The NICER Study

The Northern Ireland Childhood Errors of Refraction (NICER) study is the largest study in the UK or Ireland to examine how children's vision changes through childhood and adolescence

The NICER Study

The NICER Study

The Northern Ireland Childhood Errors of Refraction (NICER) study is the largest study in the UK or Ireland to examine how children's vision changes through childhood and adolescence


The NICER Study

The Northern Ireland Childhood Errors of Refraction (NICER) study is the largest study in the UK and Ireland to examine how children's vision, in particular their refractive error (i.e. how long- or short-sighted they are) changes through childhood and adolescence. The study began in 2006 when over a thousand 6-7 and 12-13 year old local school children were recruited and had their first vision assessment. Our research team visited primary and post-primary schools in the North and West of Northern Ireland where we measured how well each child could see, how long- or short-sighted they were, the size of their eyes, their height and weight and also asked them and their parents about their child's lifestyle, diet and the family's history of spectacle wear.

Longitudinal Studies

Three, six and nine years after the initial assessment, each participant was invited to have these measures repeated. These data, spanning nine years for each child, provide us with a unique insight into the visual development of children in Northern Ireland and the factors influencing their vision and visual status. The study has been funded throughout by the College of Optometrists.

Key findings from The NICER Study to date:

  • Nearly one in 5 teenagers in Northern Ireland are short-sighted (myopic)
  • Teenagers in Northern Ireland are three times more likely to be short-sighted than comparable Australian teenagers, but not as likely to be short-sighted as Asian teenagers. The interplay between environment and genetics is likely to be important in determining how many children become short-sighted and how short-sighted they become. Our current research is exploring how environmental factors influence childhood myopia development in more detail.
  • Children in the UK are becoming short-sighted at a younger age than we previously thought, the development of short-sightedness is most likely to occur in the primary school years.
  • Long-sightedness (hyperopia), astigmatism (sometimes referred to as ‘rugby ball’ shaped eyes) and a difference in refractive error between a person's two eyes (anisometropia) are more common in Northern Ireland than in other populations
  • Few children in Northern Ireland have significant visual impairment. However, 25% of children needing glasses, don't routinely bring them to school and their vision is poorer because of this

With these findings in mind, we are starting a new study to find out whether the situation is getting worse and what is causing it. Like before, we are hoping local school children will help us to complete our new research study.

The new NICER Study

What is this new study about?

Short-sight (myopia) is becoming more common across the world and is starting in children at younger ages than ever before. This means that many children need glasses or contact lenses to see far away objects and will continue to need glasses through their adult life to see clearly for driving, watching TV etc. Short-sight is not just a problem because it means wearing glasses for clear vision; it is also linked to some serious eye problems in later life. So, the fact that more children are becoming short-sighted is worrying for their long-term eye health and vision.

Short-sight tends to ‘run’ in families but research has shown that children’s lifestyles are encouraging short-sightedness to develop, even when their parents don’t wear glasses. Research from other countries suggests that modern children spend less time outdoors, more time studying and more time using smart phones and tablets. Do these features of modern life encourage short-sight?

We want to find out more about this by investigating;

1. How many children in Northern Ireland are short-sighted now and compare this with our previous figures from 2006 (before smart phones and tablets became commonly used) and,

2. How much time children spend studying, playing outside and using smart phones and tablets.

What is involved if you and your child consent to take part in this new study?

Your child (and their classmates) will have their eyes tested at school by an Optometrist; the test should take about 1 hour. We will measure how well your child sees (without/with glasses if they wear them). We will ask them to look into a piece of equipment so we can measure the size and shape of their eyes and how long- or short-sighted they are. Nothing touches their eyes and these measurements are taken very quickly whilst they look at a small target, usually a light. We will measure each child’s height, waist circumference and weight and help them fill in a questionnaire to find out how much time they think they spend on activities like playing outside, reading, watching television, using a smartphone or tablet. After the eye test we will check the results carefully. If we find your child needs glasses or needs to update his/her glasses we will write to you advising that your child should visit your local Optometrist to have a full eye test.

