eye

NR

Li e

t al

2008

45n

= 6

74

Sing

le v

isit 3

mon

ths a

fter

inte

rven

tion

prov

ided

597

(88

6)Pu

rcha

sed

35

2 (2

105

97)

wea

ring

63

9

(of t

hose

that

pur

chas

ed

134

210)

Sign

ifica

ntc w

orse

VA

at b

asel

ine

sp

heric

al e

quiv

alen

t lt ndash

200

D w

illin

g to

pa

y m

ore

for s

pect

acle

s N

on-s

igni

fican

tc age

sex

par

ents

rsquo ed

ucat

ion

bas

elin

e vi

sual

fiel

d sc

ore

ho

me

floor

spac

e pe

r res

iden

t

Ow

ned

spec

tacl

es a

t bas

elin

e c

urre

nt

spec

tacl

es a

re g

ood

enou

gh (7

79

10

914

0) s

pect

acle

s too

exp

ensiv

e (1

14

16

140

) ha

ve sy

mpt

oms f

rom

cur

rent

sp

ecta

cles

(64

9

140

) D

id n

ot o

wn

spec

tacl

es a

t bas

elin

e

spec

tacl

es n

ot n

eede

d (4

87

110

226

) pr

ice

(17

7 4

022

6) h

arm

ful e

ffect

s of

spec

tacl

es o

n vi

sion

(12

8 2

922

6)

( continued)

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Ode

dra

et a

l 20

0848

n =

not

stat

ed

Una

nnou

nced

sing

le v

isit

3 m

onth

s afte

r int

erve

ntio

n

108

Wea

ring

37

0 (4

010

8)N

on-s

igni

fican

tc sex

Nam

e-ca

lling

con

cern

s ove

r saf

ety

of

spec

tacl

es (h

arm

) co

st

Keay

et a

l 20

1044

n =

428

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter d

ispen

sing

spec

tacl

es

415

(97

0)W

earin

g 4

65

(193

415

) in

po

sses

sion

27

(1

141

5)Si

gnifi

cant

c fem

ale

low

er in

com

e

spec

tacl

es V

A lt

66

pup

il siz

e ge

4 m

m

less

trou

ble

with

app

eara

nce

Non

-sig

nific

antc a

ge h

avin

g cu

stom

-m

ade

spec

tacl

es

NR

Sant

os e

t al

2011

37n

= 7

9 Si

ngle

visi

t 3 m

onth

s afte

r di

spen

sing

spec

tacl

es

62 (7

85)

Wea

ring

87

1 (5

462

)N

on-s

igni

fican

te sex

age

pre

sent

ing

VAPo

or fr

ame

to fa

ce a

djus

tmen

t pr

ejud

ice

from

col

leag

ues

Rust

agi e

t al

2012

36n

= 5

1 Si

ngle

visi

t 8 m

onth

s afte

r di

spen

sing

spec

tacl

es

48 (9

41)

Purc

hase

d 7

08

(34

48)

wea

ring

20

8

(10

48)

Non

-sig

nific

ante se

xH

arm

ful e

ffect

of s

pect

acle

s on

visio

n (5

79

22

38)

antic

ipat

ion

of te

asin

g fro

m

othe

r stu

dent

s (52

6

20

38)

diffi

culty

in

gett

ing

mar

ried

(50

0 1

938

)G

ogat

e et

al

2013

43n

= 2

312

Una

nnou

nced

sing

le v

isit a

t 6ndash

12 m

onth

s afte

r disp

ensin

g sp

ecta

cles

1018

(44

0)W

earin

g 2

95

(300

101

8) i

n po

sses

sion

21

o

f tho

se n

ot w

earin

g sp

ecta

cles

(15

718)

g

Sign

ifica

ntcf

myo

pia

lt ndash

200

D V

A lt

61

8 to

36

0 at

bas

elin

e h

ighe

r aca

dem

ic

perfo

rman

ce

Non

-sig

nific

antcf

sex

age

VA

612

to

618

Teas

ed a

bout

spec

tacl

es (1

98

142

718

) sp

ecta

cles

bro

ken

(17

4 1

257

18)

spec

tacl

es a

t hom

e (1

63

117

718

)

Rew

ri et

al

2013

61n

= 7

42

Sing

le v

isit 9

wee

ks a

fter s

econ

d vi

sion

scre

enin

g

493

(66

4)Pu

rcha

sed

40

2 (1

984

93)

wea

ring

81

3

(of t

hose

who

pur

chas

ed)

(161

198

)

NR

NR

Glew

we

et a

l 20

1642

n =

197

8 As

sess

ed a

ccep

tanc

e of

re

ceiv

ing

spec

tacl

es ra

ther

than

w

earin

g

NR

Acce

pted

spec

tacl

es 7

00

(1

384

1978

)Si

gnifi

cant

d mal

e w

orse

VA

hou

seho

ld

head

is a

teac

her

high

er to

wns

hip

per

capi

ta in

com

e N

on-s

igni

fican

t ha

ving

spec

tacl

es a

t ba

selin

e h

ouse

hold

hea

d is

a vi

llage

le

ader

hea

d ye

ars o

f sch

oolin

g te

st

scor

es c

ount

y lo

catio

n T

ibet

an s

choo

l le

vel

Hou

seho

ld h

ead

refu

sed

(31

5 1

875

94)

child

refu

sed

(15

0 8

959

4) c

anno

t ad

just

to sp

ecta

cles

(10

3 6

159

4)

D d

iopt

re N

R n

ot re

porte

d VA

visu

al a

cuity

a S

pect

acle

s wer

e re

com

men

ded

to b

e pu

rcha

sed

afte

r pro

visio

n of

a p

resc

riptio

n b

ut n

ot p

rovi

ded

b Int

erve

ntio

n pa

ckag

e co

nsist

ed o

f 23

com

pone

nts r

elat

ed to

spec

tacl

e fra

me

and

fit e

duca

tion

and

mot

ivat

ion

and

con

duct

of t

he sc

reen

ing

c Mul

tivar

iate

ana

lysis

d P

robi

t est

imat

e as

soci

ated

with

acc

eptin

g sp

ecta

cles

e U

niva

riate

ana

lysis

f M

yopi

a sa

mpl

e on

lyg P

erce

ntag

es h

ave

been

reca

lcul

ated

as d

iscre

panc

ies e

xist

ed b

etw

een

the

repo

rted

valu

es a

nd re

porte

d pe

rcen

tage

s Co

mpl

ianc

e ra

tes m

ay n

ot b

e re

liabl

e

( continued)



Tabl

e 3

Ab

ility

of v

ario

us ca

dres

to id

entif

y visi

on im

pairm

ent f

rom

revi

ew o

f sch

ool-b

ased

eye

-car

e pr

ogra

mm

es in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySc

reen

ing

cadr

ePo

pula

tion

scre

ened

Gold

stan

dard

Outc

ome

Perc

enta

ge

sens

itivi

ty

(95

CI)

Perc

enta

ge

spec

ificit

y (9

5 CI

)

PPV

(95

CI)

NPV

(95

CI)

Khan

deka

r et a

l 20

0951

Kind

erga

rten

te

ache

rs77

68 c

hild

ren

aged

3ndash6

yea

rsO

ptom

etris

tVA

lt 2

040

(61

2)

corre

ctab

le b

y sp

ecta

cles

of

gt plusmn

05

D

745

(72

7ndash76

3)

972

(96

7ndash97

6)

966

866

Taba

nsi e

t al

2009

55Te

ache

rs13

00 c

hild

ren

aged

6ndash1

1 ye

ars

Stud

y in

vest

igat

ors a

nd

doct

ors

VA lt

61

8 in

eith

er o

r bot

h ey

es53

398

479

394

7

Adhi

kari

amp Sh

rest

ha 2

01149

Cert

ified

med

ical

as

sista

nts

528

child

ren

aged

3ndash7

yea

rsPa

edia

tric

opht

halm

olog

istVA

lt 6

12

(HO

TVa c

hart

)80

099

0ndash

ndashAb

norm

al re

d re

flex

test

160

970

ndashndash

Scre

enin

g pa

ssf

ail

580

960

304

988

Rew

ri et

al

2013

6174

11 c

hild

ren

aged

10

ndash19

year

s81

7 ch

ildre

n w

ith se

lf-as

sess

ed im

paire

d vi

sion

aged

10

ndash19

year

s

Opt

omet

rist

VA le

61

2 (s

elf-

exam

inat

ion)

962

(94

5ndash97

4)

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Tabl

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Hig

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Eval

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2012

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ate

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ong

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igh

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2013

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seco

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ren

aged

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ears

Eval

uate

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dia

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l10

4 pr

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y sc

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Eval

uate

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enin

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Eval

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h

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Asse

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h

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Mea

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he p

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ospe

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hort

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aged

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ears

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ss th

e eff

ect o

f eye

hea

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h

( continued)

(contin

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)



Stud

yCo

untr

ySt

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nSt

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ampl

ePu

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eQu

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e35

par

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ed 5

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the

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ors t

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nflue

nce

the

seek

ing

of e

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ium

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an amp

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ani

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41In

dia

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dom

ized

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al84

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cond

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n ag

ed 1

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yea

rs sc

reen

ed 2

38 re

quire

d sp

ecta

cles

of

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ch 1

24 fo

rmed

the

inte

rven

tion

grou

p an

d 11

4 th

e co

ntro

l gro

up

Asse

ss sp

ecta

cle

and

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rral c

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e fo

llow

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ram

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a We

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e qu

ality

of s

tudy

met

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by

usin

g th

e M

ixed

Met

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App

raisa

l Too

l (v-

2011

) St

udie

s wer

e cl

assifi

ed a

s hig

h qu

ality

if gt

90

of c

riter

ia w

ere

adeq

uate

med

ium

qua

lity

if gt

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ere

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if gt

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0 o

f crit

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ery

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e ad

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e el

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n so

no

stud

ies w

ere

excl

uded

bas

ed o

n th

is qu

ality

ass

essm

ent

( continued)

Figure 1

Table 2

Table 1




Gender inequity


Acceptability



Sex






Quality










Tabl

e 2

Sp

ecta

cle co

mpl

ianc

e an

d ac

cept

abili

ty fr

om sy

stem

atic

revi

ew o

f eye

-car

e se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

spe

ctac

le p

rom

otio

nCo

ngdo

n et

al

2011

65Sp

ecta

cle

prom

otio

na n

= 2

236

Co

ntro

l n

= 2

212

Anno

unce

d sin

gle

visit

6

mon

ths a

fter d

ispen

sing

spec

tacl

es

Spec

tacl

e pr

omot

ion

162

2 (7

25)

Co

ntro

l 15

78 (7

13)

Spec

tacl

e pr

omot

ion

pu

rcha

sed

25

7 (4

171

622)

w

earin

gin

pos

sess

ion

82

0 (3

424

17)

Cont

rol

purc

hase

d 3

40

(537

157

8)

wea

ring

in p

osse

ssio

n 8

72

(468

537

)

Purc

hasin

g sp

ecta

cles

c Si

gnifi

cant

fem

ale

poo

rer u

ncor

rect

ed V

A at

bas

elin

e h

ighe

r ref

ract

ive

erro

r sh

orte

r fo

llow

-up

afte

r spe

ctac

le p

rovi

sion

Non

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nific

ant

age

bes

t cor

rect

ed

VA h

avin

g sp

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cles

at b

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ine

ra

ndom

ized

to in

terv

entio

n gr

oup

Wea

ring

in p

osse

ssio

n of

spec

tacl

esc

Sign

ifica

nt f

emal

e p

oore

r unc

orre

cted

VA

at b

asel

ine

Non

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nific

ant

age

bes

t cor

rect

ed

VA r

efra

ctiv

e er

ror m

agni

tude

hav

ing

spec

tacl

es a

t bas

elin

e ra

ndom

ized

to

inte

rven

tion

grou

p

Lack

of p

erce

ived

nee

d (3

40

738

217

0)

satis

fied

with

cur

rent

spec

tacl

es (3

05

66

221

70)

fear

s tha

t spe

ctac

les w

ill h

arm

ey

es (1

32

287

217

0)

Nar

ayan

an amp

Ram

ani

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41

Inte

rven

tion

pack

age

b n =

124

Co

ntro

l n

= 1

14

Thre

e un

anno

unce

d sin

gle

visit

s at 1

and

4 m

onth

s afte

r di

spen

sing

spec

tacl

es

Inte

rven

tion

pack

age

1

mon

th 1

01 (8

14)

4 m

onth

s 10

4 (8

39)

Co

ntro

l 1

mon

th 1

02 (8

95)

4

mon

ths

96 (8

42)

Inte

rven

tion

pack

age

wea

r at 1

mon

th

465

(4

710

1g ) w

ear a

t 4 m

onth

s 52

9

(55

104g )

Cont

rol

wea

r at 1

mon

th 1

76

(18

102)

wea

r at

4 m

onth

s 23

(2

296

)

NR

NR

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

fre

e sp

ecta

cles

ver

sus

purc

hase

d sp

ecta

cles

Wed

ner e

t al

2008

38Fr

ee sp

ecta

cles

n =

68

Pr

escr

iptio

n on

ly n

= 5

7 Si

ngle

visi

t 3 m

onth

s afte

r in

terv

entio

n pr

ovid

ed

Free

spec

tacl

es

58 (8

53)

Pr

escr

iptio

n on

ly 5

0 (8

77)

Free

spec

tacl

es

wea

ring

or in

pos

sess

ion

46

6 (2

758

) Pr

escr

iptio

n on

ly w

earin

g or

in

poss

essio

n 2

60

(13

50)

