|Year : 2010 | Volume
| Issue : 1 | Page : 83-87
Challenges, Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy
Abdulkabir A Ayanniyi1, Feyi G Adepoju2, Rashidat O Ayanniyi3, Regina E Morgan4
1 Department of Ophthalmology, University of Abuja, Abuja, Nigeria
2 Department of Ophthalmology, University of Ilorin, Abuja, Nigeria
3 Department of Pharmacology and Therapeutics, University of Ilorin, Abuja, Nigeria
4 Department of Pharmacology and Therapeutics, National Hospital, Abuja, Nigeria
|Date of Web Publication||22-Mar-2010|
Abdulkabir A Ayanniyi
Department of Ophthalmology, College of Health Sciences, University of Abuja, P.M.B 117, FCT
| Abstract|| |
Purpose: To evaluate challenges, attitudes and practices among spectacle wearers to effect positive change when necessary, and determine positive change in a resource-limited economy.
Materials and Methods: A multi-hospital descriptive, cross sectional survey of spectacle wearers was conducted between May 2007 and December 2008 in Nigeria.
Results: A total of 214 wearers comprising 43.5% males and 56.5% females aged 18-84 years were surveyed. The majority of subjects (92.6%) had at least secondary education. The wearers' challenges included expensive spectacles (43.0%), falling/ scratched/broken lenses (29.4%) and fear that spectacles would damage the eyes (23.8%). The wearers' attitudes were comprised of consultations with 'road side dispensers' (7%) and permitting other individuals to select spectacle frames for them (26%). Care and maintaince practices included use of handkerchief, tissue paper, fingers and water to clean spectacles (49.5%) and placing spectacles inside spectacle cases (30.4%). There were no associations (P > 0.05) between gender or literacy levels and who selected the frames for the subjects, caregivers consulted for spectacles, and cleaning materials for spectacles. The placement of spectacles when not in use was significantly associated (P < 0.05) with the wearers' gender and literacy levels but not with the length of spectacle wear.
Conclusion: Attitudes and practices requiring positive change crossed gender and educational levels among spectacle wearers. The cost of spectacles should be regulated and availability of standard eye care practices would reduce challenges including lens-related defects and quackery. During consultation with a recognized eye care professional, counseling of wearers on positive attitudes/practices as well as allaying fear of spectacle wear is required.
Keywords: Attitudes, Challenges, Positive Change, Practices, Spectacles, Wearers
|How to cite this article:|
Ayanniyi AA, Adepoju FG, Ayanniyi RO, Morgan RE. Challenges, Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy. Middle East Afr J Ophthalmol 2010;17:83-7
|How to cite this URL:|
Ayanniyi AA, Adepoju FG, Ayanniyi RO, Morgan RE. Challenges, Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy. Middle East Afr J Ophthalmol [serial online] 2010 [cited 2015 Mar 1];17:83-7. Available from: http://www.meajo.org/text.asp?2010/17/1/83/61223
| Introduction|| |
Spectacles or eyeglasses are frames bearing lenses worn in front of the eyes, usually to enhance vision. ,,,,, Other reasons for spectacle wear include eye protection, to conceal eyes defects and as a fashion accesory.  Despite the increasing popularity of contact lenses and refractive surgery ,, , the use of spectacles still remains the most popular method of correcting refractive errors. ,,,,
Despite inherent merits such as control over their use, spectacles do pose some significant challenges. For example, spectacles are not readily affordable ,, by many who require them and can be a source of ocular discomfort especially when incorrectly prescribed. Refractive errors are a major cause of visual impairment globally.  There has been abuse of spectacle dispensing due to a lack of standardization, superfluous prescriptions and distribution by individuals who have no professional experience in eye care or dispensing. ,
Although many studies had been conducted on refractive errors ,,,,, there comparatively few studies on attitudes and practices among spectacle wearers. The aim of this study was to provide knowledge to bridge this important gap. The findings in this study are important and will assist stakeholders in the eye care industry to enhance eye care.
| Materials And Methods|| |
This was a prospective, cross-sectional study conducted between May 2007 and December 2008 at six health facilities in Nigeria. The six health facilities were located in the cities of Ilorin and Ado Ekiti, both state capitals in Nigeria.