Watch our animation for more information on what to expect if you are asked to participate in our study;

Can anything be done to stop Myopia getting worse?

Traditionally, when someone has myopia, they are given glasses or contact lenses to allow them to see clearly. Some people have surgery on their eyes to provide clear vision without glasses or contact lenses (refractive surgery). However, none of these options stop myopia getting worse. Our researchers are working with other researchers across the world, and in the UK and Ireland to find out if an eye drop can help slow down the progression of myopia, so that children don’t continue to need stronger glasses as they get older. This will ultimately help to keep their eyes as healthy as possible throughout their lives.

Ulster University were the first UK site to enrol children into this research in April 2019.  Children who are already short-sighted are being enrolled and will use eye drops every night for up to four years.  The drops will either contain the active treatment (low dose atropine) or will be a ‘placebo’ eye drop. More children will receive the treatment than be on the placebo drop, and all children will be offered the treatment at some point during the trial. For more information on this research please visit The CHAMP Study webpages.


Invited research and professional presentations related to the NICER study research

Saunders KJ, ‘Are disrupted circadian rhythms responsible for the myopia epidemic?’, Association for Optometry and Vision Science, Vancouver, April 2019.

Saunders KJ, ‘Myopia and the Modern Child: Findings from the NICER study’, International Aeir Optometry Development Conference, Changsha, China, 19-21 November 2018

Saunders KJ, ‘Is Modern Life Bad for Children’s Eyes?’, Congresso Internacional de Optometria e Ciencias da Visao (CIOCV2018), Braga, Portugal, 28-29 April 2018

Saunders KJ, ‘Childhood Myopia in the 21st Century: Results of the NICER Study’, Specsavers Nordic Conference Series, Sweden, Denmark, Norway, Finland, 10-13 Oct 2016

Saunders KJ, Childhood ‘Myopia in the 21st Century: Results of the NICER Study’, Optometry Tomorrow, Birmingham, March 2016

Saunders KJ, ‘Childhood Myopia in the 21st Century: Results of the NICER Study’, Optrafair, Birmingham, April 2016

Invited articles

McCullough SJ. ‘Your eyes and the outdoors’. Vista Magazine, Eye Health Week 2018.

McCullough, S.J., Saunders, K.J. ‘The Northern Ireland Childhood Errors of Refraction (NICER) Study: Childhood Myopia in the 21st Century’, Optometry Today, June 2016

Saunders KJ, Breslin K, McClelland J, McCullough S and O’Donoghue L. ‘Myopia: a growing problem’. Expert Statement: Royal Irish Academy Life and Medical Sciences Committee,https://www.ria.ie/sites/default/files/myop.pdf, Oct 2015

Saunders KJ ‘Testing visual acuity of young children: an evidenced-based guide for optometrists’. Profile (Specsavers global journal for all professional staff and students), June 2015.

O’Donoghue L and Saunders KJ (2011). Uncorrected childhood refractive error in the UK. Points de Vue International Review of Ophthalmic Optics.


Print and Broadcast Media dissemination of NICER study outcomes

Media Source

Date

Viewership/Readership Estimates

The Times (London)

24th April 2015

396,621

The Telegraph

20th July 2015

494,675

The Sunday Times

18th September 2016

770,370

The Daily Mail

21st January 2016

1,589,471

The Daily Mirror

21st January 2016

809,147

The Sun

21st January 2016

1,787,096

The Western Daily Express

21st January 2016

58,892

This is Money

21st January 2016

>153,333

The Daily Mail

2nd September 2013

1,863,151

The Financial Times

12th October 2016

198,237

Vista Magazine

28th September 2018

Readership figures unavailable

The Guardian

25th September 2018

137,839

BBC Radio 4’s Today Programme

4th May 2012

7.45 million listeners per week

BBC1’s Health: Truth or Scare

First shown 9.15pm April 25th 2017 (then on iPlayer)

1.23 million viewers of original broadcast – source - the BBC

BBC Radio 5Live

23rd January 2016

4.73  million listeners per week

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