Sign

ifica

ntc w

orse

VA

myo

pia

(refra

ctiv

e er

ror s

tatu

s)

Non

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nific

antc p

rovi

ded

with

free

sp

ecta

cles

NR

Ma

et a

l 20

1446

Free

spec

tacl

es n

= 5

27 F

ree

spec

tacl

es +

edu

catio

n n

= 6

26

Vouc

her

n =

492

Vou

cher

+

educ

atio

n n

= 4

96

Cont

rol

n =

510

Co

ntro

l + e

duca

tion

n =

526

U

nann

ounc

ed si

ngle

visi

t 8

mon

ths a

fter i

nter

vent

ion

prov

ided

Free

spec

tacl

es 5

06 (9

60)

Fr

ee sp

ecta

cles

+ e

duca

tion

59

8 (9

55)

Vo

uche

r 47

3 (9

61)

Vo

uche

r + e

duca

tion

474

(9

56)

Co

ntro

l 49

0 (9

61)

Co

ntro

l + e

duca

tion

513

(97

5)

Free

spec

tacl

es 3

68

wea

ring

(194

527

) Fr

ee sp

ecta

cles

+ e

duca

tion

43

9

wea

ring

(275

626

) Vo

uche

r 37

6

wea

ring

(185

492

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uche

r +

educ

atio

n 3

54

wea

ring

(176

496

) Co

ntro

l 25

3

wea

ring

(129

510

) Co

ntro

l + e

duca

tion

26

0 w

earin

g (1

375

26)

Sign

ifica

ntc p

rovi

ded

spec

tacl

es v

ouch

er

(with

out e

duca

tion)

pro

vide

d sp

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cles

(w

ith e

duca

tion)

pro

vide

d fre

e sp

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cles

(w

ithou

t edu

catio

n) p

rovi

ded

free

spec

tacl

es (w

ith e

duca

tion)

NR

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

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ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Yi e

t al

2015

39Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

n =

358

Pre

scrip

tion

+

pare

nt le

tter

n =

370

U

nann

ounc

ed v

isits

at 6

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ks

and

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s

6 w

eek

follo

w-u

p

Free

spec

tacl

es +

teac

her

ince

ntiv

e 3

52 (9

83)

Pr

escr

iptio

n +

par

ent l

ette

r 36

3 (9

81)

6

mon

th fo

llow

-up

Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

341

(95

3)

Pres

crip

tion

+ p

aren

t let

ter

352

(95

1)

Free

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es +

teac

her i

ncen

tive

6

wee

ks w

earin

g 81

5

(287

352

) 6

mon

ths w

earin

g 6

83

(233

341

) Pr

escr

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n +

par

ent l

ette

r 6

wee

ks

wea

ring

16

5 (6

036

3) 6

mon

ths

wea

ring

23

9 (8

435

2)

At th

e 6-

mon

th v

isit

Sign

ifica

ntc in

terv

entio

n gr

oup

VA lt

61

8

at le

ast o

ne p

aren

t wea

rs sp

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cles

ha

ving

spec

tacl

es a

t bas

elin

e N

on-s

igni

fican

tc sex

age

loc

atio

n

pare

nts e

duca

tion

bei

ng o

nly

child

be

lieve

s wea

ring

spec

tacl

es h

arm

s visi

on

mat

hem

atic

s sco

re p

aren

ts e

mpl

oyed

fa

mily

wea

lth b

lack

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d us

e

NR

Rand

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edn

on-r

ando

miz

ed c

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rea

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e sp

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Zeng

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l 20

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Read

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U

nann

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t 1

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th a

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pect

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s di

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sed

Read

y-m

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cust

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206

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69

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cu

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514

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Non

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ith

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red

with

read

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ade

spec

tacl

es

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Mor

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et a

l 20

1747

Read

y-m

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232

cus

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nann

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ed si

ngle

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t 3ndash

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s afte

r int

erve

ntio

n pr

ovid

ed

Read

y-m

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184

(79

3)

cust

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ade

178

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had

them

at s

choo

l re

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55

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184

) cu

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73

6 (1

311

78)

Non

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ante b

eing

pro

vide

d w

ith

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with

read

y-m

ade

spec

tacl

es

NR

Obs

erva

tion

al s

tudi

es fo

llow

ing

scho

ol e

ye-c

are

prog

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mes

Cast

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guin

et a

l 20

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n =

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Si

ngle

visi

t at 4

ndash18

mon

ths a

fter

disp

ensin

g sp

ecta

cles

493

(75

4) P

artic

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ts a

ged

ge 1

9 ye

ars w

ere

excl

uded

Wea

ring

13

4 (6

649

3)

in p

osse

ssio

n 3

43

(169

493

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gnifi

cant

c old

er a

ge r

ural

resid

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m

othe

rrsquos e

duca

tion

myo

pia

lt ndash

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D

hype

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a gt

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50 D

N

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fican

tc sex

leng

th o

f tim

e sin

ce

spec

tacl

es d

ispen

sed

Conc

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abo

ut a

ppea

ranc

e an

d be

ing

teas

ed (1

66

82

493)

for

got (

166

824

93)

use

only

occ

asio

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2

704

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Cong

don

et a

l 20

0835

n =

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U

nann

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ngle

visi

t at

4ndash11

mon

ths a

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tacl

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483

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483

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pos

sess

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9 (6

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gnifi

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ter t

ime

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follo

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p N

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t ag

e p

rese

ntin

g VA

wor

se

eye

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Li e

t al

2008

45n

= 6

74

Sing

le v

isit 3

mon

ths a

fter

inte

rven

tion

prov

ided

597

(88

6)Pu

rcha

sed

35

2 (2

105

97)

wea

ring

63

9

(of t

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that

pur

chas

ed

134

210)

Sign

ifica

ntc w

orse

VA

at b

asel

ine

sp

heric

al e

quiv

alen

t lt ndash

200

D w

illin

g to

pa

y m

ore

for s

pect

acle

s N

on-s

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fican

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par

ents

rsquo ed

ucat

ion

bas

elin

e vi

sual

fiel

d sc

ore

ho

me

floor

spac

e pe

r res

iden

t

Ow

ned

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es a

t bas

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e c

urre

nt

spec

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re g

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79

10

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pect

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s too

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16

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ve sy

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rent

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(64

9

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) D

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87

110

226

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ice

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7 4

022

6) h

arm

ful e

ffect

s of

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n vi

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(12

8 2

922

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( continued)

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)



Stud

ySt

udy s

ampl

e an

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ts (

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ecta

cle co

mpl

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e or

acc

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Fact

ors a

sses

sed

for a

ssoc

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ith

incr

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d sp

ecta

cle co

mpl

ianc

e or

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cept

ance

Reas

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epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Ode

dra

et a

l 20

0848

n =

not

stat

ed

Una

nnou

nced

sing

le v

isit

3 m

onth

s afte

r int

erve

ntio

n

108

Wea

ring

37

0 (4

010

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fican

tc sex

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lling

con

cern

s ove

r saf

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of

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tacl

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arm

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st

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et a

l 20

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n =

428

U

nann

ounc

ed si

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visi

t 1

mon

th a

fter d

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sing

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tacl

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415

(97

0)W

earin

g 4

65

(193

415

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po

sses

sion

27

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141

5)Si

gnifi

cant

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low

er in

com

e

spec

tacl

es V

A lt

66

pup

il siz

e ge

4 m

m

less

trou

ble

with

app

eara

nce

Non

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nific

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ge h

avin

g cu

stom

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ade

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tacl

es

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os e

t al

2011

37n

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9 Si

ngle

visi

t 3 m

onth

s afte

r di

spen

sing

spec

tacl

es

62 (7

85)

Wea

ring

87

1 (5

462

)N

on-s

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fican

te sex

age

pre

sent

ing

VAPo

or fr

ame

to fa

ce a

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ejud

ice

from

col

leag

ues

Rust

agi e

t al

2012

36n

= 5

1 Si

ngle

visi

t 8 m

onth

s afte

r di

spen

sing

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tacl

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48 (9

41)

Purc

hase

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48)

wea

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20

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48)

Non

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nific

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xH

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ffect

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pect

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22

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ipat

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6

20

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culty

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gett

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ried

(50

0 1

938

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al

2013

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Una

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nced

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le v

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r disp

ensin

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117

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ri et

al

2013

61n

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Sing

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et a

l 20

1642

n =

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ceiv

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rovi

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ckag

e co

nsist

ed o

f 23

com

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nts r

elat

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spec

tacl

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me

and

fit e

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mot

ivat

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con

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mpl

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etw

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repo

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valu

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nd re

porte

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mpl

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ay n

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Tabl

e 3

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of v

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dres

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on im

pairm

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rom

revi

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ogra

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stan

dard

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itivi

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CI)

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enta

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ificit

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CI)

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CI)

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deka

r et a

l 20

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ache

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t al

2009

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Stud

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Cert

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Reacutesumeacute



Резюме











Resumen




















































































Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

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view

of i

nter

vent

ions

to im

prov

e ey

e-ca

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rvice

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low

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inco

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esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

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gui e

t al

2006

34M

exic

oPr

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ctiv

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serv

atio

nal

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prim

ary

and

seco

ndar

y sc

hool

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ren

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ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

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Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

scho

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ean

age

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Sout

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cond

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fract

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mor

e eff

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iden

tify

child

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with

impr

oved

visi

on

and

incr

ease

com

plia

nce

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alle

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al

2008

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publ

ic o

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met

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inte

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cont

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Hig

h

Li e

t al

2008

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ary

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ed 1

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Wed

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t al

2008

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publ

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h

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raisa

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t al

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spec

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ldre

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reen

edEv

alua

te e

ffica

cy o

f eye

hea

lth o

utre

ach

serv

ices

Med

ium

Raja

ram

an e

t al

2012

23In

dia

Mix

ed m

etho

ds52

chi

ldre

n ag

ed 9

ndash17

year

s 35

scho

ol st

aff

13 sc

hool

hea

lth c

ouns

ello

rs 4

par

ents

and

3

clin

icia

ns

Eval

uate

the

effec

tiven

ess o

f del

iver

y of

sc

hool

hea

lth p

rom

otio

n by

lay

scho

ol

heal

th c

ouns

ello

rs

Hig

h

Rust

agi e

t al

2012

36In

dia

Mix

ed m

etho

ds51

seco

ndar

y sc

hool

child

ren

aged

11ndash

18 y

ears

sa

mpl

ed fo

r ref

ract

ion

out

of 1

075

scre

ened

Asse

ss th

e m

agni

tude

of v

ision

im

pairm

ent a

mon

g ch

ildre

n an

d th

eir

spec

tacl

e co

mpl

ianc

e

Med

ium

Bala

subr

aman

iam

et a

l 20

1364

Indi

aQ

ualit

ativ

e35

par

ents

with

scho

ol-a

ged

child

ren

and

16

eye-

care

spec

ialis

tsEff

ectiv

enes

s of s

choo

l visi

on sc

reen

ing

Med

ium

Gog

ate

et a

l 20

1343

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

e)10

18 se

cond

ary

scho

olch

ildre

n ag

ed

8ndash16

yea

rsAs

sess

spec

tacl

e co

mpl

ianc

e am

ong

rura

l chi

ldre

nH

igh

Rew

ri et

al

2013

61In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

7411

seco

ndar

y sc

hool

child

ren

aged

11ndash

19 y

ears

Eval

uate

stud

ents

rsquo abi

lity

to se

lf-ex

amin

e th

eir v

ision

and

seek

inte

rven

tion

such

as

spec

tacl

es

Hig

h

Thum

mal

apal

li et

al

2013

60In

dia

Pros

pect

ive

obse

rvat

iona

l10

4 pr

imar

y sc

hool

teac

hers

Eval

uate

effe

ctiv

enes

s of e

ye h

ealth

pr

omot

ion

and

scre

enin

g in

terv

entio

n am

ong

teac

hers

Low

Bai e

t al

2014

62Ch

ina

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s-se

ctio

nal

(retro

spec

tive)

19 9

77 p

rimar

y sc

hool

stud

ents

(in

grad

es 4

an

d 5)

Effec

tiven

ess o

f sch

ool v

ision

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enin

gM

ediu

m

Lato

rre-A

rtea

ga e

t al

2014

52Pe

ruCr

oss-

sect

iona

l (p

rosp

ectiv

e)21

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hers

Eval

uate

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effec

tiven

ess o

f tea

cher

vi

sion

scre

enin

g an

d es

timat

e ch

ildho

od

refra

ctiv

e er

ror p

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e

Med

ium

Ma

et a

l 20

1446

Chin

aRa

ndom

ized

cont

rolle

d tri

al31

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rimar

y sc

hool

child

ren

aged

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ars

in 2

51 sc

hool

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sess

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effec

t of f

ree

spec

tacl

e pr

ovisi

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n ac

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ic p

erfo

rman

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ediu

m

Puri

et a

l 20

1422

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

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hild

ren

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ars s

cree

ned

and

71 te

ache

rs su

rvey

edEv

alua

te sc

hool

visi

on p

rogr

amm

eM

ediu

m

Teer

awat

tana

non

et a

l 20

1456

Thai

land

Mix

ed m

etho

ds58

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uden

ts 1

335

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ary

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rs 4

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ary

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ren

aged

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12 y

ears

Asse

ss a

ccur

acy

and

feas

ibili

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f te

ache

r scr

eeni

ngM

ediu

m

Zhou

et a

l 20

1425

Chin

aM

ixed

met

hods

136

urba

n pr

imar

y sc

hool

child

ren

aged

9ndash

11 y

ears

290

rura

l sec

onda

ry sc

hool

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ren

aged

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17 y

ears

16

pare

nts

Asse

ss th

e ta

ke-u

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cles

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Hig

h

Anur

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aman

i 20

1563

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r opt

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ectiv

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s of o

ptom

etry

stud

ents

in

cond

uctin

g sc

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ngle

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untr

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rpos

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ality

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raisa

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enel

e et

al

2015

27Br

azil

Cros

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ctio

nal

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spec

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94 sc

hool

hea

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urse

s age

d 20

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sAs

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n ch

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ium

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day

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l 20

1528

Tim

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Mix

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y sc

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child

ren

aged

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ears

te

ache

rs a

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aren

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umbe

r und

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Eval

uate

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in-s

choo

l hea

lth

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otio

nal i

nter

vent

ion

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ium

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erna

th amp

Kni

ght

2015

29So

uth

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aRa

ndom

ized

cont

rolle

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al37

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hers

or p

rinci

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19

in in

terv

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oup

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d 23

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roup

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ged

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ars)

