Social and ophthalmic factors influencing prescribing patterns for childhood myopia

在发达国家，教育是生活机会的主要驱动力。高教育程度与就业前景改善、收入增加和社会经济地位提高之间有很强的关联性。教育是社会流动的引擎，最重要的是早年。众所周知，教育缺陷在儿童时期很早就出现，并在整个儿童时期扩大。在英国，视力低下对教育水平的影响是一个很少受到关注的因素。视力低下会极大地降低儿童的教育潜力。视力受损的最常见原因是未矫正的屈光不正，即眼睛的形状不能正确地将光线聚焦到视网膜上，从而产生模糊的图像。近视(近视)儿童可能难以看到黑板，远视儿童阅读困难。近视是最常见的屈光不正形式，只需戴眼镜就可以矫正；试验表明，这可以提高教育程度。然而，很可能是社会因素阻碍了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，这些领域构成了这项研究的重点。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测试，正是在这里，近视经常被诊断为近视。然而，视力测试是自愿参加的，所以只要父母不带孩子去测试，近视就不会被发现。儿童视力测试的接受率不得而知，但根据之前对其他儿童健康服务(尤其是牙科)的研究，很可能存在有利于较富裕人群的强烈社会梯度。因此，近视矫正的延迟可能是教育程度社会差异背后的因素之一。减少儿童视力测试差异的一个方法是对学龄儿童进行近视筛查，将出勤率与父母的态度和行为分开。目前，儿童正在接受早期视力问题的筛查，如懒眼，无论是学龄前还是入学时，但对于大多数近视病例来说，这还为时过早。在这项研究的一部分中，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，以减少未得到满足的眼镜需求中的社会梯度。在这项研究中，我们将使用北爱尔兰行政数据研究中心的设施首次安全地连接三个大型行政(政府)数据库：所有NHS视力测试和儿童眼镜处方的记录(2009-2016)；16岁时的教育程度来自学校毕业生调查；详细的家庭结构、社会和经济信息来自2011年人口普查。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、城乡位置、距离验光师的距离和近视家族史。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)近视矫正的时机是否与16岁时的教育程度有关？C)在什么情况下，对学龄儿童进行近视筛查是有成本效益的？我们预计有两个主要的实际好处：改善近视儿童的护理，以及有更好的证据针对NHS视力测试服务。我们将分享我们的结果，并与政策制定者、验光组织和其他利益相关者密切合作，以确保英国的近视儿童尽可能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.