Article Text

Download PDFPDF
Visual impairment due to undiagnosed refractive error in working age adults in Britain
  1. J S Rahi1,2,3,
  2. C S Peckham1,
  3. P M Cumberland1
  1. 1
    MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
  2. 2
    Great Ormond Street Hospital, London, UK
  3. 3
    UCL Institute of Ophthalmology, London, UK
  1. Dr J S Rahi, MRC Centre of Epidemiology for Child Health/Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; j.rahi{at}


Background: Detection and treatment of undiagnosed refractive error (RE), with its attendant functional consequences, is a priority of VISION 2020, the global initiative against avoidable visual disability. The authors investigated the frequency of visual impairment due to undiagnosed RE and its associations with vision-related quality of life (VRQOL), general health and social circumstances in a contemporary and nationally representative population of British working-age adults.

Methods: 9271 members of the 1958 British birth cohort had visual acuity and VRQOL assessed at 44/45 years. The authors compared those with undiagnosed RE with those with diagnosed RE, defining undiagnosed RE as ⩾0.2 logMAR units/2 lines acuity improvement in both eyes with pinhole in individuals without current or prior optical treatment or ophthalmic history.

Results: 144/9271 (1.6%) individuals had undiagnosed and 3513/9271 (37.9%) diagnosed RE. 18% (24/144) of those with undiagnosed RE were classifiable as visually impaired. Individuals with undiagnosed RE were more likely to have a manual (vs non-manual) occupation and to be separated, divorced or widowed, and less likely to be in social or professional organisations. There is also some evidence that they are more likely to express concern, embarrassment and frustration about their eyesight and worry about coping with life.

Conclusion: A significant proportion of working age adults in Britain appear to have undiagnosed but visually significant RE. Improvements in existing opportunities for detecting RE in adults could benefit these individuals during their working lives and avoid the serious adverse consequences associated with vision impairment in later life.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: The biomedical survey was funded by the Medical Research Council (grant G0000934, Health of the Public initiative, principal grant holders C Power and D Strachan). Phillippa Cumberland was supported at different times during the course of this work by the Medical Research Council and the Wellcome Trust. This work was undertaken at GOSH/UCL Institute of Child Health which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme. The Centre for Paediatric Epidemiology and Biostatistics also benefits from funding support from the Medical Research Council in its capacity as the MRC Centre of Epidemiology for Child Health. The funders played no role in study design, collection, analysis and interpretation of data, writing the report, or submitting the paper for publication. The authors are independent of the funders.

  • Competing interests: None.

  • Ethics approval: This study is part of a broader programme of work approved by the South East Multi Centre Research Ethics Committee (ref: 01/1/44) and the Institute of Child Health’s Research Ethics Committee.

  • Patient consent: Obtained.

  • All authors contributed to the design and conduct of the study, the analysis and the writing of this paper. JSR is the guarantor.

Linked Articles

  • At a glance
    Harminder S Dua Arun D Singh