Vision Science Research Group

NICER Study

Northern Ireland Childhood Errors of Refraction (NICER) Study

How you can help us in the next phase of the NICER study!

Contact Us

Information for parents and 12-13 year olds

Information for 18-19 year olds

Information for Schools


Introduction

The NICER study is an on-going study of the eyes and vision of children and young adults in Northern Ireland. We are particularly interested in how the need for glasses (refractive error) differs between different people at different ages. Part of the study is examining whether we can predict how long- or short-sighted a child might become depending on their parents’ need for glasses, the amount of reading and studying they do, the length of time they spend outdoors and the size and shape of the eyes in early childhood.

The NICER study is the first of its kind in the UK and Ireland to publish robust information on school age children’s vision and refractive error since the 1960’s. So far, we have published papers (see Journal publications) in high quality scientific journals and have also presented the results of the study at professional conferences around the world.

These webpages are designed to update parents, children and schools who participated in the study on what their involvement has helped us achieve.

We hope you will continue to be involved in this ground breaking study and help us with our next phase - How you can help us in the next phase of the NICER study!


Our findings so far

Children in Northern Ireland are more likely to need glasses

Short-sightedness is a growing problem across the world with more and more people needing glasses to correct this. We have found that in Northern Ireland, children of secondary or grammar school age are more likely to be short-sighted than children in Australia and Poland but less likely to be short-sighted than children in Singapore and Sweden.

We also found that children in Northern Ireland of both primary and secondary/grammar school age were more likely to be long-sighted and had greater levels of astigmatism (sometimes called "rugby ball shaped" eyes) than children from other countries. Work is ongoing to explore why these population differences exist and we are currently working with partners in Birmingham (UK) and Sydney (Australia).

Children in Northern Ireland do not bring their glasses to school

One in four children who had been prescribed glasses did not have them available at school. Forgetting to bring your glasses to school is likely to cause reduced vision, visual discomfort and may impact on school performance.

No evidence of over-prescribing in Northern Ireland

The study found no evidence of over-prescribing glasses; therefore those who did not have their glasses at school were likely to require them.

Measuring vision is a poor method for detecting refractive errors

Vision screening programmes often depend on the measurement of vision to detect eye disorders. Our results have shown that this is a poor method of detecting whether a child needs glasses or not and children who are long-sighted may be missed. Where there is a family history of wearing glasses, parents/guardians/carers should be aware of the importance of taking their child for a full eye examination with an optometrist to detect whether their child may also need to wear glasses themselves.

Progression of Refractive Error

There are very few studies in the world that have assessed how the need for glasses changes as children get older. We know that myopia (short-sightedness) becomes more common and often increases as children grow. We are in the process of checking how the children in the NICER study’s refractive error changed between the first and second visits. We will soon be able to tell you these results! Keep checking the website for regular updates on our findings!


How will the information from the NICER study be used?

The knowledge we have gained from the study will be passed on to eye care professionals within Northern Ireland, the UK and throughout the world. Optometrists are often quizzed by patients seeking information on how their eye conditions, such as short-sightedness may change over the years and the results from the NICER study will help inform both practitioners and patients. Government agencies are also in need of data relating to the prevalence of eye conditions in order that appropriate services are provided. Your contribution to the NICER study may help to provide better eye care services for children in the future.


Acknowledgments

The members of the NICER Study would like to thank the College of Optometrists for their generous funding of the project. We would also like to thank all the children who participate in the study, their parents/guardians for their support and the cooperation of the primary and post-primary schools who facilitate the data collection.


Journal Publications

  • O’Donoghue, L., Saunders, K.J., McClelland, J.F., Logan, N.S., Rudnicka, A.R.,Gilmartin, B., Owen, C.G. (2010). Sampling and measurement methods for a study of childhood refractive error in a UK population, British Journal of Ophthalmology, 94(9):1150-1154.
  • O’Donoghue, L., McClelland, J.F., Logan, N.S., Rudnicka, A.R., Owen, C.G., Saunders, K.J. (2010). Refractive error and visual impairment in school children in Northern Ireland, British Journal of Ophthalmology, 94(9):1155-1159.
  • O’Donoghue, L., Rudnicka, A.R., McClelland, J.F., Logan, N.S., Owen, C.G., Saunders, K.J. (2011). Refractive and corneal astigmatism in white school children in Northern Ireland, Investigative Ophthalmology & Visual Science, 52(7):4048-4053.
  • McClelland, J.F., O’Donoghue, L., McIntyre, M., Saunders, K.J. (2012). Cup-to-disc and arteriole-to-venule ratios in children aged 6-7 and 12-13 years, Ophthalmic & Physiological Optics, 32(1):31-38.

