Understanding myopic change: what makes NICER worth talking about?

What do the latest findings on myopia mean for your practice?

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Author: Daniel Hardiman-McCartney MCOptom, Clinical Adviser
Date: 26 January 2016

Refracting myopia. You do it every day, but how much do we really know about it? Around the globe a myopia epidemic is taking hold, with a seemingly ever increasing number of the world's population affected. But we do not know why, or how, and we are only starting to be able to predict the potential consequences.  

The most worrying is myopic visual impairment, where diseases such as retinal detachment and myopic degeneration cause reduced sight despite correction. This is not a new revelation, and research in the area has been common for decades by academics from many disciplines, but led perhaps by optometrists more so than anyone else.

Into this arena now steps Phase 3 of a study the College has part-funded for many years, the Northern Ireland Childhood Errors of Refraction study (NICER). The NICER study, being undertaken by Ulster University, has gathered data from children for over six years, in order to answer some of the many questions we have about childhood myopia. The lead investigator, Professor Kathryn Saunders will be presenting the findings in the session, “The NICER study: childhood refractive error in the 21st Century” (Monday 14 March, 9.00am), the most notable being that myopia prevalence in children in the UK has more than doubled in the last 50 years.

But other than this headline, what makes NICER worth talking about? Why are we so sure that what it has to say is worth paying attention to? Well, because it is a great example of a population-based longitudinal study.

This means that the children (over 1,000 children selected to be representative of the population as a whole) were selected first and then tested thoroughly at ages 6-7 through to 12-13 years or 12-13 through to 18-20 years (the longitudinal bit). What the children had experienced in the meantime, from their lifestyle and diet to home and school environment (as well as their family’s ocular history) was also assessed via questionnaires so that the researchers could see if these factors were related to how vision and refractive error changed. 

In only a few years, optometric practice may look very different to that of today.

In selecting the children first this also made it a prospective study. This means that you can’t deliberately choose more or less myopic children to take part in the study and therefore it ensures you gather exactly the data you need to answer your questions. The alternative is to look back at existing myopes and to try to find out when they developed their myopia, but these ‘retrospective’ studies are more prone to confounding factors than prospective ones like NICER (such as the failure to gather the most useful data about exactly what each individual’s myopic development over the time period actually was). In addition, a study is more robust if you have bigger numbers taking part, as smaller numbers mean that changes can be more likely to be due to chance. In fact, NICER is the largest study of this kind in the UK or Ireland. Longitudinal studies can be blighted by drop-outs (participants move away, lose interest in the intervening years), but thanks to Northern Ireland’s relatively stable population, participation in the study has remained strong.

Such studies are so important because you get extensive and thorough evidence of what is actually happening in a population; who is more likely to become myopic, based on their background, their lifestyle or their environment (or all three). This is the crucial first step in understanding what might actually be causing a myopic increase, and what can be done to address it.

This is a great example of how research studies like NICER become relevant to many patients through your practice. Patients often ask whether there is any point in reducing myopic progression, if spectacles are still required either way. Although a reduction of 1.00D, may not seem to have a tangible benefit for an individual patient who is -5.00DS, their risk of complications increases as their myopia increases. Also, for the population as a whole the benefit could be profound, as a small myopic shift in the population by 1.00D could result in a national increase in myopic maculopathy by around a third. 

In only a few years, optometric practice may look very different to that of today. As worldwide myopia rates soar, progression management could become a staple part of the day job, through interventions such as low dose atropine and peripheral defocus daily contact lenses (both of which have a growing base of evidence for their effectiveness). So to answer your patient’s question, yes, there are good reasons for both you and the wider population to reduce levels of myopia. 

Book your place for Optometry Tomorrow and reserve your space for this session, or read more about the findings from the third phase of the NICER study.



Study shows myopia prevalence in children in the UK has more than doubled in the last 50 years (Collge of Optometrists press release, 20 January 2016)

Risk Factors for Childhood Myopia: Findings From the NICER Study (Investigative Ophthalmology & Visual Science March 2015, Vol.56, 1524-1530. doi:10.1167/iovs.14-15549)

The Changing Profile of Astigmatism in Childhood: The NICER Study (Investigative Ophthalmology & Visual Science May 2015, Vol.56, 2917-2925. doi:10.1167/iovs.14-16151)

Myopia and public health (Optometry Times, 29 May 2015)

The complex interactions of retinal, optical and environmental factors in myopia aetiology (Progress in Retinal and Eye Research 2012 Nov;31(6):622-60. doi: 10.1016/j.preteyeres.2012.06.004. Epub 2012 Jul 4)

Myopia (The Lancet, Volume 379, Issue 9827, 5–11 May 2012, Pages 1739–1748)

Daniel Hardiman-McCartney FCOptom
Clinical Adviser, The College of Optometrists

Daniel graduated from Anglia Ruskin University, where he won the Haag Strait prize for best dissertation. Before joining the College, he was Managing Director of an independent practice in Cambridge and a visiting clinician at Anglia Ruskin University. He has also worked as a senior glaucoma optometrist with Addenbrooke’s Hospital in Cambridge, with Newmedica across East Anglia and as a diabetic retinopathy screening optometrist. Daniel was a member of Cambridgeshire LOC from 2007 to 2015 and a member of the College of Optometrists’ Council from 2009 to 2014, representing its Eastern region.  

He is Clinical Adviser to the College of Optometrists for four days each week, dividing the remainder of his time between primary care practice and glaucoma community clinics. Daniel is a passionate advocate of the profession of optometry, committed to supporting all members of the profession and ensuring patient care is always at the heart of optometry. He was awarded Fellowship by Portfolio in December 2018.

Martin Cordiner
Head of Research, College of Optometrists

Martin graduated with a Masters in Modern History from York University in 2005, having completed his BA there in 2003. Since then he has worked in project management in higher education before joining the College and its fledgling research department in 2009, where he now supports the Director of Research and manages the research team to implement all elements of the College’s Research Strategy. 

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