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Original Investigation
February 18, 2021

Prevalence and Factors Associated With Eyeglass Wear Compliance Among Preschoolers From Low-Income Families in San Francisco, California

Author Affiliations
  • 1Tufts University School of Medicine, Boston, Massachusetts
  • 2San Francisco Partnerships for Children’s Vision, San Francisco, California
  • 3University of California San Francisco School of Medicine, San Francisco
  • 4Department of Ophthalmology, University of California, San Francisco
JAMA Ophthalmol. 2021;139(4):433-440. doi:10.1001/jamaophthalmol.2020.7053
Key Points

Question  What is the prevalence of eyeglass use compliance among preschool children from low-income families, and what factors are associated with this compliance?

Findings  In this longitudinal cross-sectional study of 188 preschool students, 133 (71%) were consistently compliant with eyeglass wear during the 2017 to 2018 school year. Baseline uncorrected visual acuity was significantly associated with consistent eyeglass wear.

Meaning  Among preschoolers receiving free glasses through a school-based program, compliance with eyeglass wear was relatively stable throughout the school year, and compliance was solely associated with poor baseline visual acuity.


Importance  Despite growing support for early school-based vision screening and eyeglass provision, few studies have rigorously monitored the compliance of eyeglass wear among preschool-aged children who receive eyeglasses through such programs.

Objective  To assess the prevalence and factors associated with eyeglass wear compliance among preschoolers from low-income families who receive eyeglasses through the See Well to Learn program.

Design, Setting, and Participants  Longitudinal cross-sectional study of eyeglass wear compliance patterns among 188 children 3 to 5 years of age from 51 Bay Area Head Start preschools in San Francisco, California. The study conducted during the 2017 to 2018 school year included students with a failed vision screening who met predetermined refractive criteria following cycloplegic refraction and received eyeglasses through the See Well to Learn program.

Exposures  Eyeglass distribution.

Main Outcomes and Measures  Eyeglass wear compliance, measured by a school-year’s worth of weekly teacher reports, was a longitudinal measure of consistent eyeglass wear, defined by eyeglass wear for more than 50% of every school day (compliance score of 4).

Results  Of 188 students (91 boys [49%]; 94 girls [51%]; mean [SD] age, 3.89 [0.5] years), 133 (71%; 95% CI, 64%-77%) maintained a mean compliance score throughout the school year of 4 or higher. Compliance prevalence was relatively stable throughout the school year, ranging from 139 students (74%) to 164 students (87%). Baseline uncorrected visual acuity in both the better-seeing and worse-seeing eyes was the only assessed factor that was associated with compliance. In the better-seeing eye, the mean uncorrected visual acuity of students with eyeglass wear compliance was 0.473 logMAR (95% CI, 0.433-0.514) (Snellen equivalent, 20/60) compared with 0.394 logMAR (95% CI, 0.334-0.454) (Snellen equivalent, 20/50) for students with noncompliance (P = .03). In the worse-seeing eye, the mean uncorrected visual acuity of students with compliance was 0.576 logMAR (95% CI, 0.530-0.623) (Snellen equivalent, 20/75) compared with 0.492 logMAR (95% CI, 0.433-0.551) (Snellen equivalent, 20/62) for students with noncompliance (P = .03). In the better-seeing eye, the difference between students with compliance vs noncompliance was 0.079 logMAR (95% CI, 0.009-0.150) (5 Snellen letter difference) compared with 0.084 logMAR (95% CI, 0.007-0.160) (5 Snellen letter difference) in the worse-seeing eye.

Conclusions and Relevance  This study found that nearly 3 of 4 preschool students consistently wore their glasses at school during their first year of use, supporting the continued implementation of preschool-based vision screening programs. These findings suggest that programs involving school-based screening and eyeglass delivery may lessen disparities in accessing pediatric vision care. Consistent with previous studies, students with poorer uncorrected baseline visual acuity were found to be more likely to wear eyeglasses compliantly.

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