Purpose: Urban migrants now number some 300 million in China and often have poor access to healthcare. We sought to measure the population prevalence of vision impairment and spectacle wear among Chinese urban migrant children.
Methods: Children in a single fifth grade class in each of 94 randomly-selected primary schools in migrant communities in Shanghai, Suzhou and Wuxi underwent vision screening and answered questionnaires. All children with visual acuity <= 6/12 in either eye underwent cycloplegic automated refraction with refinement by an ophthalmologist. Spectacle wear was defined as producing glasses at school after having been told to bring them.
Results: Among 4409 children, 4376 (99.3%) completed vision screening (mean age 11.0 years, 53.1% boys), with<br /> 4225 (96.5%) self-identifying as migrants, and 151 (3.45%) as local children. Among 1204 (Total: 27.5%, Migrant: 27.1%, Local : 37.1%) children failing vision screening, 850 (70.6%) completed refraction. Compared to children completing refraction, those who did not were more likely to be boys (61.0 versus 52.6%, P = 0.005) and less likely to have uncorrected VA < 6/18 (28.0% versus 38.5%, P < 0.001), though age, migrant status and glasses wear did not differ. Spectacle wear in migrant children with myopia <= -0.5D in both eyes (112/606 = 18.5%) was half that in local children (10/32 = 31.3%, P = 0.029), and comparable to that for similar-aged children in poor, rural western China (16%) measured previously using an identical protocol. Both migrant and local myopic children attending migrant schools had much lower rates of spectacle wear than such children at conventional Chinese urban schools (72%, He M, IOVS, 2004). Myopia< -2.0D (P = 0.03) and parental glasses wear (P = 0.04), but not parental education or family wealth, were associated with children's glasses wear.
Conclusions: Urban migrant children represent a very large group about whose eye health little is known. Though one out of four primary school migrant children was visually impaired, only 18% of those needing them wore glasses, a proportion similar to China's poorest rural areas. Programs providing spectacles that target migrant children are needed, particularly in view of recent trial evidence (Ma X et al, BMJ, 2014) that spectacle wear significantly improves children's educational outcomes.