The participants in this study were spectacle wearers who presented for eye consultations in the eye clinics of the six health care facilities. The criteria for inclusion in the study were age 18 years or older, current use of spectacles for a period of at least six months, and consent to participate in the study. Informed consent was obtained from all subjects and the study was performed in accordance with the tenets of the Declaration of Helsinki. Each subject was interviewed using a prepared questionnaire. The questionnaire had been previously pretested at one of the health facilities in Ilorin, on spectacle wearers who were not included in the analysis. The questionnaire covered the demographic parameters, challenges, attitudes and practices on the use of spectacles.
The data were entered into SPSS 15.0 (SPSS Inc., Chicago, IL, USA), and analyzed. The associations were tested using the Chi square test and was considered significant at a level of P < 0.05.
| Results|| |
Two hundred and fourteen spectacle wearers comprised of 93 (43.5%) males and 121 (56.5%) females were surveyed. The mean age of the study cohort was 40.2 ± 15.8 years (range, 18 years to 84 years). Cohort demographics are presented in [Table 1]. All subjects wore spectacles for at least six months and 194 (90.7%) subjects found the spectacles were satisfactory or very satisfactory for their needs [Table 2].
The most frequent reasons for spectacle wear were reading in 80 (37.4%) subjects and distance vision in 80 (37.4%) subjects [Figure 1]. There were a number of challenges to spectacle wear with the high cost of the spectacles being the most common [Table 3].
Subjects consulted a variety of providers to buy spectacles including 'road side dispensers' 16 (7%) [Figure 2]. In 26.2% of the cases, spectacle frames were not selected by the wearers [Table 4]. Almost half of the cohort (49.5%) did not use a lens cleaner to clean their spectacles [Table 5]. Spectacles were not stored in their cases by 30.4% of the cohort [Table 5].
There were no associations between subject gender and the individual who selected their frames ( P = 0.234), or the caregivers whom the subjects consulted for spectacles ( P = 0.055), or the cleaning materials used ( P = 0.732). There were no associations between the subjects' educational level and who selected the frames for them ( P = 0.216), or the caregivers whom they consulted for spectacles ( P = 0.129), or the cleaning regimen ( P = 0.372). There was no assocation in the duration of spectacles use and how the spectacles were stored ( P = 0.141). Gender ( P = 0.006) and educational levels ( P = 0.029) were significantly associated with how the spectacles were stored.
| Discussion|| |
This study found a significant association between gender and the method used by subjects to store their spectacles. However, the gender was skewed in this study with females being 1.3 times greater than the number of males. Analyses found that gender had no association with who selected the frames for the subjects.
The two most common age groups (21-30 years; 41-50 years) using spectacles correlated with vocations such as civil service and school attendance, due to the need for clear vision. Subjects in the 41-50 years age category required presbyopic spectacles to function effectively and perform at an optimal level.
Over 90% of the study cohort had at least secondary education which was commensurate with the two most common reasons for spectacle wear (reading and clear vision). Similar to previous studies ,,, that underscore the positive influence of education on health conditions, we found the education level was significantly associated with the way subjects frequently stored their spectacles. Remarkably, higher educational levels were not associated to who selected the spectacle frames for the subjects. It was observed that the wearers consulted the caregivers on the choice of spectacles, and the cleaning materials required for the spectacles.
In this cohort, 75% of the subjects had worn spectacles for at least a year and the remaining individuals for at least six months. This duration of wear makes their views representative of the spectacle wearing population. However, we found, the duration of spectacles use had no relationship with how the spectacles were frequently stored.
In this study, the overwhelming majority of the cohort (90.2%) confirmed the utility of spectacles. This was likely due to the fact that spectacle wear allowed invidividuals to see well. Undoubtedly, the use of spectacles can improve the quality of life of many individuals who have uncorrected refractive errors.  Visual impairment due to uncorrected refractive error is a global health burden. However, this is a treatable form of blindness with a positive effect on quality of life when corrected. The effective use of spectacles in correcting visual impairment and blindness from refractive errors will improve quality of life by enhancing educational opportunities among children and by inclusion of adults in productive working life.  Other significant effects include the reduction of morbidity from hip fractures and falls among the elderly. 
Notably, most subjects consulted eye care professionals for their spectacles. The subjects who were displeased with the use of spectacles should be those who had significant challenges using spectacles. The consultation of 'road side dispensers' suggested ignorance on the part of some subjects. It was not unusual for some spectacle wearers to circumvent professional services by consulting quacks for a number of reasons including the 'false belief' of cost savings.
