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Uncorrected refractive error in older British adults: the EPIC-Norfolk Eye Study
  1. Justin C Sherwin1,
  2. Anthony P Khawaja1,
  3. David Broadway2,
  4. Robert Luben1,
  5. Shabina Hayat1,
  6. Nichola Dalzell1,
  7. Nicholas J Wareham3,
  8. Kay-Tee Khaw1,
  9. Paul J Foster4,5
  1. 1Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
  3. 3MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
  4. 4Division of Genetics & Epidemiology, UCL Institute of Ophthalmology, University College London, London, UK
  5. 5National Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
  1. Correspondence to Professor Paul J Foster, Division of Genetics and Epidemiology, UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK; p.foster{at}


Aim To investigate the prevalence of, and demographic associations with, uncorrected refractive error (URE) in an older British population.

Methods Data from 4428 participants, aged 48–89 years, who attended an eye examination in the third health check of the European Prospective Investigation into Cancer-Norfolk study and had also undergone an ophthalmic examination were assessed. URE was defined as ≥1 line improvement of visual acuity with pinhole-correction in the better eye in participants with LogMar presenting visual acuity (PVA) <0.3 (PVA <6/12). Refractive error was measured using an autorefractor without cycloplegia. Myopia was defined as spherical equivalent ≤−0.5 dioptre, and hypermetropia ≥0.5 dioptre.

Results Adjusted to the 2010 midyear British population, the prevalence of URE in this Norfolk population was 1.9% (95% CI 0.6% to 3.1%). Lower self-rated distance vision was correlated with higher prevalence of URE (ptrend<0.001). In a multivariate logistic regression model adjusting for age, gender, retirement status, educational level and social class, independent significant associations with URE were increasing age (ptrend<0.001) and having hypermetropic or myopic refractive error. Wearing distance spectacles was inversely associated with URE (OR 0.34, 95% CI 0.21 to 0.55, p<0.001). There were 3063 people (69.2%) who wore spectacles/contact lenses for distance vision. Spectacle wear differed according to type of refractive error (p<0.001), and use rose with increasing severity of refractive error (ptrend<0.001).

Conclusion Although refractive error is common, the prevalence of URE was found to be low in this population reflecting a low prevalence of PVA<0.3.

  • Uncorrected refractive error
  • epidemiology
  • spectacles
  • public health
  • treatment medical
  • wound healing
  • field of vision
  • optic nerve
  • drugs
  • intraocular pressure
  • imaging
  • ciliary body
  • clinical trial
  • treatment surgery
  • experimental and laboratory
  • glaucoma
  • vision
  • optics and refraction
  • treatment lasers
  • angle

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  • Funding EPIC was funded by The Medical Research Council, UK (G0401527), Cancer Research UK (C864/A8257) and Research into Ageing, UK (262). Professor Foster has received additional support from The Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and The UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology.

  • Competing interests None.

  • Ethics approval Approval provided by the East Norfolk and Waverney NHS Research Governance Committee (2005EC07L) and the Norfolk Research Ethics Committee (05/Q0101/191).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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