Refractive error in children

Visual health is linked to school achievement. PAKISTAN

Caption: Young girl having her visual acuity tested in Pakistan, as part of a broader school health initiative.


Refractive errors in children

Programs for the detection and treatment of significant refractive error in school children are popular in many developing countries. However, children often do not wear their spectacles and there remain other unanswered questions.



Standard Guidelines for Comprehensive School Eye Health ProgramsStandard Guidelines for Comprehensive School Eye Health Programs

  • This document has been developed in a joint collaboration between Sightsavers International, London School of Hygiene and Tropical Medicine and the Brien Holden Vision Institute.
  • Authors: Clare Gilbert, Hasan Minto, Priya Morjaria, Imran Khan.
  • Contributing authors: David Wilson, May Ho, Pirindha Govender, Andrew Bastawrous.
  • Support acknowledged: Daveena Brain, Brien Holden Vision Institute Design and
  • Communications – Frelda Cedeno, Emimari Riquezes, Andres Diaz.

Standard Guidelines for Comprehensive School Eye Health Programs. – PDF

Review Article: 

  • Abhishek Sharma, Nathan Congdon, Mehul Patel, and Clare Gilbert.  A review of school-based approaches to the correction of refractive error in children. Surveys in Ophthalmol. 2012 57 272-283. Abstract.

Visual acuity testing in a school, Brazil

Caption: Vision screening in China, where myopia is very common.

Clinical trial of free spectacles vs a prescription for spectacles in Tanzania

In this trial, secondary schools were randomized to two arms: in one arm children needing spectacles were given free spectacles, and in the other they were given a prescription for spectacles. At follow up a significantly higher proportion of children given free spectacles were wearing them. Reasons for non-wear were also explored.


  • Wedner , Masanja H., Bowman R., Todd J. , Bowman R and Gilbert CE. Two strategies for correcting refractive errors in school students in Tanzania: randomised comparison, with implications for screening programmes. Brit J Ophthalmol. 2008 92 19-24. Abstract.
  • Nita Odedra, Susanne H Wedner, Zachayo S. Shigongo, Kija Nyalali and Clare Gilbert. Barriers to spectacle-use in Tanzanian secondary school students. Ophthalmic Epidemiology 2008 15: 410-7. Abstract.

Clinical trial to compare ready made spectacles (i.e. with the same spherical prescription in each eye) with standard prescription spectacles in India

A study to assess the utility and cost savings to programmes of ready-made spectacles (i.e., they have the same power in each eye, without astimagtism) is currently being undertaken in India. Children with significant refractive error who would be eligible for ready-made spectacles are being randomized to ready-made spectacles or full-prescription spectacles. The outcome is spectacle wear at 3-4 months, and the cost saving to programmes.


L’Occitane Foundation
Vision Impact Institute


  • Sankara Eye Care Institutes, Bangalore