Important challenges were expressed by spectacles wearers in this study. Many wearers identified the cost of spectacles as an important issue. In Tanzania, a study identified cost of spectacles as one of barriers to spectacles use by secondary school students.  Other problems including falling/scratched/ broken lenses could be reduced with consumer education and by the spectacle dispensers. For example, the providers should make available affordable, quality spectacles while the wearers should seek spectacles from specialists and practice proper care and maintenance of their spectacles. The challenges of distorted vision and incorrect prescriptions could be minimised by obtaining spectacles from eyecare professionals. This could also reduce the incidence of quackery, providing a 'double barrel' solution, as quackery could only thrive if there is demand.
The fear of spectacles damaging the eyes although unfounded,was a significant hinderance to spectacle use and is not limited to this report. In studies of Chinese children, a common reason for not wearing spectacles was the belief that spectacles weaken the eyes. , In a report among secondary school students in Tanzania, this 'fear' was referred to as 'parental concerns about safety of spectacle use' and listed among the barriers to use of spectacles by students.  It has been suggested that spectacle wear could disrupt normal 'emmetropization' (which depends on growth of the eye, the refractive state, and visual stimulation) in infants. Yet, the long term effect of spectacles on normal changes in the refractive error of the human eye is negligible.  The fear of spectacles damaging the eyes should be directly addressed and the concerns alleviated during consultations at eye care clinics.
The 7.5% of subjects who reported the weight of spectacles as a challenge to spectacle wear could have been aphakes or high myopes or hyperopes. Apart from the unfounded fear of ocular damage due to spectacle wear, other challenges as expressed by the wearers were genuine and should be addressed by stakeholders in eye care. Appropriate health education of wearers on care for spectacles should be provided at eye care clinics. The eye care providers should ensure that effective and affordable spectacles are made available to the spectacle wearing population. Self selection of frames may reduce dissatisfaction with frames that may otherwise be selected by other individuals who may have the same tastes. The practice of cleaning spectacles with lens cleaner and storing them in their cases was acceptable and should be reinforced at consultations. Additionally educating wearers on avoiding the use of materials that are not recommended for cleaning their lenses and proper storing and handling would enhance the longevity of spectacles.
One caveat remains, a resource-limited economy has an inadequate number of eye care providers. The ophthalmologists and optometrists who are the key players in managing un-corrected refractive errors are inadequate in number and are available mainly in major cities. This lack of availability and inadequate distribution results in the majority of individuals with refractive error being underserviced or neglected.  However other eye care professionals such as refractionists, opticians and ophthalmic technicians with limited training but relevant skills should be available to provide basic services for the correction of refractive error including presbyopia correction at primary and secondary eye care clinics. This solution would result in the majority of the population being effectively served. , We recommend that refractionists, opticians and ophthalmic technicians update their knowledge and skills through periodic retraining. The availability of adequately trained eye care providers would reduce incidence of spectacle intolerance from improperly fitted lenses, distorted vision, incorrect prescriptions and quackery.
In conclusion, attitudes and practices requiring positive change cut across gender and educational levels among spectacle wearers. One possible solution is regulation of the cost of spectacles. Availability of qualified eye care providers in sufficient numbers can ensure standard eye care practices that would reduce spectacle-associated challenges including lens related defects and quackery. Spectacle wearer and prospective candidates should be educated on spectacles wear, emphasizing positive attitudes and practices, and eliminating unfounded fear of spectacles during consultations.
