A prospective study of refractive change

in childhood.
Phase 2 of the NICER Study.

Karen Breslin BSc(Hons) MCOptom

Lisa ODonoghue
Julie McClelland
Kathryn Saunders

Background

The Northern Ireland Childhood Errors of

Refraction (NICER) Study described the
prevalence of refractive error in Northern Irish
schoolchildren.
Prospective study NICER Phase 2

Purpose

Evaluation of the progression of myopia

(Pointer,2001; Williams et al.,2008)
Evaluation of the progression of hyperopia
(Saunders,1995)

Methods
Subject Recruitment (Phase 2)

Previous participation in NICER

Time-frame of 363 months
Acquisition of parental consent

Protocols

Questionnaires
Vision Assessment
Oculomotor Status
Cycloplegia
Ocular Biometry measures
Refractive error
Anthropometrics

Definitions
Right spherical equivalent (SE) was used to
categorize refractive error
Myopia -0.50DS (Negrel et al.,2000; Ojaimi et
al.,2000)
Emmetropia >-0.50DS to +0.50DS (Negrel et
al.,2000; Ojaimi et al.,2000)
Low Hyperopia >+0.50DS to <+2.00DS
Moderate Hyperopia +2.00DS to <+4.00DS
High Hyperopia +4.00DS

Results
Participation
(Phase 1)
399

Contactable
pupils
358(90%)

Consent
(Phase 2)
312(87%)

Participation
(Phase 2)
301(84%)

Participation rate 75%

Data presented for white participants only (n=297)(99%)

Mean time interval 36.05 months (SD 1.03)
Mean age 10.07 years (SD 0.4) (Range 9.23-10.93)

Results
Mean change in refractive error (SE) over
a 3 year period was -0.38 D (SD 0.64)
Mean change in axial length over a 3 year
period was 0.52mm (SD 0.21)

pi
a

pi
a

hy
pe
ro

=5
5)

=8
)

=1
8)

=4
6)

(n

(n

-0.34

H
ig
h

(n

(n

(n
=1
70
)

pi
a

er
op
ia

pe
ro

hy

hy
p

od
er
at
e

Lo
w

et
ro

Em

M
yo
pi
a

-.5
-1

-1.5

Results

The mean change in refractive error in a three year period

-1.25

-0.54

-0.34
-0.16

pi
a

op
ia

hy
pe
ro

=5
5)

=8
)

=1
8)

=4
6)

(n

(n

.2

.4

0.49

H
ig
h

(n

(n

(n
=1
70
)

pi
a

er
op
ia

hy
pe
r

hy
p

od
er
at
e

Lo
w

et
ro

Em

yo
pi
a

.6

.8
1

Results

The mean change in axial length in a three year period

0.91

0.62
0.51
0.34

H
ig
h

hy
pe
ro

n=
18
)

pi
a(

n=
46
)

pe
ro
pi
a(

=1
70
)

n=
55
)

pi
a(

er
op
ia
(n

hy

hy
p

od
er
at
e

Lo
w

et
ro

Em

yo
pi
a(
n=
8)

-4

-2
0

Results

Difference in SE Refractive Error between Phase 1 and Phase 2

Results
Prevalence of myopia in 6-7 year-old
children 2% (95%CIs 0.45-3.6)
(n=393)

Prevalence of myopia in 9-10 year-old

children 9.8% (95%CIs 6.8-12.7)
(n=297)

hy
p

pi
a

H
ig
h

pi
a

pi
a

hy
pe
ro

pe
ro

hy

=1
8)

(n
=4
)

(n

er
op
ia

od
er
at
e

Lo
w

et
ro

Em

yo
pi
a

10

15

20

Results

Previous refractive class of new myopes at Phase 2

hy
p

n=
69
)

pia
(

Refractive error classification (Phase1)(n=393)

et
ro

=3
0)
pia
(n
=6
0)

yo
pia
(n

er
op
ia(
M
n=
od
16
er
1)
at
e
hy
pe
ro
pia
(n
=2
Hi
8)
gh
hy
pe
ro
pia
(n
=1
8)

hy
p

Em

62
)

pia
(

pia
(n
=2
5)

hy
pe
ro

pe
ro

hy

er
op
ia(
n=
22
9)

et
ro

=8
)

40

20

40

Prevalence (%)

20

60

60

Prevalence of Refractive Error (Phase1)

Lo
w

Hi
gh

od
er
at
e

Lo
w

Em

yo
pia
(n

Results
Prevalence of Refractive Error (Phase 2)

Refractive error classification (Phase 2)(n=297)

Conclusions
Subjects classified as myopic at age 6-7
years show the greatest change in
refractive error and axial length in a three
year period.
A low refractive error at age 6-7 years may
be a risk factor for future myopia.

Further Analysis
Further analysis of ocular biometric data

Analysis of change in refractive error and axial length in

astigmatic and anisometropic subjects
Investigation of the risk factors for the progression of
myopia
Analysis of data from the older cohort

Further research

Phase 3 of NICER.............

Acknowledgements
The College of Optometrists
Bernard Gilmartin and Nicola Logan
Alicia Rudnicka and Chris Owen
The schools and pupils who took part

References
Negrel AD, Maul E, Pokharel GP, et al. Refractive error study in
children: sampling and measurement methods for a multi-country
survey. Am J Ophthalmol 2000;129:421-6.
Ojaimi E, Rose KA, Smith w, et al. Methods for a population-based
study of myopia and other eye conditions in school children: The
Sydney Myopia Study. Ophthalmic Epidemiol 2005;12:59-69.
Pointer JS. A 6-year longitudinal optometric study of the refractive trend
in school-aged children. Ophthalmic Physiol Opt 2001;21:361-7.
Saunders KJ. Early refractive development in humans. Survey of
Ophthalmology 1995;40,3:207-216.
Williams C, Miller LL, Gazzard G, et al. A comparison of measures of
reading and intelligence as risk factors for the development of myopia
in a UK cohort of children. Br J Ophthalmol 2008;92:117-21.