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Are there inequities in the utilisation of childhood eye-care services in relation to socio-economic status? Evidence from the ALSPAC cohort
  1. M Majeed1,
  2. C Williams2,
  3. K Northstone3,
  4. Y Ben-Shlomo1
  1. 1
    Department of Social Medicine, Canynge Hall, Bristol, UK
  2. 2
    Academic Centre of Child and Adolescent Health, Bristol, UK
  3. 3
    Department of Social Medicine, ALSPAC, Bristol, UK
  1. Ms C Williams, Department of Community Based Medicine, 24 Tyndall Avenue, Bristol BS8 1TQ, UK; cathy.williams{at}


Background: Equity of access to eye care in childhood remains poorly researched, and most studies report data on utilisation without any objective measure of clinical need.

Participants/method: 8271 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a longitudinal birth cohort, were seen at age 7, when they underwent a comprehensive eye examination and details of family history of eye conditions, vision problems and contact with eye-care services were obtained.

Results: 2931 (35.4%) children had been in contact with an eye-care specialist, and 1452 (17.6%) had received vision screening. Compared with social class I, the prevalence of eye conditions was higher in the lower groups (social class IIIM, IV, V) (OR 1.69, 95% CI 1.15 to 2.46). However, children from lower socio-economic status groups were less likely to see an eye-care specialist (OR 0.83, 95% CI 0.70 to 1.00) or to use screening services (OR 0.65, 95% CI 0.43 to 0.98).

Discussion/conclusion: The differences in the trends between socio-economic groups in eye conditions and utilisation of services suggest inequitable access to services. These data highlight the limitations of community-based preschool vision screening, which fails to abolish this inequity. It is important that future research explores the reasons behind these patterns. Compulsory school-entry vision screening, as recommended by the National Screening Committee and the Hall Report may redress this differential uptake of services.

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  • Funding: The Research and Development Directorate of the Southwest Regional Health Authority specifically funded this collection of the vision data, presented here.

  • Competing interests: None.

  • Ethics approval: Ethical approval for the study was obtained from the ALSPAC Law and Ethics Committee and the Local Research Ethics Committees.

  • Patient consent: Patient consent was obtained.

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