Asse

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g fo

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ium

Ma

et a

l 20

1531

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aRa

ndom

ized

cont

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d tri

al28

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rimar

y sc

hool

child

ren

aged

8ndash1

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ars

in 2

49 sc

hool

sAs

sess

the

safe

ty o

f spe

ctac

les i

n ru

ral

cont

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here

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ar th

at sp

ecta

cles

ha

rm th

e ey

es is

an

impo

rtan

t bar

rier

Hig

h

Priy

a et

al

2015

53In

dia

Case

ndashcon

trol

917

teac

hers

Asse

ss c

ost a

nd e

ffect

iven

ess o

f sc

reen

ing

prog

ram

me

invo

lvin

g al

l te

ache

rs c

ompa

red

with

usin

g a

limite

d nu

mbe

r of t

each

ers

Hig

h

Saxe

na e

t al

2015

54In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

40 te

ache

rs 9

838

prim

ary

scho

olch

ildre

n ag

ed

6ndash15

yea

rsAs

sess

acc

urac

y of

teac

her s

cree

ning

s co

mpa

red

with

prim

ary

eye-

care

w

orke

rs

Hig

h

Wan

g et

al

2015

24Ch

ina

Cros

s-se

ctio

nal

(pro

spec

tive)

4376

prim

ary

scho

olch

ildre

n ag

ed ~

9ndash12

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4225

mig

rant

chi

ldre

n an

d 15

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cal c

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ren

Mea

sure

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nce

of sp

ecta

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an

d ow

ners

hip

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g m

igra

nt c

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ren

Low

Yi e

t al

2015

39Ch

ina

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omize

d co

ntro

lled

trial

693

prim

ary

scho

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n ag

ed 1

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effec

t of t

he p

rovi

sion

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spec

tacl

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ombi

ned

with

teac

her

ince

ntiv

es o

n co

mpl

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e

Hig

h

Glew

we

et a

l 20

1642

Chin

aM

ixed

qua

ntita

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28 7

98 p

rimar

y sc

hool

child

ren

aged

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12 y

ears

Det

erm

ine

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impa

ct o

f fre

e sp

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prov

ision

on

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s aca

dem

ic

perfo

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ce

Hig

h

Kaur

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l 20

1650

Indi

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entif

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pro

blem

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chi

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Med

ium

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l 20

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l 20

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Com

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ediu

m

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el e

t al

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et N

amPr

ospe

ctiv

e co

hort

300

child

ren

aged

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ears

Asse

ss th

e eff

ect o

f eye

hea

lth

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n on

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ed 5

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ium

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ani

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41In

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e co

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l gro

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e qu

ality

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g th

e M

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Met

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App

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l Too

l (v-

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h qu

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Figure 1

Table 2

Table 1



Tabl

e 2

Sp

ecta

cle co

mpl

ianc

e an

d ac

cept

abili

ty fr

om sy

stem

atic

revi

ew o

f eye

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e se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

spe

ctac

le p

rom

otio

nCo

ngdo

n et

al

2011

65Sp

ecta

cle

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otio

na n

= 2

236

Co

ntro

l n

= 2

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Anno

unce

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gle

visit

6

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ths a

fter d

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sing

spec

tacl

es

Spec

tacl

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omot

ion

162

2 (7

25)

Co

ntro

l 15

78 (7

13)

Spec

tacl

e pr

omot

ion

pu

rcha

sed

25

7 (4

171

622)

w

earin

gin

pos

sess

ion

82

0 (3

424

17)

Cont

rol

purc

hase

d 3

40

(537

157

8)

wea

ring

in p

osse

ssio

n 8

72

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537

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Purc

hasin

g sp

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cles

c Si

gnifi

cant

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ale

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rer u

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A at

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orte

r fo

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Non

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rect

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avin

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ized

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oup

Wea

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Sign

ifica

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Non

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ndom

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inte

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p

Lack

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erce

ived

nee

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40

738

217

0)

satis

fied

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rent

spec

tacl

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05

66

221

70)

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s tha

t spe

ctac

les w

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arm

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32

287

217

0)

Nar

ayan

an amp

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41

Inte

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tion

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age

b n =

124

Co

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l n

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Thre

e un

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gle

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and

4 m

onth

s afte

r di

spen

sing

spec

tacl

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Inte

rven

tion

pack

age

1

mon

th 1

01 (8

14)

4 m

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s 10

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39)

Co

ntro

l 1

mon

th 1

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95)

4

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ths

96 (8

42)

Inte

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r at 1

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Cont

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r at

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296

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Rand

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e sp

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cles

ver

sus

purc

hase

d sp

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Wed

ner e

t al

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ee sp

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cles

n =

68

Pr

escr

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ly n

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53)

Pr

escr

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ly 5

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77)

Free

spec

tacl

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wea

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pos

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46

6 (2

758

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escr

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ly w

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g or

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60

(13

50)

Sign

ifica

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s)

Non

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nific

antc p

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ded

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free

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cles

NR

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et a

l 20

1446

Free

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tacl

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= 5

27 F

ree

spec

tacl

es +

edu

catio

n n

= 6

26

Vouc

her

n =

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Vou

cher

+

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atio

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96

Cont

rol

n =

510

Co

ntro

l + e

duca

tion

n =

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U

nann

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ed si

ngle

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t 8

mon

ths a

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vent

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ided

Free

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60)

Fr

ee sp

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+ e

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tion

59

8 (9

55)

Vo

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61)

Vo

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tion

474

(9

56)

Co

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l 49

0 (9

61)

Co

ntro

l + e

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513

(97

5)

Free

spec

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es 3

68

wea

ring

(194

527

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ee sp

ecta

cles

+ e

duca

tion

43

9

wea

ring

(275

626

) Vo

uche

r 37

6

wea

ring

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492

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uche

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educ

atio

n 3

54

wea

ring

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496

) Co

ntro

l 25

3

wea

ring

(129

510

) Co

ntro

l + e

duca

tion

26

0 w

earin

g (1

375

26)

Sign

ifica

ntc p

rovi

ded

spec

tacl

es v

ouch

er

(with

out e

duca

tion)

pro

vide

d sp

ecta

cles

(w

ith e

duca

tion)

pro

vide

d fre

e sp

ecta

cles

(w

ithou

t edu

catio

n) p

rovi

ded

free

spec

tacl

es (w

ith e

duca

tion)

NR

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

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ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Yi e

t al

2015

39Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

n =

358

Pre

scrip

tion

+

pare

nt le

tter

n =

370

U

nann

ounc

ed v

isits

at 6

wee

ks

and

6 m

onth

s

6 w

eek

follo

w-u

p

Free

spec

tacl

es +

teac

her

ince

ntiv

e 3

52 (9

83)

Pr

escr

iptio

n +

par

ent l

ette

r 36

3 (9

81)

6

mon

th fo

llow

-up

Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

341

(95

3)

Pres

crip

tion

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aren

t let

ter

352

(95

1)

Free

spec

tacl

es +

teac

her i

ncen

tive

6

wee

ks w

earin

g 81

5

(287

352

) 6

mon

ths w

earin

g 6

83

(233

341

) Pr

escr

iptio

n +

par

ent l

ette

r 6

wee

ks

wea

ring

16

5 (6

036

3) 6

mon

ths

wea

ring

23

9 (8

435

2)

At th

e 6-

mon

th v

isit

Sign

ifica

ntc in

terv

entio

n gr

oup

VA lt

61

8

at le

ast o

ne p

aren

t wea

rs sp

ecta

cles

ha

ving

spec

tacl

es a

t bas

elin

e N

on-s

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fican

tc sex

age

loc

atio

n

pare

nts e

duca

tion

bei

ng o

nly

child

be

lieve

s wea

ring

spec

tacl

es h

arm

s visi

on

mat

hem

atic

s sco

re p

aren

ts e

mpl

oyed

fa

mily

wea

lth b

lack

boar

d us

e

NR

Rand

omiz

edn

on-r

ando

miz

ed c

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olle

d tr

ials

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s cu

stom

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e sp

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cles

Zeng

et a

l 20

0940

Read

y-m

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250

cus

tom

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n =

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U

nann

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visi

t 1

mon

th a

fter s

pect

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s di

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sed

Read

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206

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1)W

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69

(98

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062

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Non

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vide

d w

ith

cust

om- c

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with

read

y-m

ade

spec

tacl

es

NR

Mor

jaria

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l 20

1747

Read

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232

cus

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228

U

nann

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t 3ndash

4 m

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s afte

r int

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ntio

n pr

ovid

ed

Read

y-m

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184

(79

3)

cust

om-m

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178

(78

1)W

earin

g or

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them

at s

choo

l re

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55

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184

) cu

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73

6 (1

311

78)

Non

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nific

ante b

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vide

d w

ith

cust

om- c

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with

read

y-m

ade

spec

tacl

es

NR

Obs

erva

tion

al s

tudi

es fo

llow

ing

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ye-c

are

prog

ram

mes

Cast

anon

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guin

et a

l 20

0634

n =

654

Si

ngle

visi

t at 4

ndash18

mon

ths a

fter

disp

ensin

g sp

ecta

cles

493

(75

4) P

artic

ipan

ts a

ged

ge 1

9 ye

ars w

ere

excl

uded

Wea

ring

13

4 (6

649

3)

in p

osse

ssio

n 3

43

(169

493

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gnifi

cant

c old

er a

ge r

ural

resid

ence

m

othe

rrsquos e

duca

tion

myo

pia

lt ndash

125

D

hype

ropi

a gt

+0

50 D

N

on-s

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fican

tc sex

leng

th o

f tim

e sin

ce

spec

tacl

es d

ispen

sed

Conc

erns

abo

ut a

ppea

ranc

e an

d be

ing

teas

ed (1

66

82

493)

for

got (

166

824

93)

use

only

occ

asio

nally

(14

2

704

93)

Cong

don

et a

l 20

0835

n =

810

U

nann

ounc

ed si

ngle

visi

t at

4ndash11

mon

ths a

fter d

ispen

sing

spec

tacl

es

483

(59

6)W

earin

g 3

08

(149

483

) in

pos

sess

ion

13

9 (6

748

3)Si

gnifi

cant

c fem

ale

shor

ter t

ime

to

follo

w-u

p N

on-s

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fican

t ag

e p

rese

ntin

g VA

wor

se

eye

NR

Li e

t al

2008

45n

= 6

74

Sing

le v

isit 3

mon

ths a

fter

inte

rven

tion

prov

ided

597

(88

6)Pu

rcha

sed

35

2 (2

105

97)

wea

ring

63

9

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hose

that

pur

chas

ed

134

210)

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ifica

ntc w

orse

VA

at b

asel

ine

sp

heric

al e

quiv

alen

t lt ndash

200

D w

illin

g to

pa

y m

ore

for s

pect

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s N

on-s

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fican

tc age

sex

par

ents

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ucat

ion

bas

elin

e vi

sual

fiel

d sc

ore

ho

me

floor

spac

e pe

r res

iden

t

Ow

ned

spec

tacl

es a

t bas

elin

e c

urre

nt

spec

tacl

es a

re g

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enou

gh (7

79

10

914

0) s

pect

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s too

exp

ensiv

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14

16

140

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ve sy

mpt

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rom

cur

rent

sp

ecta

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9

140

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id n

ot o

wn

spec

tacl

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elin

e

spec

tacl

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ot n

eede

d (4

87

110

226

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ice

(17

7 4

022

6) h

arm

ful e

ffect

s of

spec

tacl

es o

n vi

sion

(12

8 2

922

6)

( continued)

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

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r

Ode

dra

et a

l 20

0848

n =

not

stat

ed

Una

nnou

nced

sing

le v

isit

3 m

onth

s afte

r int

erve

ntio

n

108

Wea

ring

37

0 (4

010

8)N

on-s

igni

fican

tc sex

Nam

e-ca

lling

con

cern

s ove

r saf

ety

of

spec

tacl

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arm

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st

Keay

et a

l 20

1044

n =

428

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter d

ispen

sing

spec

tacl

es

415

(97

0)W

earin

g 4

65

(193

415

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po

sses

sion

27

(1

141

5)Si

gnifi

cant

c fem

ale

low

er in

com

e

spec

tacl

es V

A lt

66

pup

il siz

e ge

4 m

m

less

trou

ble

with

app

eara

nce

Non

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nific

antc a

ge h

avin

g cu

stom

-m

ade

spec

tacl

es

NR

Sant

os e

t al

2011

37n

= 7

9 Si

ngle

visi

t 3 m

onth

s afte

r di

spen

sing

spec

tacl

es

62 (7

85)

