Experimental studieshave suggested in animals1,2 and children3 that treatment at an early stage for childhood visual problems leads to improved visual outcomes . There is debate about the consequences for a child of treating vs. not treating their visual problem, but data from ALSPAC suggests some common visual problems are associated with under achievement at school8 . There is also disagreement about the use of population vs. targeted visual screening services, offered at different stages of childhood and their effectiveness in reducing visual problems in children at population levels4

Although, in theory, eye services should be accessible to everyone, it is not known "if the people who use it are the people who need it". Inequity access to health care is defined as a mismatch between provision of clinical services and clinical need. 5 A study6 by the ALSPAC group has highlighted a clear gradient in maternal social class and prevalence of childhood hypermetropia as well as amblyopia at age 7. We therefore have robust epidemiological evidence that inequalities in visual health do indeed exist. The aim of this proposal is to now relate this pattern of need to actual receipt of clinical eye services and identify whether the latter pattern is consistent with need, thereby identifying if equitable access to care does not does not exist within this population and possibly the UK in general. Such an approach has been used for other chronic diseases.7 In addition we will adjust for the potential confounding effects of other covariates such as maternal eye problems, other siblings in the family