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Abstract

Purpose: Scotland has comprehensive child vision screening at age 3.5-5.5 years, with ~85% participation (40,000-50,000 screening episodes annually). Orthoptists deliver the screening, including presenting vision, cover test, and other tests. Screening failures are referred for eye examinations, including cycloplegic refraction. The study aims to report refractive error data from these examinations (~5,000-6,000 annually) for three years pre- and two years postpandemic and to investigate correlations between myopia and socio-economic factors.

Methods: Right eye data from eight Scottish Health Boards (HB) are reported for spherical equivalent refraction (SER) for the years 2013-14, 2014-15, 2015-16, 2020-21, 2021-22. Associations were investigated between the proportion of the sample in each HB with myopia and the proportion of the population in each HB with different levels of deprivation index, classification on a rural/urban continuum, and dwelling type.

Results: Refractive error frequency distributions revealed a myopic shift in SER over the five years. Median SER (interquartile range) was, in 2013-14, +1.38D (+0.50 to +2.75); 2014-15, +1.38D (+0.25 to +2.63); 2015-16, +1.38D (+0.50 to +2.75); 2020-21, +1.13D (+0.25 to +2.25); 2021-22, +1.25D (+0.38 to +2.25). The increase in myopia was statistically significant in each of the last two years compared with each of the first three (p<0.0005). The proportion of myopes (≤-0.50D) increased from <7.8% annually 2013-16 to 11.51% in 2020-21, 10.65% in 2021-22 (linear trend: r 2=0.94, p=0.006). Associations between the proportions of children in each HB with myopia and: deprivation index was low and not statistically significant; proportion of population in the most urban environment was high (r2 = 0.79; p=0.003), and proportion of dwellings that were flats/apartments was high (r2 = 0.83, p=0.002).

Conclusions: In this predominantly Caucasian population, proportions of children with myopia have increased post-COVID. A strong association exists between myopia and living in flats/apartments and urbanicity, but not with a deprivation index.

Publication Type:	Article
Additional Information:	This is the peer reviewed version of the following article: Evans, B. J. W., Pentland, L., Evans, B , Edgar, D. F , Shah, R. & Conway, M. A. (2025). Increasing myopia in Scotland at age 3.5-5.5 years: a retrospective epidemiological study. Ophthalmic and Physiological Optics, which is to be published in final form at https://onlinelibrary.wiley.com/journal/14751313. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Publisher Keywords:	children, myopia, Scotland, school screening, vision screening
Subjects:	R Medicine > RE Ophthalmology
Departments:	School of Health & Psychological Sciences School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:	Symplectic Administrator

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