Wea

ring

87

1 (5

462

)N

on-s

igni

fican

te sex

age

pre

sent

ing

VAPo

or fr

ame

to fa

ce a

djus

tmen

t pr

ejud

ice

from

col

leag

ues

Rust

agi e

t al

2012

36n

= 5

1 Si

ngle

visi

t 8 m

onth

s afte

r di

spen

sing

spec

tacl

es

48 (9

41)

Purc

hase

d 7

08

(34

48)

wea

ring

20

8

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48)

Non

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nific

ante se

xH

arm

ful e

ffect

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pect

acle

s on

visio

n (5

79

22

38)

antic

ipat

ion

of te

asin

g fro

m

othe

r stu

dent

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6

20

38)

diffi

culty

in

gett

ing

mar

ried

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0 1

938

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ogat

e et

al

2013

43n

= 2

312

Una

nnou

nced

sing

le v

isit a

t 6ndash

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onth

s afte

r disp

ensin

g sp

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cles

1018

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95

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101

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o

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718)

g

Sign

ifica

ntcf

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pia

lt ndash

200

D V

A lt

61

8 to

36

0 at

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r aca

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rman

ce

Non

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nific

antcf

sex

age

VA

612

to

618

Teas

ed a

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4 1

257

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tacl

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t hom

e (1

63

117

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Rew

ri et

al

2013

61n

= 7

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Sing

le v

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wee

ks a

fter s

econ

d vi

sion

scre

enin

g

493

(66

4)Pu

rcha

sed

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2 (1

984

93)

wea

ring

81

3

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hose

who

pur

chas

ed)

(161

198

)

NR

NR

Glew

we

et a

l 20

1642

n =

197

8 As

sess

ed a

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tanc

e of

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ceiv

ing

spec

tacl

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ther

than

w

earin

g

NR

Acce

pted

spec

tacl

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00

(1

384

1978

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gnifi

cant

d mal

e w

orse

VA

hou

seho

ld

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teac

her

high

er to

wns

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per

capi

ta in

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e N

on-s

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fican

t ha

ving

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tacl

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t ba

selin

e h

ouse

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hea

d is

a vi

llage

le

ader

hea

d ye

ars o

f sch

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g te

st

scor

es c

ount

y lo

catio

n T

ibet

an s

choo

l le

vel

Hou

seho

ld h

ead

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sed

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5 1

875

94)

child

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sed

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0 8

959

4) c

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t ad

just

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ecta

cles

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3 6

159

4)

D d

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R n

ot re

porte

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visu

al a

cuity

a S

pect

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s wer

e re

com

men

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visio

n of

a p

resc

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n b

ut n

ot p

rovi

ded

b Int

erve

ntio

n pa

ckag

e co

nsist

ed o

f 23

com

pone

nts r

elat

ed to

spec

tacl

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me

and

fit e

duca

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and

mot

ivat

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and

con

duct

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he sc

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c Mul

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lysis

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robi

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ated

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acc

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ecta

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niva

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f M

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mpl

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nd re

porte

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rcen

tage

s Co

mpl

ianc

e ra

tes m

ay n

ot b

e re

liabl

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( continued)



Tabl

e 3

Ab

ility

of v

ario

us ca

dres

to id

entif

y visi

on im

pairm

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rom

revi

ew o

f sch

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ogra

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low

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Stud

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Gold

stan

dard

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Perc

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ificit

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aged

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1 ye

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Stud

y in

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VA lt

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8 in

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Cert

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Scre

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580

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10

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year

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Opt

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2 (s

elf-

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l 20

1452

Teac

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for c

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onfid

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valu

es o

f tru

e po

sitiv

e tr

ue n

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false

pos

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and

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Reacutesumeacute



Резюме











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Tabl

e 1

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t al

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ss te

ache

r per

cept

ions

of s

choo

l vi

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hea

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ampa

igns

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2007

26M

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ctiv

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serv

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plia

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h

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rven

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se

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2011

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ine

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ality

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2011

37Br

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spec

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62 p

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ror

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ompl

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2012

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14 6

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h

Pere

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t al

2012

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mor

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ses

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alua

te e

ffica

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hea

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utre

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serv

ices

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ium

Raja

ram

an e

t al

2012

23In

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ds52

chi

ldre

n ag

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s 35

scho

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aff

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Eval

uate

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rom

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Hig

h

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agi e

t al

2012

36In

dia

Mix

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etho

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seco

ndar

y sc

hool

child

ren

aged

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ears

sa

mpl

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ract

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ualit

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reen

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ium

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ate

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l 20

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ong

rura

l chi

ldre

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igh

Rew

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2013

61In

dia

Cros

s-se

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nal

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seco

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y sc

hool

child

ren

aged

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ears

Eval

uate

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ents

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lity

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lf-ex

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inte

rven

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Hig

h

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mal

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2013

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dia

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pect

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rvat

iona

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imar

y sc

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Eval

uate

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ctiv

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ealth

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ion

and

scre

enin

g in

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19 9

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(in

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rre-A

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Eval

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et a

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1446

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Chin

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urba

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Stud

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2015

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ium

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erna

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2015

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rm th

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h

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2015

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teac

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Asse

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h

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2015

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cree

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orke

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Hig

h

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2015

24Ch

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Mea

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Det

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m

Paud

el e

t al

2017

59Vi

et N

amPr

ospe

ctiv

e co

hort

300

child

ren

aged

12ndash

15 y

ears

Asse

ss th

e eff

ect o

f eye

hea

lth

prom

otio

n on

eye

hea

lth li

tera

cy in

sc

hool

s

Hig

h

( continued)

(contin

ues

)



Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Ebei

gbe

201

866N

iger

iaQ

ualit

ativ

e35

par

ents

of s

choo

lchi

ldre

n ag

ed 5

ndash12

year

sAs

sess

the

fact

ors t

hat i

nflue

nce

the

seek

ing

of e

ye-c

are

Med

ium

Nar

ayan

an amp

Ram

ani

2018

41In

dia

Non

-ran

dom

ized

cont

rolle

d tri

al84

42 se

cond

ary

scho

olch

ildre

n ag

ed 1

3ndash17

yea

rs sc

reen

ed 2

38 re

quire

d sp

ecta

cles

of

whi

ch 1

24 fo

rmed

the

inte

rven

tion

grou

p an

d 11

4 th

e co

ntro

l gro

up

Asse

ss sp

ecta

cle

and

refe

rral c

ompl

ianc

e fo

llow

ing

scho

ol sc

reen

ing

prog

ram

me

Low

a We

appr

aise

d th

e qu

ality

of s

tudy

met

hods

by

usin

g th

e M

ixed

Met

hods

App

raisa

l Too

l (v-

2011

) St

udie

s wer

e cl

assifi

ed a

s hig

h qu

ality

if gt

90

of c

riter

ia w

ere

adeq

uate

med

ium

qua

lity

if gt

60 to

90

of c

riter

ia w

ere

adeq

uate

low

qua

lity

if gt

30

to 6

0 o

f crit

eria

wer

e ad

equa

te a

nd v

ery

low

qua

lity

if le

30

crit

eria

wer

e ad

equa

te N

o st

udie

s of v

ery

low

qua

lity

wer

e el

igib

le fo

r inc

lusio

n so

no

stud

ies w

ere

excl

uded

bas

ed o

n th

is qu

ality

ass

essm

ent

( continued)

Figure 1

Table 2

Table 1



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Yi e

t al

2015

39Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

n =

358

Pre

scrip

tion

+

pare

nt le

tter

n =

370

U

nann

ounc

ed v

isits

at 6

wee

ks

and

6 m

onth

s

6 w

eek

follo

w-u

p

Free

spec

tacl

es +

teac

her

ince

ntiv

e 3

52 (9

83)

Pr

escr

iptio

n +

par

ent l

ette

r 36

3 (9

81)

6

mon

th fo

llow

-up

Fr

ee sp

ecta

cles

+ te

ache

r in

cent

ive

341

(95

3)

Pres

crip

tion

+ p

aren

t let

ter

352

(95

1)

Free

spec

tacl

es +

teac

her i

ncen

tive

6

wee

ks w

earin

g 81

5

(287

352

) 6

mon

ths w

earin

g 6

83

(233

341

) Pr

escr

iptio

n +

par

ent l

ette

r 6

wee

ks

wea

ring

16

5 (6

036

3) 6

mon

ths

wea

ring

23

9 (8

435

2)

At th

e 6-

mon

th v

isit

Sign

ifica

ntc in

terv

entio

n gr

oup

VA lt

61

8

at le

ast o

ne p

aren

t wea

rs sp

ecta

cles

ha

ving

spec

tacl

es a

t bas

elin

e N

on-s

igni

fican

tc sex

age

loc

atio

n

pare

nts e

duca

tion

bei

ng o

nly

child

be

lieve

s wea

ring

spec

tacl

es h

arm

s visi

on

mat

hem

atic

s sco

re p

aren

ts e

mpl

oyed

fa

mily

wea

lth b

lack

boar

d us

e

NR

Rand

omiz

edn

on-r

ando

miz

ed c

ontr

olle

d tr

ials

rea

dy- v

ersu

s cu

stom

-mad

e sp

ecta

cles

Zeng

et a

l 20

0940

Read

y-m

ade

n =

250

cus

tom

-m

ade

n =

245

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter s

pect

acle

s di

spen

sed

Read

y-m

ade

208

(83

2)

cust

om-m

ade

206

(84

1)W

earin

g re

ady-

mad

e 4

69

(98

209)

cu

stom

-mad

e

514

(1

062

06)

Non

-sig

nific

antc b

eing

pro

vide

d w

ith

cust

om- c

ompa

red

with

read

y-m

ade

spec

tacl

es

NR

Mor

jaria

et a

l 20

1747

Read

y-m

ade

n =

232

cus

tom

-m

ade

n =

228

U

nann

ounc

ed si

ngle

visi

t 3ndash

4 m

onth

s afte

r int

erve

ntio

n pr

ovid

ed

Read

y-m

ade

184

(79

3)

cust

om-m

ade

178

(78

1)W

earin

g or

had

them

at s

choo

l re

ady-

mad

e 7

55

(139

184

) cu

stom

-m

ade

73

6 (1

311

78)

Non

-sig

nific

ante b

eing

pro

vide

d w

ith

cust

om- c

ompa

red

with

read

y-m

ade

spec

tacl

es

NR

Obs

erva

tion

al s

tudi

es fo

llow

ing

scho

ol e

ye-c

are

prog

ram

mes

Cast

anon

Hol

guin

et a

l 20

0634

n =

654

Si

ngle

visi

t at 4

ndash18

mon

ths a

fter

disp

ensin

g sp

ecta

cles

493

(75

4) P

artic

ipan

ts a

ged

ge 1

9 ye

ars w

ere

excl

uded

Wea

ring

13

4 (6

649

3)

in p

osse

ssio

n 3

43

(169

493

)Si

gnifi

cant

c old

er a

ge r

ural

resid

ence

m

othe

rrsquos e

duca

tion

myo

pia

lt ndash

125

D

hype

ropi

a gt

+0

50 D

N

on-s

igni

fican

tc sex

leng

th o

f tim

e sin

ce

spec

tacl

es d

ispen

sed

Conc

erns

abo

ut a

ppea

ranc

e an

d be

ing

teas

ed (1

66

82

493)

for

got (

166

824

93)

use

only

occ

asio

nally

(14

2

704

93)

Cong

don

et a

l 20

0835

n =

810

U

nann

ounc

ed si

ngle

visi

t at

4ndash11

mon

ths a

fter d

ispen

sing

spec

tacl

es

483

(59

6)W

earin

g 3

08

(149

483

) in

pos

sess

ion

13

9 (6

748

3)Si

gnifi

cant

c fem

ale

shor

ter t

ime

to

follo

w-u

p N

on-s

igni

fican

t ag

e p

rese

ntin

g VA

wor

se

eye

NR

Li e

t al

2008

45n

= 6

74

Sing

le v

isit 3

mon

ths a

fter

inte

rven

tion

prov

ided

597

(88

6)Pu

rcha

sed

35

2 (2

105

97)

wea

ring

63

9

(of t

hose

that

pur

chas

ed

134

210)

Sign

ifica

ntc w

orse

VA

at b

asel

ine

sp

heric

al e

quiv

alen

t lt ndash

200

D w

illin

g to

pa

y m

ore

for s

pect

acle

s N

on-s

igni

fican

tc age

sex

par

ents

rsquo ed

ucat

ion

bas

elin

e vi

sual

fiel

d sc

ore

ho

me

floor

spac

e pe

r res

iden

t

Ow

ned

spec

tacl

es a

t bas

elin

e c

urre

nt

spec

tacl

es a

re g

ood

enou

gh (7

79

10

914

0) s

pect

acle

s too

exp

ensiv

e (1

14

16

140

) ha

ve sy

mpt

oms f

rom

cur

rent

sp

ecta

cles

(64

9

140

) D

id n

ot o

wn

spec

tacl

es a

t bas

elin

e

spec

tacl

es n

ot n

eede

d (4

87

110

226

) pr

ice

(17

7 4

022

6) h

arm

ful e

ffect

s of

spec

tacl

es o

n vi

sion

(12

8 2

922

6)

( continued)

(contin

ues

)



