Social and ophthalmic factors influencing prescribing patterns for childhood myopia

在发达社会，教育是生活机会的主要驱动力。教育程度高与就业前景改善、收入增加和社会经济地位提高之间有着密切的联系。教育是社会流动的引擎，最早的几年最为重要。众所周知，儿童的教育缺陷在其生命的早期就出现了，并在整个童年时期不断扩大。在英国，一个很少受到关注的因素是视力不良对教育成就的影响。视力差会大大降低儿童的教育潜力。视力障碍最常见的原因是未矫正的屈光不正，眼睛的形状不能正确地将光线聚焦到视网膜上，产生模糊的图像。未矫正的近视儿童可能很难看清黑板，远视儿童阅读有困难。近视是最常见的屈光不正形式，可以简单地用眼镜矫正;试验表明，这可以提高教育程度。然而，社会因素可能会阻止一些英国儿童及时接受眼镜矫正，这可能会危及他们的教育。在英国，社会因素如何影响近视的检测、矫正和教育程度尚不清楚，这些领域构成了本研究的重点。在英国，近视由社区验光师管理。学龄儿童有资格接受免费的年度视力检查，正是在这里，近视经常被诊断出来。然而，视力检查是自愿的，因此只要父母不带孩子去检查，近视就不会被发现。儿童视力测试的接受率尚不清楚，但根据以前对其他儿童健康服务（特别是牙科）的研究，可能存在强烈的社会梯度，有利于更富裕的人。因此，近视矫正的延迟可能是教育程度社会梯度背后的因素之一，减少儿童视力测试接受率差异的一种方法是对学童进行近视筛查，将上学与父母的态度和行为分开。目前，儿童在学龄前或入学时都会接受筛查，以发现早期发展的视力问题，如弱视，但这对于发现大多数近视病例来说还为时过早。在这项研究中，我们将建立一个数学模型来评估近视筛查是否具有成本效益，以减少未满足的眼镜需求的社会梯度。在这项研究中，我们将使用北方爱尔兰行政数据研究中心的设施，安全地将三个大型行政数据库连接起来。（政府）数据库首次：所有NHS视力测试和儿童眼镜处方的记录（2009-2016年）;从离校生调查中得出的16岁受教育程度;从2011年人口普查中得出的详细家庭结构、社会和经济信息。我们将考虑一系列因素，包括性别、种族、父母的教育程度和社会经济地位、城市/农村地区、与验光师的距离以及近视家族史。我们将使用相关数据来解决三个主要研究问题：a）哪些社会和经济因素与儿童视力测试的接受和近视矫正的时间有关？B）近视矫正的时间与随后16岁时的教育程度相关吗？c）在什么情况下，为学童进行近视检查才符合成本效益？我们设想了两个主要的实际好处：改善近视儿童的护理和更好的证据，以针对NHS视力测试服务。我们将分享我们的研究结果，并与政策制定者、验光机构和其他利益相关者密切合作，以确保英国的近视儿童能够最好地管理他们的病情和教育前景。

Education is a major driver of life chances in developed societies. There are strong associations between high educational attainment and improved employment prospects, increased income and raised socio-economic status. Education is the engine of social mobility and the earliest years are most important. It is known that educational deficits emerge early in children's lives, and widen throughout childhood.One factor that has received little attention in the UK is the influence of poor eyesight on educational attainment. Poor eyesight can dramatically reduce the educational potential of children. The most common cause of visual impairment is uncorrected refractive error, where the shape of the eye does not focus light onto the retina correctly, producing a blurred image. Children with uncorrected myopia (near-sight) may struggle to see the blackboard and long-sighted children have difficulty reading. Myopia is the most common form of refractive error and can be corrected simply with spectacles; trials have shown that this can lead to improved educational attainment. However, it is likely that social factors prevent some UK children from receiving spectacle correction in a timely manner, potentially jeopardising their education. The ways in which social factors influence myopia detection, correction and hence educational attainment in the UK are unknown and these areas form the focus of this study.In the UK, myopia is managed by community optometrists. School age children are eligible to receive free annual sight tests and it is here that myopia is frequently diagnosed. However, sight test attendance is voluntary and so myopia will remain undetected for as long as parents do not present their children for testing. Uptake rates of child sight testing are unknown but based on previous research into other child health services (especially dentistry) there are likely to be strong social gradients favouring the more affluent. Hence, delayed correction of myopia may be one of the factors behind social gradients in educational attainment.One way to reduce disparities in uptake of child sight tests would be to screen schoolchildren for myopia, disconnecting attendance from parental attitudes and behaviours. Children are currently screened for early-developing sight problems such as lazy eye either pre-school or on school entry but this is too early to detect the majority of myopia cases. In one strand of this study we will build a mathematical model to assess whether screening for myopia would be cost-effective for reducing social gradients in unmet need for spectacles.In this study we will use the facilities of the Administrative Data Research Centre - Northern Ireland to securely link three large administrative (government) databases for the first time: records of all NHS sight tests and spectacle prescriptions for children (2009-2016); educational attainment at age 16 drawn from the School Leavers Survey; detailed family structure, social and economic information drawn from the 2011 Census. We will consider a range of factors including sex, ethnicity, parental educational attainment and socio-economic status, urban/rural location, distance to optometrists and family history of myopia.We will use the linked data to address three main research questions: a) Which social and economic factors are associated with uptake of child sight tests and timing of myopia correction? b) Is timing of myopia correction associated with subsequent educational attainment at age 16? c) Under what conditions would screening of schoolchildren for myopia be cost-effective?We envisage two main practical benefits: improved care for children with myopia and better evidence to target NHS sight test services. We will share our results and work closely with policy makers, optometry organisations and other stakeholders to ensure that myopic children in the UK have the best possible management of their condition and educational prospects.