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Purpose: To compare whether free spectacles or only a prescription for spectacles influences wearing rates among Tanzanian students with un/undercorrected refractive error (RE)., Design: Cluster randomised trial., Setting: 37 secondary schools in Dar es Salaam, Tanzania., Participants: Distance visual acuity was measured in 6,904 year-1 students (90.2% response rate; median age 14 years; range 11-25 years) using a Snellen E-chart. 135 had RE requiring correction., Interventions: Schools were randomly allocated to free spectacles (arm A) or prescription only (arm B)., Primary Outcome: Spectacle use at 3 months., Results: The prevalence of un/undercorrected RE was 1.8% (95% CI: 1.5 to 2.2%). At 3 months, 27/58 (47%) students in arm A were wearing spectacles or had them at school compared with 13/50 (26%) in arm B (adjusted OR 2.4, 95% CI 1.0 to 6.7). Free spectacles and myopia were independently associated with spectacle use., Conclusions: The low prevalence of un/undercorrected RE and poor uptake of spectacles, even when provided free, raises doubts about the value of vision-screening programmes in Tanzanian secondary schools. Policy decisions on school vision screening in middle- and low-income countries should take account of the cost-effectiveness as well as competing demands for scarce resources.

Background: Although the benefits of vision screening seem intuitive, the value of such programmes in junior and senior schools has been questioned. In addition to this there exists a lack of clarity regarding the optimum age, and frequency at which to carry out screening., Objectives: The objective of this review is to evaluate the effectiveness of vision screening programmes carried out in schools in reducing the prevalence of undetected, correctable visual acuity deficits due to refractive error in school-age children., Search Strategy: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) on The Cochrane Library (Issue 3 2004), MEDLINE (1966 to August 2004) and EMBASE (1980 to August 2004). No language or date restrictions were placed on these searches. To date it has not been possible to carry out any manual searches but it is hoped to include these in a future update., Selection Criteria: We planned to include randomised controlled trials including randomised cluster controlled trials., Data Collection and Analysis: Two reviewers independently assessed study abstracts identified by the electronic searches. No trials were identified that met the inclusion criteria., Main Results: As no trials were identified, no formal analysis was performed. A narrative synthesis of other retrieved studies was undertaken in order to explain current practice., Authors' Conclusions: At present there are no robust trials available that allow the benefits of school vision screening to be measured. The disadvantage of attending school with a visual acuity deficit also needs to be quantified. The impact of a screening programme will depend on the geographical, and socio-economic setting in which it is conducted. There is therefore clearly a need for well planned randomised controlled trials, in various settings, to be undertaken so that the potential benefits and harms of vision screening can be measured.

Background/aims: The prevalence of significant refractive errors and other eye diseases was measured in 2511 secondary school students aged 11-27 years in Mwanza City, Tanzania. Risk factors for myopia were explored., Methods: A questionnaire assessed the students' socioeconomic background and exposure to near work followed by visual acuity assessment and a full eye examination. Non-cycloplegic objective and subjective refraction was done on all participants with visual acuity of worse than 6/12 in either eye without an obvious cause., Results: 154 (6.1%) students had significant refractive errors. Myopia was the leading refractive error (5.6%). Amblyopia (0.4%), strabismus (0.2%), and other treatable eye disorders were uncommon. Only 30.3% of students with significant refractive errors wore spectacles before the survey. Age, sex, ethnicity, father's educational status, and a family history of siblings with spectacles were significant independent risk factors for myopia., Conclusion: The prevalence of uncorrected significant refractive errors is high enough to justify a regular school eye screening programme in secondary schools in Tanzania. Risk factors for myopia are similar to those reported in European, North-American, and Asian populations.