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Ode

dra

et a

l 20

0848

n =

not

stat

ed

Una

nnou

nced

sing

le v

isit

3 m

onth

s afte

r int

erve

ntio

n

108

Wea

ring

37

0 (4

010

8)N

on-s

igni

fican

tc sex

Nam

e-ca

lling

con

cern

s ove

r saf

ety

of

spec

tacl

es (h

arm

) co

st

Keay

et a

l 20

1044

n =

428

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter d

ispen

sing

spec

tacl

es

415

(97

0)W

earin

g 4

65

(193

415

) in

po

sses

sion

27

(1

141

5)Si

gnifi

cant

c fem

ale

low

er in

com

e

spec

tacl

es V

A lt

66

pup

il siz

e ge

4 m

m

less

trou

ble

with

app

eara

nce

Non

-sig

nific

antc a

ge h

avin

g cu

stom

-m

ade

spec

tacl

es

NR

Sant

os e

t al

2011

37n

= 7

9 Si

ngle

visi

t 3 m

onth

s afte

r di

spen

sing

spec

tacl

es

62 (7

85)

Wea

ring

87

1 (5

462

)N

on-s

igni

fican

te sex

age

pre

sent

ing

VAPo

or fr

ame

to fa

ce a

djus

tmen

t pr

ejud

ice

from

col

leag

ues

Rust

agi e

t al

2012

36n

= 5

1 Si

ngle

visi

t 8 m

onth

s afte

r di

spen

sing

spec

tacl

es

48 (9

41)

Purc

hase

d 7

08

(34

48)

wea

ring

20

8

(10

48)

Non

-sig

nific

ante se

xH

arm

ful e

ffect

of s

pect

acle

s on

visio

n (5

79

22

38)

antic

ipat

ion

of te

asin

g fro

m

othe

r stu

dent

s (52

6

20

38)

diffi

culty

in

gett

ing

mar

ried

(50

0 1

938

)G

ogat

e et

al

2013

43n

= 2

312

Una

nnou

nced

sing

le v

isit a

t 6ndash

12 m

onth

s afte

r disp

ensin

g sp

ecta

cles

1018

(44

0)W

earin

g 2

95

(300

101

8) i

n po

sses

sion

21

o

f tho

se n

ot w

earin

g sp

ecta

cles

(15

718)

g

Sign

ifica

ntcf

myo

pia

lt ndash

200

D V

A lt

61

8 to

36

0 at

bas

elin

e h

ighe

r aca

dem

ic

perfo

rman

ce

Non

-sig

nific

antcf

sex

age

VA

612

to

618

Teas

ed a

bout

spec

tacl

es (1

98

142

718

) sp

ecta

cles

bro

ken

(17

4 1

257

18)

spec

tacl

es a

t hom

e (1

63

117

718

)

Rew

ri et

al

2013

61n

= 7

42

Sing

le v

isit 9

wee

ks a

fter s

econ

d vi

sion

scre

enin

g

493

(66

4)Pu

rcha

sed

40

2 (1

984

93)

wea

ring

81

3

(of t

hose

who

pur

chas

ed)

(161

198

)

NR

NR

Glew

we

et a

l 20

1642

n =

197

8 As

sess

ed a

ccep

tanc

e of

re

ceiv

ing

spec

tacl

es ra

ther

than

w

earin

g

NR

Acce

pted

spec

tacl

es 7

00

(1

384

1978

)Si

gnifi

cant

d mal

e w

orse

VA

hou

seho

ld

head

is a

teac

her

high

er to

wns

hip

per

capi

ta in

com

e N

on-s

igni

fican

t ha

ving

spec

tacl

es a

t ba

selin

e h

ouse

hold

hea

d is

a vi

llage

le

ader

hea

d ye

ars o

f sch

oolin

g te

st

scor

es c

ount

y lo

catio

n T

ibet

an s

choo

l le

vel

Hou

seho

ld h

ead

refu

sed

(31

5 1

875

94)

child

refu

sed

(15

0 8

959

4) c

anno

t ad

just

to sp

ecta

cles

(10

3 6

159

4)

D d

iopt

re N

R n

ot re

porte

d VA

visu

al a

cuity

a S

pect

acle

s wer

e re

com

men

ded

to b

e pu

rcha

sed

afte

r pro

visio

n of

a p

resc

riptio

n b

ut n

ot p

rovi

ded

b Int

erve

ntio

n pa

ckag

e co

nsist

ed o

f 23

com

pone

nts r

elat

ed to

spec

tacl

e fra

me

and

fit e

duca

tion

and

mot

ivat

ion

and

con

duct

of t

he sc

reen

ing

c Mul

tivar

iate

ana

lysis

d P

robi

t est

imat

e as

soci

ated

with

acc

eptin

g sp

ecta

cles

e U

niva

riate

ana

lysis

f M

yopi

a sa

mpl

e on

lyg P

erce

ntag

es h

ave

been

reca

lcul

ated

as d

iscre

panc

ies e

xist

ed b

etw

een

the

repo

rted

valu

es a

nd re

porte

d pe

rcen

tage

s Co

mpl

ianc

e ra

tes m

ay n

ot b

e re

liabl

e

( continued)



Tabl

e 3

Ab

ility

of v

ario

us ca

dres

to id

entif

y visi

on im

pairm

ent f

rom

revi

ew o

f sch

ool-b

ased

eye

-car

e pr

ogra

mm

es in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySc

reen

ing

cadr

ePo

pula

tion

scre

ened

Gold

stan

dard

Outc

ome

Perc

enta

ge

sens

itivi

ty

(95

CI)

Perc

enta

ge

spec

ificit

y (9

5 CI

)

PPV

(95

CI)

NPV

(95

CI)

Khan

deka

r et a

l 20

0951

Kind

erga

rten

te

ache

rs77

68 c

hild

ren

aged

3ndash6

yea

rsO

ptom

etris

tVA

lt 2

040

(61

2)

corre

ctab

le b

y sp

ecta

cles

of

gt plusmn

05

D

745

(72

7ndash76

3)

972

(96

7ndash97

6)

966

866

Taba

nsi e

t al

2009

55Te

ache

rs13

00 c

hild

ren

aged

6ndash1

1 ye

ars

Stud

y in

vest

igat

ors a

nd

doct

ors

VA lt

61

8 in

eith

er o

r bot

h ey

es53

398

479

394

7

Adhi

kari

amp Sh

rest

ha 2

01149

Cert

ified

med

ical

as

sista

nts

528

child

ren

aged

3ndash7

yea

rsPa

edia

tric

opht

halm

olog

istVA

lt 6

12

(HO

TVa c

hart

)80

099

0ndash

ndashAb

norm

al re

d re

flex

test

160

970

ndashndash

Scre

enin

g pa

ssf

ail

580

960

304

988

Rew

ri et

al

2013

6174

11 c

hild

ren

aged

10

ndash19

year

s81

7 ch

ildre

n w

ith se

lf-as

sess

ed im

paire

d vi

sion

aged

10

ndash19

year

s

Opt

omet

rist

VA le

61

2 (s

elf-

exam

inat

ion)

962

(94

5ndash97

4)

902

(87

8ndash92

2)

908

(88

6ndash92

7)

960

(94

1ndash97

2)

Lato

rre-A

rtea

ga

et a

l 20

1452

Teac

hers

33 c

hild

ren

aged

3ndash5

yea

rsO

phth

alm

ic a

ssist

ants

VA lt

69

in o

ne o

r bot

h ey

esndash

958

(92

8ndash98

7)

591

(36

3ndash81

9)

ndash

30 c

hild

ren

aged

5ndash1

1 ye

ars)

VA le

69

in o

ne o

r bot

h ey

esndash

930

(89

0ndash96

9)

478

(25

2ndash70

4)

ndash

Teer

awat

tana

non

et a

l 20

1456

Pre-

prim

ary

teac

hers

1132

chi

ldre

n p

re-p

rimar

y gr

ades

Oph

thal

mol

ogist

Pres

entin

g VA

lt 2

040

(lt

61

2) (lsquo

Ersquo ch

art)

250

(23

0ndash27

0)

980

(97

0ndash99

0)

ndashndash

Prim

ary

teac

hers

4171

chi

ldre

n p

rimar

y gr

ades

Pres

entin

g VA

lt 2

040

(6

12)

(Sne

llen

char

t)59

0 (5

70ndash

610

)98

0ndash

ndash

Priy

a et

al

2015

53Se

lect

ed te

ache

rs62

25 c

hild

ren

aged

6ndash1

7 ye

ars

Oph

thal

mic

team

VA lt

20

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Eval

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Eval

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ruCr

oss-

sect

iona

l (p

rosp

ectiv

e)35

5 te

ache

rsAs

sess

teac

her s

cree

ning

pro

gram

me

impl

emen

tatio

n fo

llow

ing

pilo

t pha

seH

igh

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et a

l 20

1757

Uni

ted

Repu

blic

of T

anza

nia

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s-se

ctio

nal

(pro

spec

tive)

120

scho

olch

ildre

n ag

ed 1

1ndash12

yea

rsEff

ectiv

enes

s of c

hild

-to-

child

hea

lth

prom

otio

n st

rate

gyH

igh

de M

elo

et a

l 20

1719

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ilCr

oss-

sect

iona

l (p

rosp

ectiv

e)74

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ary

and

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ndar

y sc

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aged

13

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year

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ectiv

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s of a

n ed

ucat

iona

l in

terv

entio

n on

the

topi

c of

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bilit

yLo

w

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jaria

et a

l 20

1747

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aRa

ndom

ized

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rolle

d tri

al46

0 se

cond

ary

scho

ol a

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ars

232

read

y-m

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tacl

es 2

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usto

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ade

spec

tacl

es

Com

pare

com

plia

nce

betw

een

read

y-

and

cust

om-m

ade

spec

tacl

esM

ediu

m

Paud

el e

t al

2017

59Vi

et N

amPr

ospe

ctiv

e co

hort

300

child

ren

aged

12ndash

15 y

ears

Asse

ss th

e eff

ect o

f eye

hea

lth

prom

otio

n on

eye

hea

lth li

tera

cy in

sc

hool

s

Hig

h

( continued)

(contin

ues

)



Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

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gbe

201

866N

iger

iaQ

ualit

ativ

e35

par

ents

of s

choo

lchi

ldre

n ag

ed 5

ndash12

year

sAs

sess

the

fact

ors t

hat i

nflue

nce

the

seek

ing

of e

ye-c

are

Med

ium

Nar

ayan

an amp

Ram

ani

2018

41In

dia

Non

-ran

dom

ized

cont

rolle

d tri

al84

42 se

cond

ary

scho

olch

ildre

n ag

ed 1

3ndash17

yea

rs sc

reen

ed 2

38 re

quire

d sp

ecta

cles

of

whi

ch 1

24 fo

rmed

the

inte

rven

tion

grou

p an

d 11

4 th

e co

ntro

l gro

up

Asse

ss sp

ecta

cle

and

refe

rral c

ompl

ianc

e fo

llow

ing

scho

ol sc

reen

ing

prog

ram

me

Low

a We

appr

aise

d th

e qu

ality

of s

tudy

met

hods

by

usin

g th

e M

ixed

Met

hods

App

raisa

l Too

l (v-

2011

) St

udie

s wer

e cl

assifi

ed a

s hig

h qu

ality

if gt

90

of c

riter

ia w

ere

adeq

uate

med

ium

qua

lity

if gt

60 to

90

of c

riter

ia w

ere

adeq

uate

low

qua

lity

if gt

30

to 6

0 o

f crit

eria

wer

e ad

equa

te a

nd v

ery

low

qua

lity

if le

30

crit

eria

wer

e ad

equa

te N

o st

udie

s of v

ery

low

qua

lity

wer

e el

igib

le fo

r inc

lusio

n so

no

stud

ies w

ere

excl

uded

bas

ed o

n th

is qu

ality

ass

essm

ent

( continued)

Figure 1

Table 2

Table 1



Stud

ySt

udy s

ampl

e an

d fo

llow

-up

perio

dNo

of p

artic

ipan

ts (

)Sp

ecta

cle co

mpl

ianc

e or

acc

epta

nce

Fact

ors a

sses

sed

for a

ssoc

iatio

n w

ith

incr

ease

d sp

ecta

cle co

mpl

ianc

e or

ac

cept

ance

Reas

ons r

epor

ted

for n

on-p

urch

ase

or

non-

wea

r

Ode

dra

et a

l 20

0848

n =

not

stat

ed

Una

nnou

nced

sing

le v

isit

3 m

onth

s afte

r int

erve

ntio

n

108

Wea

ring

37

0 (4

010

8)N

on-s

igni

fican

tc sex

Nam

e-ca

lling

con

cern

s ove

r saf

ety

of

spec

tacl

es (h

arm

) co

st

Keay

et a

l 20

1044

n =

428

U

nann

ounc

ed si

ngle

visi

t 1

mon

th a

fter d

ispen

sing

spec

tacl

es

415

(97

0)W

earin

g 4

65

(193

415

) in

po

sses

sion

27

(1

141

5)Si

gnifi

cant

c fem

ale

low

er in

com

e

spec

tacl

es V

A lt

66

pup

il siz

e ge

4 m

m

less

trou

ble

with

app

eara

nce

Non

-sig

nific

antc a

ge h

avin

g cu

stom

-m

ade

spec

tacl

es

NR

Sant

os e

t al

2011

37n

= 7

9 Si

ngle

visi

t 3 m

onth

s afte

r di

spen

sing

spec

tacl

es

62 (7

85)