International Presentations

  • March 2009, College of Optometrists Research Symposium, Brighton, O’Donoghue, L., Saunders, K.J., McClelland, J.F., Logan, N.S., Rudnicka, A.R., Owen, C.G. The Northern Ireland Childhood Refractive Error Study: prevalence of refractive error.
  • May 2009, Association for Research in Vision and Ophthalmology Annual Meeting, Florida, K.J. Saunders, McClelland, J.F., O’Donoghue, L. Uncorrected refractive error in the United Kingdom.
  • May 2009, Association for Research in Vision and Ophthalmology Annual Meeting, Florida, O’Donoghue, L., Saunders, K.J., McClelland, J.F., Logan, N.S., Rudnicka, A.R., Owen, C.G. Prevalence of childhood refractive error in the United Kingdom.
  • June 2009, Child Vision Research Society Annual Meeting,O’Donoghue, L., Saunders, K.J., McClelland, J.F., Logan, N.S., Rudnicka, A.R., Owen, C.G. Prevalence of refractive error in Northern Irish children.
  • July 2010, International Myopia Conference, Tűbingen, Germany, O’Donoghue, L., Rudnicka, A.R., McClelland, J.F., Logan, N., Owen, C.G., Saunders, K.J. Refractive astigmatism in school-children in the United Kingdom.
  • July 2010, International Myopia Conference, Tűbingen, Germany, Saunders, K.J., McClelland, J.F., O’Donoghue, L. The use of LogMAR visions in detectign ametropia in school-children in the United Kingdom.
  • July 2010, International Myopia Conference, Tűbingen, Germany, Breslin, K.M.M., Saunders, K.J., O’Donoghue, L., McClelland, J.F. Inter-examiner repeatability of the Zeiss IOL Master on post-primary school children aged 15-16 years.
  • September 2010, World Congress on Refractive Error, Durban, South Africa, O’Donogue, L., McClelland, J.F., Saunders, K.J. Visual impairment in childhood in Northern Ireland; Comparisons with South Africa.
  • September 2010, World Congress on Refractive Error, Durban, South Africa, Saunders, K.J., McClelland, J.F., O’Donoghue, L. Prevalence of childhood myopia and hyperopia in Northern Ireland; Comparisons with South Africa.
  • March 2011, College of Optometrists Research Symposium, Liverpool, Breslin, K.M.M., McClelland, J.F., O’Donoghue, L., Saunders, K.J. A prospective study of refractive error change in school children in the UK: Phase 2 of the Northern Ireland Childhood Errors of Refraction (NICER) Study.
  • May 2011, Association for Research in Vision and Ophthalmology Annual Meeting, Florida, O’Donoghue, L., McClelland, J.F., Saunders, K.J. The use of visual acuity to screen for significant refractive error in white school children in the United Kingdom.
  • May 2011, Association for Research in Vision and Ophthalmology Annual Meeting, Florida, Breslin, K., Saunders, K.J., O’Donoghue, L., McClelland, J.F. Axial Length And Refractive Error Prior To And After The Onset Of Myopia.

    Information for 18-19 year old Participants

    What would taking part in the study involve?

    The same measurements that were previously taken on your eyes when you last participated in the study will be repeated in the new study. You (along with other study participants) will have your eyes tested by an optometrist at a test centre close to your former school. We will reimburse your travel costs to the study location to the value of £10.

    • We will assess how well you can see asking you to read some letters on a chart and will assess whether you might need glasses to help you see better.
    • We will use special instruments to measure the shape and length of your eyes very accurately; these tests are very quick and painless and do not touch the eye. To accurately measure the eyes we will need to put some drops into each eye, which take about 30 minutes to work. Click on the icon below for further information on the eye drops used in the study.
    PDF - 229.7 kb
    Information on Eye Drops
    • We will also measure your height, weight and waist measurement.
    • Finally, you will be asked to complete a short questionnaire on your health and lifestyle.
    • We would also like to compare your achievements at school (GCSE Mathematics and English performance) with the eye measures we have taken. If you are willing to provide this information, we will ask you about it when you attend the test session.

    The whole examination will take 60 minutes in all. A member of the research team will be in contact with you once you have returned your consent form. They will arrange a suitable time and venue for you to take part in the NICER study and discuss any concerns you may have about the eye examination.


    What will happen after the study?

    We will check the results carefully. If we find that you need glasses or need to update your glasses we will write to you advising that you should visit your optometrist to have an eye examination.

    We hope very much that you will be able to take part in the study. All the information from the study will be treated in complete confidence.


    What to do next?

    If you have been contacted by the research team please fill in and sign the consent form enclosed to say whether or not you will take part in the NICER study Phase 3. Click on the icon below for an extra copy of the consent form.

    PDF - 83.4 kb
    18-19yr old Consent form

    Please put the consent form in the stamped addressed envelope provided and return it as soon as possible. If you would like any further information please telephone Sara McCullough on 028 70123047 or email sj.mccullough@ulster.ac.uk.

    We look forward to hearing from you!



    Information for 12-13 year old Participants

    What would taking part in the study involve?

    The same measurements that were taken on your child the last time they took part in the study will be repeated in the new study. Additionally, to help us understand how vision may impact on school performance, we would like to compare your child’s Key Stage 2 results with our measurements of their eyes. To do this, we need your permission to ask the school for their Key Stage 2 results. If you don’t want us to have this information, that is fine, your child can still take part in the eye.


    For your child

    Your child (along with other children) will have their eyes tested at school by an optometrist.

