Social and ophthalmic factors influencing prescribing patterns for childhood myopia

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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.