Wea

ring

87

1 (5

462

)N

on-s

igni

fican

te sex

age

pre

sent

ing

VAPo

or fr

ame

to fa

ce a

djus

tmen

t pr

ejud

ice

from

col

leag

ues

Rust

agi e

t al

2012

36n

= 5

1 Si

ngle

visi

t 8 m

onth

s afte

r di

spen

sing

spec

tacl

es

48 (9

41)

Purc

hase

d 7

08

(34

48)

wea

ring

20

8

(10

48)

Non

-sig

nific

ante se

xH

arm

ful e

ffect

of s

pect

acle

s on

visio

n (5

79

22

38)

antic

ipat

ion

of te

asin

g fro

m

othe

r stu

dent

s (52

6

20

38)

diffi

culty

in

gett

ing

mar

ried

(50

0 1

938

)G

ogat

e et

al

2013

43n

= 2

312

Una

nnou

nced

sing

le v

isit a

t 6ndash

12 m

onth

s afte

r disp

ensin

g sp

ecta

cles

1018

(44

0)W

earin

g 2

95

(300

101

8) i

n po

sses

sion

21

o

f tho

se n

ot w

earin

g sp

ecta

cles

(15

718)

g

Sign

ifica

ntcf

myo

pia

lt ndash

200

D V

A lt

61

8 to

36

0 at

bas

elin

e h

ighe

r aca

dem

ic

perfo

rman

ce

Non

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nific

antcf

sex

age

VA

612

to

618

Teas

ed a

bout

spec

tacl

es (1

98

142

718

) sp

ecta

cles

bro

ken

(17

4 1

257

18)

spec

tacl

es a

t hom

e (1

63

117

718

)

Rew

ri et

al

2013

61n

= 7

42

Sing

le v

isit 9

wee

ks a

fter s

econ

d vi

sion

scre

enin

g

493

(66

4)Pu

rcha

sed

40

2 (1

984

93)

wea

ring

81

3

(of t

hose

who

pur

chas

ed)

(161

198

)

NR

NR

Glew

we

et a

l 20

1642

n =

197

8 As

sess

ed a

ccep

tanc

e of

re

ceiv

ing

spec

tacl

es ra

ther

than

w

earin

g

NR

Acce

pted

spec

tacl

es 7

00

(1

384

1978

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gnifi

cant

d mal

e w

orse

VA

hou

seho

ld

head

is a

teac

her

high

er to

wns

hip

per

capi

ta in

com

e N

on-s

igni

fican

t ha

ving

spec

tacl

es a

t ba

selin

e h

ouse

hold

hea

d is

a vi

llage

le

ader

hea

d ye

ars o

f sch

oolin

g te

st

scor

es c

ount

y lo

catio

n T

ibet

an s

choo

l le

vel

Hou

seho

ld h

ead

refu

sed

(31

5 1

875

94)

child

refu

sed

(15

0 8

959

4) c

anno

t ad

just

to sp

ecta

cles

(10

3 6

159

4)

D d

iopt

re N

R n

ot re

porte

d VA

visu

al a

cuity

a S

pect

acle

s wer

e re

com

men

ded

to b

e pu

rcha

sed

afte

r pro

visio

n of

a p

resc

riptio

n b

ut n

ot p

rovi

ded

b Int

erve

ntio

n pa

ckag

e co

nsist

ed o

f 23

com

pone

nts r

elat

ed to

spec

tacl

e fra

me

and

fit e

duca

tion

and

mot

ivat

ion

and

con

duct

of t

he sc

reen

ing

c Mul

tivar

iate

ana

lysis

d P

robi

t est

imat

e as

soci

ated

with

acc

eptin

g sp

ecta

cles

e U

niva

riate

ana

lysis

f M

yopi

a sa

mpl

e on

lyg P

erce

ntag

es h

ave

been

reca

lcul

ated

as d

iscre

panc

ies e

xist

ed b

etw

een

the

repo

rted

valu

es a

nd re

porte

d pe

rcen

tage

s Co

mpl

ianc

e ra

tes m

ay n

ot b

e re

liabl

e

( continued)



Tabl

e 3

Ab

ility

of v

ario

us ca

dres

to id

entif

y visi

on im

pairm

ent f

rom

revi

ew o

f sch

ool-b

ased

eye

-car

e pr

ogra

mm

es in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

ySc

reen

ing

cadr

ePo

pula

tion

scre

ened

Gold

stan

dard

Outc

ome

Perc

enta

ge

sens

itivi

ty

(95

CI)

Perc

enta

ge

spec

ificit

y (9

5 CI

)

PPV

(95

CI)

NPV

(95

CI)

Khan

deka

r et a

l 20

0951

Kind

erga

rten

te

ache

rs77

68 c

hild

ren

aged

3ndash6

yea

rsO

ptom

etris

tVA

lt 2

040

(61

2)

corre

ctab

le b

y sp

ecta

cles

of

gt plusmn

05

D

745

(72

7ndash76

3)

972

(96

7ndash97

6)

966

866

Taba

nsi e

t al

2009

55Te

ache

rs13

00 c

hild

ren

aged

6ndash1

1 ye

ars

Stud

y in

vest

igat

ors a

nd

doct

ors

VA lt

61

8 in

eith

er o

r bot

h ey

es53

398

479

394

7

Adhi

kari

amp Sh

rest

ha 2

01149

Cert

ified

med

ical

as

sista

nts

528

child

ren

aged

3ndash7

yea

rsPa

edia

tric

opht

halm

olog

istVA

lt 6

12

(HO

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hart

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099

0ndash

ndashAb

norm

al re

d re

flex

test

160

970

ndashndash

Scre

enin

g pa

ssf

ail

580

960

304

988

Rew

ri et

al

2013

6174

11 c

hild

ren

aged

10

ndash19

year

s81

7 ch

ildre

n w

ith se

lf-as

sess

ed im

paire

d vi

sion

aged

10

ndash19

year

s

Opt

omet

rist

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61

2 (s

elf-

exam

inat

ion)

962

(94

5ndash97

4)

902

(87

8ndash92

2)

908

(88

6ndash92

7)

960

(94

1ndash97

2)

Lato

rre-A

rtea

ga

et a

l 20

1452

Teac

hers

33 c

hild

ren

aged

3ndash5

yea

rsO

phth

alm

ic a

ssist

ants

VA lt

69

in o

ne o

r bot

h ey

esndash

958

(92

8ndash98

7)

591

(36

3ndash81

9)

ndash

30 c

hild

ren

aged

5ndash1

1 ye

ars)

VA le

69

in o

ne o

r bot

h ey

esndash

930

(89

0ndash96

9)

478

(25

2ndash70

4)

ndash

Teer

awat

tana

non

et a

l 20

1456

Pre-

prim

ary

teac

hers

1132

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ldre

n p

re-p

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y gr

ades

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thal

mol

ogist

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entin

g VA

lt 2

040

(lt

61

2) (lsquo

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art)

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0)

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Prim

ary

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ldre

n p

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y gr

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entin

g VA

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040

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12)

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llen

char

t)59

0 (5

70ndash

610

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0ndash

ndash

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a et

al

2015

53Se

lect

ed te

ache

rs62

25 c

hild

ren

aged

6ndash1

7 ye

ars

Oph

thal

mic

team

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20

30 (6

95

) in

eith

er

eye

ndash bndash b

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each

ers

3806

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ldre

n ag

ed 6

ndash17

year

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lt 2

030

(69

5) i

n ei

ther

ey

endash b

ndash bndash b

ndash b

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na e

t al

2015

54Te

ache

rs93

83 c

hild

ren

aged

6ndash1

5 ye

ars

Prim

ary

eye-

care

wor

ker

VA lt

69

579

2 (7

70ndash

812

)93

3 (9

27ndash

938

)ndash

ndashVA

lt 6

12

770

(74

1ndash79

7)

971

(96

7ndash97

4)

ndashndash

VA lt

61

555

0 (5

41ndash

597

)99

1 (9

88ndash

992

)ndash

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ur e

t al

2016

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ache

rs12

9 ch

ildre

n ag

ed le

16

year

sO

phth

alm

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ists

VA lt

69

in e

ither

eye

980

(88

0ndash99

9)c

278

(18

6ndash37

2)c

462

(36

6ndash56

1)c

957

(76

0ndash99

8)c

D d

iopt

re P

PV p

ositi

ve p

redi

ctiv

e va

lue

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neg

ativ

e pr

edic

tive

valu

e VA

visu

al a

cuity

a A

n HO

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ision

test

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char

t con

tain

s the

lette

rs H

O T

and

Vb S

ensit

ivity

and

spec

ifici

ty re

sults

not

pro

vide

d st

udie

s are

incl

uded

in th

e ta

ble

for c

ompl

eten

ess

c S

ensit

ivity

spe

cific

ity a

nd 9

5 c

onfid

ence

inte

rval

s wer

e ca

lcul

ated

from

repo

rted

valu

es o

f tru

e po

sitiv

e tr

ue n

egat

ive

false

pos

itive

and

false

neg

ativ

e
























Reacutesumeacute



Резюме











Resumen




















































































Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

ic re

view

of i

nter

vent

ions

to im

prov

e ey

e-ca

re se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

Hol

gui e

t al

2006

34M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

493

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

5ndash1

8 ye

ars

Asse

ss sp

ecta

cle

com

plia

nce

Low

Carv

alho

et a

l 20

0720

Braz

ilCr

oss-

sect

iona

l (p

rosp

ectiv

e)15

17 e

lem

enta

ry sc

hool

teac

hers

or p

rinci

pals

Asse

ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

Low

Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n (m

ean

age

12 y

ears

)As

sess

the

impa

ct o

f spe

ctac

les o

n se

lf-re

port

ed v

ision

hea

lthM

ediu

m

Cong

don

et a

l 20

0835

Sout

h Af

rica

Pros

pect

ive

obse

rvat

iona

l85

20 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n ag

ed 6

ndash19

year

sEv

alua

te re

fract

ive

erro

r cut

-offs

for

spec

tacl

e pr

ovisi

on to

mor

e eff

ectiv

ely

iden

tify

child

ren

with

impr

oved

visi

on

and

incr

ease

com

plia

nce

Low

Lew

alle

n et

al

2008

58U

nite

d Re

publ

ic o

f Tan

zani

aM

ixed

met

hods

20 sc

hool

s (10

inte

rven

tion

10

cont

rol)

139

6 sc

hool

child

ren

(gra

des 3

and

4)

Eval

uate

trac

hom

a ed

ucat

ion

outc

omes

in

clud

ing

know

ledg

e an

d hy

gien

e pr

actic

es

Hig

h

Li e

t al

2008

45Ch

ina

Pros

pect

ive

coho

rt18

92 se

cond

ary

scho

olch

ildre

n ag

ed 1

3ndash16

yea

rsAs

sess

the

dete

rmin

ants

of s

pect

acle

co

mpl

ianc

eM

ediu

m

Ode

dra

et a

l 20

0848

Uni

ted

Repu

blic

of T

anza

nia

Mix

ed m

etho

ds10

8 se

cond

ary

scho

ol st

uden

ts (a

vera

ge a

ge

15 y

ears

) 58

inte

rven

tion

grou

p 5

0 co

ntro

l gr

oup

Asse

ss re

ason

s for

poo

r com

plia

nce

follo

win

g in

-sch

ool p

rovi

sion

of

spec

tacl

es

Med

ium

Wed

ner e

t al

2008

38U

nite

d Re

publ

ic o

f Tan

zani

aRa

ndom

ized

cont

rolle

d tri

al12

5 se

cond

ary

scho

olch

ildre

n ag

ed 1

1ndash19

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h

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Table 2

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Ab

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Tabl

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Hig

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Eval

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rs 9

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ary

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y of

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red

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ary

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orke

rs

Hig

h

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g et

al

2015

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ina

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ctio

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spec

tive)

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ary

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ed ~

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rant

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d 15

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ren

Mea

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ecta

cle

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an

d ow

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hip

amon

g m

igra

nt c

hild

ren

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t al

2015

39Ch

ina

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omize

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ntro

lled

trial

693

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ary

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ildre

n ag

ed 1

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effec

t of t

he p

rovi

sion

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ned

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ince

ntiv

es o

n co

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e

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h

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et a

l 20

1642

Chin

aM

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y sc

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ine

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ct o

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e sp

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ce

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h

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l 20

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ium

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l 20

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ectiv

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l 20

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y-

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ediu

m

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el e

t al

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et N

amPr

ospe

ctiv

e co

hort

300

child

ren

aged

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ears

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ss th

e eff

ect o

f eye

hea

lth

prom

otio

n on

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lth li

tera

cy in

sc

hool

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h

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ues

)



Stud

yCo

untr

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iger

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ents

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n ag

ed 5

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fact

ors t

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nflue

nce

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ing

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ium

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an amp

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ani

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dom

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al84

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e co

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l gro

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ss sp

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rral c

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e fo

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ram

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a We

appr

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d th

e qu

ality

of s

tudy

met

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by

usin

g th

e M

ixed

Met

hods

App

raisa

l Too

l (v-

2011

) St

udie

s wer

e cl

assifi

ed a

s hig

h qu

ality

if gt

90

of c

riter

ia w

ere

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uate

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ium

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ere

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ery

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r inc

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no

stud

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uded

bas

ed o

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is qu

ality

ass

essm

ent

( continued)