    • We will assess how well your child can see by asking them to read some letters on a chart and will assess whether they might need glasses to help them see better.
    • We will use special instruments to measure the shape and length of your child’s eyes very accurately; these tests are very quick and painless and do not touch the eye. To accurately measure the eyes we will need to put some drops into each eye, which take about 30 minutes to work. Click on the icon for further information on the eye drops used in the study.
    PDF - 229.7 kb
    Information on Eye Drops
    • We will also measure your child’s height, weight and waist measurement.
    • Your child will be asked to complete a short questionnaire on his/her health and lifestyle.

    The whole examination will take 60 minutes in all. He/she will be given a special certificate at the end of the examination. Our research team will visit the school in advance to explain study arrangements to the children and to answer any questions.


    For you

    You will be asked to fill in a short questionnaire on your child’s health and development and on the eye health and circumstances of your family, after your child’s vision has been measured. Click on the icon to see a copy of the parent questionnaire.


    What will happen after the study?

    We will check the results carefully. If we find that your child needs glasses or needs to update his/her glasses we will write to you advising that your child should visit their optician to have a free eye examination.

    We hope very much that your child will be able to take part in the study. All the information from the study will be treated in complete confidence.


    What to do next?

    If you and your child have been contacted by the research team please fill in and sign the consent form enclosed to say whether or not you will take part in the NICER study Phase 3. Click on the icon below for an extra copy of the consent form.

    PDF - 224.7 kb
    12-13yr old Parental consent form

    Please put the consent form in the stamped addressed envelope provided and return it as soon as possible. If you would like any further information please telephone Sara McCullough on 028 70123047 or email sj.mccullough@ulster.ac.uk.

    We look forward to hearing from you!



    Contact Us

    If you would like further information on the study, please contact us via email, putting the NICER study as the subject heading

    Dr Sara McCullough

    sj.mccullough@ulster.ac.uk


    Dr Lisa O’Donoghue

    l.odonoghue@ulster.ac.uk


    Dr Kathryn Saunders

    kj.saunders@ulster.ac.uk




    How you can help us in the next phase of the NICER study!

    For the next phase of the NICER study we hope to review all the children six years since they first took part in the study. This will mean some children will now be 12-13 years old and some will now be young adults aged 18-19 years.

    We are very keen to include you in the study again! We are interested to see how your eyes have changed over the past six years. It does not matter whether you are long- or short-sighted, have astigmatism or do not wear glasses at all, your eyes are important to us!


    If you are now 12-13 years old

    When we last came to test your eyes you were still at primary school. Now you have moved to secondary or grammar school we will come to your new school to test your eyes (along with other children in your school). We will arrange to visit your school to talk to you about the study and answer any questions you may have. You may have already received your study information pack

    Please read the details of the study carefully with your parents/guardians/carers and if you are happy to help us, please ask them to fill out the details on the consent form and return it to us in the stamped addressed envelope included. Don’t forget to include the name of your new school so we can make arrangements to see you there! Click on the icon for an extra copy of the consent form

    PDF - 224.7 kb
    12-13yr Parent Consent Form

    If you are now 18-19 years old

    When we last came to test your eyes you were at secondary school. Now you have left school we would like to arrange for you to be tested at a study location close to where you live. You may have already received your study information pack

    Please read the details of the study carefully and if you are happy to help us please fill out the details on the consent form and return it in the stamped addressed envelope included. Don’t forget to put your contact telephone number so that a member of the study team can contact you to arrange a suitable time and venue for you to take part in the study. Click on the icon for an extra copy of the consent form

    PDF - 83.4 kb
    18-19yr Consent Form

    What will taking part in the study involve?

    The same measurements that were taken the last time you took part in the study will be carried out in the next phase of the study. This will include:

    - Visual acuity assessment - similar to an eye examination with your optometrist, you will be asked to identify some letters on a chart.

    - Height, weight and waist measurements - these will help us understand how these factors may affect the progression of refractive errors.

    - Measurement of your refractive error (need for glasses) - for this we need to use eye drops (0.5% proxymetacaine, 1% cyclopentolate hydrochloride) to accurately measure the power of your eye. Click on the icon below for further information on the eye drops used.

    PDF - 229.7 kb
    Information on Eye Drops

    - Ocular biometry - for this we use an instrument that measures the length and shape of your eye.

    The last two measurements require you to put your chin on a rest and to stare at a target (either a light or a cross). The instruments do not touch your eyes and there are no bright lights.

    - Completion of a short questionnaire on your health and lifestyle e.g. family history of spectacle wear, education, nutrition, time spent outdoors. This will help us identify how different lifestyles may affect your vision and need for glasses. Click on the icon to see a copy of the questionnaire

    PDF - 265.1 kb
    Participant Questionnaire

    What are the benefits of taking part in the next phase of the NICER study?

    By taking part in the study you will receive an assessment of how well you can see and whether you may need glasses or not. If our results do suggest you need glasses we will inform you or your parents/guardians/carers that you require a full eye examination with your optometrist.

    We hope you have enjoyed taking part in the study before. By taking part you have already made a significant difference to our knowledge of the eyes and vision of children in Northern Ireland and we hope you will continue to help us with our work!