PROJECT SUMMARYThe benefits of early spectacle treatment for moderate refractive error in asymptomatic toddlersare not known. AAPOS spectacle prescribing guidelines for children less than 3 years of ageare based on consensus and clinical experience because there are no scientifically rigorouspublished data for guidance. The United States Preventive Services Task Force concluded in2017 that there is insufficient evidence to assess the balance of benefits of vision screening forchildren less than 3 years of age because data on the benefits of spectacle correction forrefractive error in toddlers are lacking. The SPEC Trial addresses these important gaps in theliterature with a focus on assessing the developmental and visual benefits of spectacletreatment for astigmatism in toddlers and the factors associated with spectacle treatmentcompliance in this age group.SPEC is a prospective trial to determine if prescribing and providing spectacle correction forastigmatic toddlers (at 12 to < 24 months or 24 to < 36 months of age) meeting currentconsensus based prescribing guidelines result in better developmental and visual outcomecompared to astigmatic children who are prescribed and provided spectacles at age 36 to < 40months. Developmental outcomes will be measured using the Bayley Scales of Infant andToddler Development 3rd Edition. Visual acuity outcome will be measured using the AmblyopiaTreatment Study HOTV Protocol. Spectacle treatment compliance will be measured using awearable sensor attached to the spectacles.The results of the SPEC Trial will have important implications for screening and treatment ofyoung astigmatic children. This study will generate evidence to inform parents pediatriciansand eye care providers if prescribing spectacles for astigmatic toddlers will have a beneficialeffect on their global development and will allow clinicians to make evidence-based ratherthan consensus-based recommendations regarding treatment of astigmatism in toddlers. TheSPEC Trial is also unique in that it includes objective measures of spectacle treatmentcompliance and will provide much needed data on factors associated with spectacle treatmentcompliance in toddlers.