Figure 1

Table 2

Table 1
























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Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

ic re

view

of i

nter

vent

ions

to im

prov

e ey

e-ca

re se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

Hol

gui e

t al

2006

34M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

493

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

5ndash1

8 ye

ars

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ss sp

ecta

cle

com

plia

nce

Low

Carv

alho

et a

l 20

0720

Braz

ilCr

oss-

sect

iona

l (p

rosp

ectiv

e)15

17 e

lem

enta

ry sc

hool

teac

hers

or p

rinci

pals

Asse

ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

Low

Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n (m

ean

age

12 y

ears

)As

sess

the

impa

ct o

f spe

ctac

les o

n se

lf-re

port

ed v

ision

hea

lthM

ediu

m

Cong

don

et a

l 20

0835

Sout

h Af

rica

Pros

pect

ive

obse

rvat

iona

l85

20 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n ag

ed 6

ndash19

year

sEv

alua

te re

fract

ive

erro

r cut

-offs

for

spec

tacl

e pr

ovisi

on to

mor

e eff

ectiv

ely

iden

tify

child

ren

with

impr

oved

visi

on

and

incr

ease

com

plia

nce

Low

Lew

alle

n et

al

2008

58U

nite

d Re

publ

ic o

f Tan

zani

aM

ixed

met

hods

20 sc

hool

s (10

inte

rven

tion

10

cont

rol)

139

6 sc

hool

child

ren

(gra

des 3

and

4)

Eval

uate

trac

hom

a ed

ucat

ion

outc

omes

in

clud

ing

know

ledg

e an

d hy

gien

e pr

actic

es

Hig

h

Li e

t al

2008

45Ch

ina

Pros

pect

ive

coho

rt18

92 se

cond

ary

scho

olch

ildre

n ag

ed 1

3ndash16

yea

rsAs

sess

the

dete

rmin

ants

of s

pect

acle

co

mpl

ianc

eM

ediu

m

Ode

dra

et a

l 20

0848

Uni

ted

Repu

blic

of T

anza

nia

Mix

ed m

etho

ds10

8 se

cond

ary

scho

ol st

uden

ts (a

vera

ge a

ge

15 y

ears

) 58

inte

rven

tion

grou

p 5

0 co

ntro

l gr

oup

Asse

ss re

ason

s for

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r com

plia

nce

follo

win

g in

-sch

ool p

rovi

sion

of

spec

tacl

es

Med

ium

Wed

ner e

t al

2008

38U

nite

d Re

publ

ic o

f Tan

zani

aRa

ndom

ized

cont

rolle

d tri

al12

5 se

cond

ary

scho

olch

ildre

n ag

ed 1

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yea

rsAs

sess

com

plia

nce

of fr

ee sp

ecta

cles

Hig

h

Khan

deka

r et a

l 20

0951

Islam

ic R

epub

lic o

f Ira

nM

ixed

met

hods

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aren

ts a

nd 1

5 te

ache

rsEv

alua

te sc

hool

visi

on sc

reen

ing

in

kind

erga

rten

inc

ludi

ng c

ost a

nd v

alid

ity

of te

ache

r use

Med

ium

Taba

nsi e

t al

2009

55N

iger

iaCr

oss-

sect

iona

l (p

rosp

ectiv

e)13

0 te

ache

rs 1

300

prim

ary

scho

olch

ildre

n ag

ed 6

ndash11

year

sAs

sess

acc

urac

y of

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her s

cree

ning

s co

mpa

red

with

rese

arch

team

doc

tors

Hig

h

Zeng

et a

l 20

0940

Chin

aRa

ndom

ized

cont

rolle

d tri

al74

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cond

ary

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olch

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n ag

ed 1

2ndash15

yea

rsEv

alua

te c

hild

renrsquo

s visi

on a

nd

satis

fact

ion

with

read

y-m

ade

spec

tacl

esM

ediu

m

Keay

et a

l 20

1044

Chin

aPr

ospe

ctiv

e ob

serv

atio

nal

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y sc

hool

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ears

Det

erm

ine

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t infl

uenc

es re

ady-

mad

e an

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stom

-mad

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com

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nce

Hig

h

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kari

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rest

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01149

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cer

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ical

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istan

tsAs

sess

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bilit

y of

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tified

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ical

as

sista

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n sc

hool

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ed v

ision

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com

pare

d w

ith p

aedi

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op

htha

lmol

ogist

s

Med

ium

Cong

don

et a

l 20

1165

Chin

aRa

ndom

ized

cont

rolle

d tri

al11

423

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

12ndash

17 y

ears

Effec

tiven

ess o

f an

educ

atio

nal

inte

rven

tion

to p

rom

ote

spec

tacl

e pu

rcha

se

Low

Nom

a et

al

2011

32Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

767

pare

nts

Det

erm

ine

reas

ons f

or n

on-a

dher

ence

to

oph

thal

mic

exa

min

atio

ns fo

llow

ing

scho

ol sc

reen

ing

Low

(contin

ues

)



Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Sant

os e

t al

2011

37Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

62 p

rimar

y sc

hool

child

ren

aged

6ndash1

1 ye

ars

with

refra

ctiv

e er

ror

Asse

ss c

ompl

ianc

e of

chi

ldre

n to

thei

r fir

st p

air o

f gla

sses

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Nom

a et

al

2012

33Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

14 6

51 p

rimar

y sc

hool

child

ren

aged

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ars

Det

erm

ine

reas

ons f

or n

on-a

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ence

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oph

thal

mic

exa

min

atio

ns fo

llow

ing

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ol sc

reen

ing

Hig

h

Pere

ira e

t al

2012

21Ti

mor

-Les

teCr

oss-

sect

iona

l (p

rosp

ectiv

e)21

scho

ol h

ealth

nur

ses

1819

chi

ldre

n sc

reen

edEv

alua

te e

ffica

cy o

f eye

hea

lth o

utre

ach

serv

ices

Med

ium

Raja

ram

an e

t al

2012

23In

dia

Mix

ed m

etho

ds52

chi

ldre

n ag

ed 9

ndash17

year

s 35

scho

ol st

aff

13 sc

hool

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lth c

ouns

ello

rs 4

par

ents

and

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icia

ns

Eval

uate

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effec

tiven

ess o

f del

iver

y of

sc

hool

hea

lth p

rom

otio

n by

lay

scho

ol

heal

th c

ouns

ello

rs

Hig

h

Rust

agi e

t al

2012

36In

dia

Mix

ed m

etho

ds51

seco

ndar

y sc

hool

child

ren

aged

11ndash

18 y

ears

sa

mpl

ed fo

r ref

ract

ion

out

of 1

075

scre

ened

Asse

ss th

e m

agni

tude

of v

ision

im

pairm

ent a

mon

g ch

ildre

n an

d th

eir

spec

tacl

e co

mpl

ianc

e

Med

ium

Bala

subr

aman

iam

et a

l 20

1364

Indi

aQ

ualit

ativ

e35

par

ents

with

scho

ol-a

ged

child

ren

and

16

eye-

care

spec

ialis

tsEff

ectiv

enes

s of s

choo

l visi

on sc

reen

ing

Med

ium

Gog

ate

et a

l 20

1343

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

e)10

18 se

cond

ary

scho

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ildre

n ag

ed

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yea

rsAs

sess

spec

tacl

e co

mpl

ianc

e am

ong

rura

l chi

ldre

nH

igh

Rew

ri et

al

2013

61In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

7411

seco

ndar

y sc

hool

child

ren

aged

11ndash

19 y

ears

Eval

uate

stud

ents

rsquo abi

lity

to se

lf-ex

amin

e th

eir v

ision

and

seek

inte

rven

tion

such

as

spec

tacl

es

Hig

h

Thum

mal

apal

li et

al

2013

60In

dia

Pros

pect

ive

obse

rvat

iona

l10

4 pr

imar

y sc

hool

teac

hers

Eval

uate

effe

ctiv

enes

s of e

ye h

ealth

pr

omot

ion

and

scre

enin

g in

terv

entio

n am

ong

teac

hers

Low

Bai e

t al

2014

62Ch

ina

Cros

s-se

ctio

nal

(retro

spec

tive)

19 9

77 p

rimar

y sc

hool

stud

ents

(in

grad

es 4

an

d 5)

Effec

tiven

ess o

f sch

ool v

ision

scre

enin

gM

ediu

m

Lato

rre-A

rtea

ga e

t al

2014

52Pe

ruCr

oss-

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iona

l (p

rosp

ectiv

e)21

teac

hers

Eval

uate

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tiven

ess o

f tea

cher

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sion

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enin

g an

d es

timat

e ch

ildho

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ror p

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ium

Ma

et a

l 20

1446

Chin

aRa

ndom

ized

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d tri

al31

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rimar

y sc

hool

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ars

in 2

51 sc

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sess

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effec

t of f

ree

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n ac

adem

ic p

erfo

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Puri

et a

l 20

1422

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aCr

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l (p

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hild

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and

71 te

ache

rs su

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alua

te sc

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on p

rogr

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eM

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m

Teer

awat

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l 20

1456

Thai

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ary

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ears

Asse

ss a

ccur

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ediu

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et a

l 20

1425

Chin

aM

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hods

136

urba

n pr

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y sc

hool

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l sec

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Asse

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e ta

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h

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aman

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ectiv

enes

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ptom

etry

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ents

in

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ngle

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h

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Stud

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2015

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Med

ium

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day

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l 20

1528

Tim

or-L

este

Mix

ed m

etho

ds38

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imar

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hool

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te

ache

rs a

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aren

ts (n

umbe

r und

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Eval

uate

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in-s

choo

l hea

lth

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otio

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nter

vent

ion

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ium

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erna

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ght

2015

29So

uth

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ndom

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al37

teac

hers

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in in

terv

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n gr

oup

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trol g

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ars)

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ss te

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r visu

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g fo

llow

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ing

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ium

Ma

et a

l 20

1531

Chin

aRa

ndom

ized

cont

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d tri

al28

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rimar

y sc

hool

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ren

aged

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ars

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49 sc

hool

sAs

sess

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safe

ty o

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ctac

les i

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ral

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ext w

here

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ar th

at sp

ecta

cles

ha

rm th

e ey

es is

an

impo

rtan

t bar

rier

Hig

h

Priy

a et

al

2015

53In

dia

Case

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trol

917

teac

hers

Asse

ss c

ost a

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ffect

iven

ess o

f sc

reen

ing

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ram

me

invo

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g al

l te

ache

rs c

ompa

red

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g a

limite

d nu

mbe

r of t

each

ers

Hig

h

Saxe

na e

t al

2015

54In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

40 te

ache

rs 9

838

prim

ary

scho

olch

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n ag

ed

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rsAs

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urac

y of

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her s

cree

ning

s co

mpa

red

with

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ary

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care

w

orke

rs

Hig

h

Wan

g et

al

2015

24Ch

ina

Cros

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ctio

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spec

tive)

4376

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ary

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ed ~

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ldre

n an

d 15

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cal c

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ren

Mea

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nce

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ecta

cle

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an

d ow

ners

hip

amon

g m

igra

nt c

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ren

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t al

2015

39Ch

ina

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omize

d co

ntro

lled

trial

693

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ary

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n ag

ed 1

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effec

t of t

he p

rovi

sion

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ned

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her

ince

ntiv

es o

n co

mpl

ianc

e

Hig

h

Glew

we

et a

l 20

1642

Chin

aM

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ntita

tive

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y sc

hool

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ears

Det

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ine

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impa

ct o

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e sp

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ic

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rman

ce

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h

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l 20

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ium

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l 20

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anza

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ectiv

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lth

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rate

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elo

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l 20

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ary

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l 20

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y-

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m

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t al

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et N

amPr

ospe

ctiv

e co

hort

300

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ren

aged

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ears

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ss th

e eff

ect o

f eye

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lth

prom

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n on

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lth li

tera

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h

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ues

)



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yCo

untr

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ePu

rpos

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ality

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iger

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ativ

e35

par

ents

of s

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n ag

ed 5

ndash12

year

sAs

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the

fact

ors t

hat i

nflue

nce

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seek

ing

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ye-c

are

Med

ium

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ayan

an amp

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ani

2018

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dom

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e qu

ality

of s

tudy

met

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by

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g th

e M

ixed

Met

hods

App

raisa

l Too

l (v-

2011

) St

udie

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e cl

assifi

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s hig

h qu

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of c

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uded

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ality

ass

essm

ent

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Figure 1

Table 2

Table 1





Resumen




















































































Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

ic re

view

of i

nter

vent

ions

to im

prov

e ey

e-ca

re se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

Hol

gui e

t al

2006

34M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

493

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

5ndash1

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ars

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ss sp

ecta

cle

com

plia

nce

Low

Carv

alho

et a

l 20

0720

Braz

ilCr

oss-

sect

iona

l (p

rosp

ectiv

e)15

17 e

lem

enta

ry sc

hool

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hers

or p

rinci

pals

Asse

ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

Low

Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n (m

ean

age

12 y

ears

)As

sess

the

impa

ct o

f spe

ctac

les o

n se

lf-re

port

ed v

ision

hea

lthM

ediu

m

Cong

don

et a

l 20

0835

Sout

h Af

rica

Pros

pect

ive

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rvat

iona

l85

20 p

rimar

y an

d se

cond

ary

scho

olch

ildre

n ag

ed 6

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year

sEv

alua

te re

fract

ive

erro

r cut

-offs

for

spec

tacl

e pr

ovisi

on to

mor

e eff

ectiv

ely

iden

tify

child

ren

with

impr

oved

visi

on

and

incr

ease

com

plia

nce

Low

Lew

alle

n et

al

2008

58U

nite

d Re

publ

ic o

f Tan

zani

aM

ixed

met

hods

20 sc

hool

s (10

inte

rven

tion

10

cont

rol)

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hool

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(gra

des 3

and

4)