| References|| |
|1.||Ramke J, Williams C, Ximenes L, Ximenes D, Palagyi A, du Toit R, et al. A public-private partnership to provide spectacles for Timor-Leste. Community Eye Health J 2007;20:54. |
|2.||Holden BA, Sulaiman S, Knox K. The challenge of providing spectacles in the developing word. Community Eye Health J 2000;13:9-10. |
|3.||Dandona R, Dandona L, Kovai V, Giridhar P, Prasad MN, Srinivas M. Population-based study of spectacles use in southern India. Indian J Ophthalmol 2002;50:145-55. [PUBMED] |
|4.||Jayanand NS. Population-based study of spectacles use in southern India. Indian J Ophthalmol 2002;50:250. [PUBMED] |
|5.||Michon J, Michon L. Popularising eye health services in southern Mexico: Community workers meet a felt need. Community Eye Health J 2006;19:64-5. |
|6.||Piipo LJ, Coats DK. Pediatric spectacle prescription. Comp Ophthalmol Update 2002;3:113-22. |
|7.||Solomon KD, Fernández de Castro LE, Sandoval HP, Biber JM, Groat B, Neff KD, et al. LASIK world literature review: Quality of life and wearer satisfaction. Ophthalmology 2009;116:691-701. |
|8.||Hersh PS, Brint SF, Maloney RK, Durrie DS, Gordon M, Michelson MA, et al. Photorefractive keratectomy versus laser in situ keratomileusis for moderate to high myopia: A randomized prospective study. Ophthalmology 1998;105:1512-22. |
|9.||Schallhorn SC, Farjo AA, Huang D, Boxer Wachler BS, Trattler WB, Tanzer DJ, et al. Wavefront-guided LASIK for the correction of primary myopia and astigmatism a report by the American Academy of Ophthalmology. Ophthalmology 2008;115:1249-61. |
|10.||Dandona R, Dandona L. Refractive error blindness. Bull World Health Organ 2001;79:237-43. [PUBMED] |
|11.||Dandona R, Dandona L. Review of findings of the Andhra Pradesh eye disease study: Policy implications for eye-care services. Curr Ophthalmol 2001;49:215-34. |
|12.||Holden BA, Fricke TR, Ho M, Wong R, Schlenther G, Cronjé S, et al. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol 2008;126:1731-9. |
|13.||Holden BA. Uncorrected Refractive error: The major and most easily avoidable cause of vision loss. Community Eye Health J 2007;20:37-9. |
|14.||Dandona R, Dandona L, Srinivas M, Giridhar P, McCarty CA, Rao GN. Population-based assessment of refractive error in India: The Andhra Pradesh eye disease study. Clin Experiment Ophthalmol 2002;30:84-93. [PUBMED] |
|15.||McCarty CA. Refractive error: Uncorrected refractive error. Br J Ophthalmol 2006;90:521-2. [PUBMED] |
|16.||The Blue Mountains Eye Study. Br J Ophthalmol 2002;86:1041-5. |
|17.||Fredrick DR. Myopia. BMJ 2002;324:1195-9. [PUBMED] |
|18.||Krishnaiah S, Kovai V, Srinivas M, Shamanna BR, Rao GN, Thomas R. Awareness of glaucoma in the rural population of Southern India. Commun Ophthalmol 2005;53:205-8. |
|19.||Yun LS, Hassan Y, Aziz NA, Awaisu A, Ghazali R. A comparison of knowledge of diabetes mellitus between wearers with diabetes and healthy adults: A survey from north Malaysia. Wearer Educ Couns 2007;69:47-54. |
|20.||Al Shafaee MA, Al-Shukaili S, Rizvi SG, Al Farsi Y, Khan MA, Ganguly SS, et al. Knowledge and perceptions of diabetes in a semi-urban Omani population. BMC Public Health 2008;8:249. |
|21.||Mansouri K, Orgül S, Meier-Gibbons F, Mermoud A. Awareness about glaucoma and related eye health attitudes in Switzerland: A survey of the general public. Ophthalmologica 2006;220:101-8. |
|22.||Klein BE, Klein R, Lee KE, et al. Performance-based and self-assessed measures of visual function as related to history of falls, hip fractures and measured gait time: The Beaver Dam Eye Study. Ophthalmology1998;105:160-4. |
|23.||Odedra N, Wedner SH, Shigongo ZS, Nyalali K, Gilbert C. Barriers to spectacle use in Tanzanian secondary school students. Ophthalmic Epidemiol 2008;15:410-7. [PUBMED] |
|24.||Congdon N, Zheng M, Sharma A, Choi K, Song Y, Zhang M, et al. Prevalence and determinants of spectacle nonwear among rural Chinese secondary schoolchildren: The Xichang Pediatric Refractive Error Study Report 3. Arch Ophthalmol 2008;126:1717-23. |
|25.||Li L, Song Y, Liu X, Lu B, Choi K, Lam DS, et al. Spectacle Acceptance among Secondary School Students in Rural China: The Xichang Pediatric Refractive Error Study (X-PRES)-Report 5. Investig Ophthalmol Visual Sci 2008;49:2895-902. |
|26.||Holden BA, Resnikoff S. The role of optometry in vision 2020. Community Eye Health J 2002;15:33-6. |
|27.||Patel I, West SK. Presbyopia: Prevalence, impact, and interventions. Community Eye Health J 2007;20:40-1. |
|28.||Faal H, Qureshi MB. Training to meet the need for refractive error services. Community Eye Health J 2007;20:48-51. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]