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Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data

Shah, R., Edgar, D. F ORCID: 0000-0001-9004-264X & Evans, B. J. W. (2023). Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data. Ophthalmic and Physiological Optics, 43(3), pp. 454-465. doi: 10.1111/opo.13112


Purpose: Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the ‘myopia epidemic’ is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4–5 years of age.

Methods: Retrospective anonymised data from computerised vision screening at age 4–5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The cri-terion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of de-tecting bilateral, moderate myopia rather than amblyopia.

Results: Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2–8.0), 8.5 (8.1–8.9), 7.5 (7.1–7.9), 7.8 (7.4–8.2), 8.7 (8.1–9.2), 8.5 (7.9–9.0) and 9.3 (8.8–9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing fre-quency of myopia (p = 0.06). A decreasing linear trendline was noted for children ‘Under Professional Care’.

Conclusions: For children 4–5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hy-pothesis of increasing myopia. The increase in screening failures highlights the im-portance of eye care in this young population.

Publication Type: Article
Additional Information: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.
Publisher Keywords: children, myopia, school screening, vision screening
Subjects: R Medicine > RE Ophthalmology
R Medicine > RJ Pediatrics
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
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