Zimbabwe eyecare and learning (ZEAL)

This thesis investigated the prevalence of hyperopia, its association with reading performance, and the short-term effects of spectacle correction among primary schoolchildren in Zimbabwe.<br><br>

Methods

Four components were conducted: (1) a systematic review and meta-analysis of hyperopia and academic outcomes; (2) a school-based cross-sectional study of the prevalence of moderate-to-high hyperopia (>/=+2.00 D); (3) a cross-sectional study assessing the association between uncorrected hyperopia and reading performance compared with matched emmetropic peers; and (4) a pre-post interventional study evaluating changes in reading after 45 minutes of spectacle wear.<br><br>Results: The systematic review found that children with uncorrected hyperopia performed worse academically than emmetropes (standardised mean difference [SMD] -0.18, 95% CI -0.27 to -0.09), with stronger effects on reading-specific skills.

No studies were identified from Sub-Saharan Africa. In Zimbabwe, the prevalence of moderate-to-high hyperopia (>/=+2.00 D) was 4.66% (95% CI 3.72–5.77). Among Grade 4 children, uncorrected low hyperopia (>/=+1.50 D but <+2.00 D) was associated with reduced reading fluency (word fluency, P = 0.049; story fluency, P = 0.031).

Following 45 minutes of spectacle wear, short-term improvements across grades were observed, with the largest gains observed in Grade 4 for story fluency (+8.42 correct words per minute; P = 0.0005).<br><br>Conclusion: Even low levels of uncorrected hyperopia were associated with reduced reading fluency in Zimbabwean children. Short-term improvements following spectacle correction highlight the importance of accessible refractive services.

Longitudinal trials are needed to confirm sustained benefits and develop effective school-based screening strategies in LMICs.