Eval

uate

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hom

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omes

in

clud

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e pr

actic

es

Hig

h

Li e

t al

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45Ch

ina

Pros

pect

ive

coho

rt18

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cond

ary

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olch

ildre

n ag

ed 1

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rsAs

sess

the

dete

rmin

ants

of s

pect

acle

co

mpl

ianc

eM

ediu

m

Ode

dra

et a

l 20

0848

Uni

ted

Repu

blic

of T

anza

nia

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ed m

etho

ds10

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cond

ary

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ol st

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ts (a

vera

ge a

ge

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ears

) 58

inte

rven

tion

grou

p 5

0 co

ntro

l gr

oup

Asse

ss re

ason

s for

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r com

plia

nce

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win

g in

-sch

ool p

rovi

sion

of

spec

tacl

es

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ium

Wed

ner e

t al

2008

38U

nite

d Re

publ

ic o

f Tan

zani

aRa

ndom

ized

cont

rolle

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al12

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cond

ary

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n ag

ed 1

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plia

nce

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ee sp

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cles

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h

Khan

deka

r et a

l 20

0951

Islam

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epub

lic o

f Ira

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ixed

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aren

ts a

nd 1

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ache

rsEv

alua

te sc

hool

visi

on sc

reen

ing

in

kind

erga

rten

inc

ludi

ng c

ost a

nd v

alid

ity

of te

ache

r use

Med

ium

Taba

nsi e

t al

2009

55N

iger

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oss-

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l (p

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ectiv

e)13

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ache

rs 1

300

prim

ary

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n ag

ed 6

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sAs

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acc

urac

y of

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her s

cree

ning

s co

mpa

red

with

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arch

team

doc

tors

Hig

h

Zeng

et a

l 20

0940

Chin

aRa

ndom

ized

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rolle

d tri

al74

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cond

ary

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n ag

ed 1

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yea

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alua

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hild

renrsquo

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on a

nd

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fact

ion

with

read

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ade

spec

tacl

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ediu

m

Keay

et a

l 20

1044

Chin

aPr

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ctiv

e ob

serv

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nal

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ndar

y sc

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ears

Det

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ine

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t infl

uenc

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mad

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Hig

h

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amp Sh

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ical

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as

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ision

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pare

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aedi

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Med

ium

Cong

don

et a

l 20

1165

Chin

aRa

ndom

ized

cont

rolle

d tri

al11

423

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

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ears

Effec

tiven

ess o

f an

educ

atio

nal

inte

rven

tion

to p

rom

ote

spec

tacl

e pu

rcha

se

Low

Nom

a et

al

2011

32Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

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pare

nts

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erm

ine

reas

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or n

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ence

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thal

mic

exa

min

atio

ns fo

llow

ing

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ol sc

reen

ing

Low

(contin

ues

)



Stud

yCo

untr

ySt

udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Sant

os e

t al

2011

37Br

azil

Cros

s-se

ctio

nal

(pro

spec

tive)

62 p

rimar

y sc

hool

child

ren

aged

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ars

with

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ctiv

e er

ror

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ss c

ompl

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e of

chi

ldre

n to

thei

r fir

st p

air o

f gla

sses

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a et

al

2012

33Br

azil

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s-se

ctio

nal

(pro

spec

tive)

14 6

51 p

rimar

y sc

hool

child

ren

aged

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ars

Det

erm

ine

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ons f

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mic

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ns fo

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ol sc

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Hig

h

Pere

ira e

t al

2012

21Ti

mor

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teCr

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sect

iona

l (p

rosp

ectiv

e)21

scho

ol h

ealth

nur

ses

1819

chi

ldre

n sc

reen

edEv

alua

te e

ffica

cy o

f eye

hea

lth o

utre

ach

serv

ices

Med

ium

Raja

ram

an e

t al

2012

23In

dia

Mix

ed m

etho

ds52

chi

ldre

n ag

ed 9

ndash17

year

s 35

scho

ol st

aff

13 sc

hool

hea

lth c

ouns

ello

rs 4

par

ents

and

3

clin

icia

ns

Eval

uate

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effec

tiven

ess o

f del

iver

y of

sc

hool

hea

lth p

rom

otio

n by

lay

scho

ol

heal

th c

ouns

ello

rs

Hig

h

Rust

agi e

t al

2012

36In

dia

Mix

ed m

etho

ds51

seco

ndar

y sc

hool

child

ren

aged

11ndash

18 y

ears

sa

mpl

ed fo

r ref

ract

ion

out

of 1

075

scre

ened

Asse

ss th

e m

agni

tude

of v

ision

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pairm

ent a

mon

g ch

ildre

n an

d th

eir

spec

tacl

e co

mpl

ianc

e

Med

ium

Bala

subr

aman

iam

et a

l 20

1364

Indi

aQ

ualit

ativ

e35

par

ents

with

scho

ol-a

ged

child

ren

and

16

eye-

care

spec

ialis

tsEff

ectiv

enes

s of s

choo

l visi

on sc

reen

ing

Med

ium

Gog

ate

et a

l 20

1343

Indi

aCr

oss-

sect

iona

l (p

rosp

ectiv

e)10

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cond

ary

scho

olch

ildre

n ag

ed

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yea

rsAs

sess

spec

tacl

e co

mpl

ianc

e am

ong

rura

l chi

ldre

nH

igh

Rew

ri et

al

2013

61In

dia

Cros

s-se

ctio

nal

(pro

spec

tive)

7411

seco

ndar

y sc

hool

child

ren

aged

11ndash

19 y

ears

Eval

uate

stud

ents

rsquo abi

lity

to se

lf-ex

amin

e th

eir v

ision

and

seek

inte

rven

tion

such

as

spec

tacl

es

Hig

h

Thum

mal

apal

li et

al

2013

60In

dia

Pros

pect

ive

obse

rvat

iona

l10

4 pr

imar

y sc

hool

teac

hers

Eval

uate

effe

ctiv

enes

s of e

ye h

ealth

pr

omot

ion

and

scre

enin

g in

terv

entio

n am

ong

teac

hers

Low

Bai e

t al

2014

62Ch

ina

Cros

s-se

ctio

nal

(retro

spec

tive)

19 9

77 p

rimar

y sc

hool

stud

ents

(in

grad

es 4

an

d 5)

Effec

tiven

ess o

f sch

ool v

ision

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enin

gM

ediu

m

Lato

rre-A

rtea

ga e

t al

2014

52Pe

ruCr

oss-

sect

iona

l (p

rosp

ectiv

e)21

teac

hers

Eval

uate

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effec

tiven

ess o

f tea

cher

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sion

scre

enin

g an

d es

timat

e ch

ildho

od

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ctiv

e er

ror p

reva

lenc

e

Med

ium

Ma

et a

l 20

1446

Chin

aRa

ndom

ized

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rolle

d tri

al31

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rimar

y sc

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ren

aged

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ars

in 2

51 sc

hool

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sess

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effec

t of f

ree

spec

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e pr

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n ac

adem

ic p

erfo

rman

ceM

ediu

m

Puri

et a

l 20

1422

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aCr

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sect

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l (p

rosp

ectiv

e)54

04 c

hild

ren

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ars s

cree

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and

71 te

ache

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Chin

aM

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2015

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ium

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Eval

uate

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l hea

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ium

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2015

29So

uth

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in in

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oup

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ium

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1531

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ars

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49 sc

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ar th

at sp

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rm th

e ey

es is

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h

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a et

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53In

dia

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trol

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teac

hers

Asse

ss c

ost a

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iven

ess o

f sc

reen

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ram

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red

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g a

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d nu

mbe

r of t

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h

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na e

t al

2015

54In

dia

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ctio

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spec

tive)

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ache

rs 9

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ary

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urac

y of

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cree

ning

s co

mpa

red

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ary

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orke

rs

Hig

h

Wan

g et

al

2015

24Ch

ina

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ctio

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spec

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Mea

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39Ch

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ntro

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t of t

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n co

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e

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h

Glew

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et a

l 20

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Chin

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ntita

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Det

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ct o

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h

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l 20

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ium

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y-

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et N

amPr

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ctiv

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hort

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ren

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ears

Asse

ss th

e eff

ect o

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lth

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lth li

tera

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untr

ySt

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ed 5

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ors t

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ye-c

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ium

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an amp

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ani

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41In

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e qu

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tudy

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g th

e M

ixed

Met

hods

App

raisa

l Too

l (v-

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udie

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e cl

assifi

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s hig

h qu

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uded

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ality

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Figure 1

Table 2

Table 1



































































Tabl

e 1

St

udie

s ide

ntifi

ed in

the

syst

emat

ic re

view

of i

nter

vent

ions

to im

prov

e ey

e-ca

re se

rvice

s for

scho

olch

ildre

n in

low

- and

mid

dle-

inco

me

coun

trie

s

Stud

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untr

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udy d

esig

nSt

udy s

ampl

ePu

rpos

eQu

ality

app

raisa

la

Cast

anon

Hol

gui e

t al

2006

34M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

493

prim

ary

and

seco

ndar

y sc

hool

child

ren

aged

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ars

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ss sp

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cle

com

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nce

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alho

et a

l 20

0720

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ilCr

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sect

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l (p

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enta

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hool

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hers

or p

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pals

Asse

ss te

ache

r per

cept

ions

of s

choo

l vi

sual

hea

lth c

ampa

igns

Low

Este

so e

t al

2007

26M

exic

oPr

ospe

ctiv

e ob

serv

atio

nal

96 p

rimar

y an

d se

cond

ary

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olch

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n (m

ean

age

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ears

)As

sess

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impa

ct o

f spe

ctac

les o

n se

lf-re

port

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ision

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m

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don

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l 20

0835

Sout

h Af

rica

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pect

ive

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iona

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20 p

rimar

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alua

te re

fract

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mor

e eff

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tify

child

ren

with

impr

oved

visi

on

and

incr

ease

com

plia

nce

Low

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alle

n et

al

2008

58U

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publ

ic o

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zani

aM

ixed

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hool

s (10

inte

rven

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10

cont

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(gra

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Eval

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Hig

h

Li e

t al

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45Ch

ina

Pros

pect

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rt18

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ary

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dete

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dra

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l 20

0848

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rven

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p 5

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l gr

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ason

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nce

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ium

Wed

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t al

2008

38U

nite

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publ

ic o

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ndom

ized

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al12

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cond

ary

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h

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l 20

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ixed

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rten

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ludi

ng c

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alid

ity

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ache

r use

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ium

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ary

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Hig

h

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l 20

0940

Chin

aRa

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on a

nd

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fact

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read

y-m

ade

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l 20

1044

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ctiv

e ob

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Hig

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ision

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Cong

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1165

Chin

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seco

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tiven

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educ

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rom

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tacl

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rcha

se

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Nom

a et

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2011

32Br

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ctio

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pare

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erm

ine

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mic

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min

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(contin

ues

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Stud

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untr

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ampl

ePu

rpos

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ality

app

raisa

la

Sant

os e

t al

2011

37Br

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Cros

s-se

ctio

nal

(pro

spec

tive)

62 p

rimar

y sc

hool

child

ren

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ars

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ctiv

e er

ror

Asse

ss c

ompl

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e of

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n to

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r fir

st p

air o

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sses

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a et

al

2012

33Br

azil

Cros

s-se

ctio

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(pro

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14 6

51 p

rimar

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ren

aged

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ars

Det

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ine

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mic

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Hig

h

Pere

ira e

t al

2012

21Ti

mor

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sect

iona

l (p

rosp

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scho

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ealth

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ses

1819

chi

ldre

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reen

edEv

alua

te e

ffica

cy o

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hea

lth o

utre

ach

serv

ices

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ium

Raja

ram

an e

t al

2012

23In

dia

Mix

ed m

etho

ds52

chi

ldre

n ag

ed 9

ndash17

year

s 35

scho

ol st

aff

13 sc

hool

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ouns

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rs 4

par

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ns

Eval

uate

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tiven

ess o

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iver

y of

sc

hool

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lth p

rom

otio

n by

lay

scho

ol

heal

th c

ouns

ello

rs

Hig

h

Rust

agi e

t al

2012

36In

dia

Mix

ed m

etho

ds51

seco

ndar

y sc

hool

child

ren

aged

11ndash

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ears

sa

mpl

ed fo

r ref

ract

ion

out

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ss th

e m

agni

tude

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pairm

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g ch

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n an

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eir

spec

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e co

mpl

ianc

e

Med

ium

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subr

aman

iam

et a

l 20

1364

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aQ

ualit

ativ

e35

par

ents

with

scho

ol-a

ged

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ren

and

16

eye-

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spec

ialis

tsEff

ectiv

enes

s of s

choo

l visi

on sc

reen

ing

Med

ium

Gog

ate

et a

l 20

1343

Indi

aCr

oss-

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l (p

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n ag

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sess

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ong

rura

l chi

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igh

Rew

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al

2013

61In

dia

Cros

s-se

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nal

(pro

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tive)

7411

seco

ndar

y sc

hool

child

ren

aged

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ears

Eval

uate

stud

ents

rsquo abi

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Table 2

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Figure 1

Table 2

Table 1



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ixed

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amPr

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ctiv

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ect o

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ixed

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raisa

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Figure 1

Table 2

Table 1



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ixed

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h qu

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of c

riter

ia w

ere

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uate

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lity

if gt

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of c

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lity

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to 6

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uded

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is qu

ality

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essm

ent

( continued)

Figure 1

Table 2

Table 1

Interventions to improve school-based eye-care services in ... · School-based eye-care...

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