A comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit

Siofra Harrington, Karen Breslin, Veronica O'Dwyer, Kathryn J Saunders

Research output: Contribution to journalArticle

Abstract

Objectives: Report the prevalence of persistent amblyopia (post-traditional treatment age), in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems. Design: Population-based observational study of amblyopia and refractive error. Setting: Recruitment and testing in primary and post-primary schools in Ireland and NI. Participants: Two groups identified through random cluster sampling to represent the underlying population; Ireland 898 participants (12-13-years-old) and NI 723 participants (295 9-10-year-olds, 428 15-16-year-olds). Main outcome measures: Monocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic auto-refraction), ocular alignment (cover test) and history of previous eye-care. These metrics were used to determine prevalence and type of amblyopia and treatment histories. Results: Children examined in NI between 2009 and 2011 had a significantly lower amblyopia prevalence than children examined in Ireland between 2016 and 2018 (2-sample test of proportions, p<0.001). Using a criteria of pinhole acuity 0.2logMAR (6/9.5 Snellen) plus an amblyogenic factor, 4 of 295 9-10-year-old (1.3%, 95% confidence intervals (CIs):0.4 to 3.6) and 3 of 428 15-16-year-old (0.7%, 95%CIs: 0.2 to 2.2) participants were identified in NI. The corresponding numbers in Ireland were 40 of 898 12-13-year-old (4.5%, 95%CI: 3.2 to 6.1) participants. In NI strabismic amblyopia was the most prevalent type of persistent amblyopia, whereas anisometropic was predominant in Ireland. In Ireland, amblyopia was associated with socioeconomic disadvantage (OR=2.2, 95%CIs: 1.4 to 3.6, p=0.002), and poor spectacle compliance (OR: 2.5 95%CIs 2.0 to 3.2, p<0.001). Conclusions: Amblyopia prevalence persisting beyond traditional treatment ages, was significantly lower amongst NI children compared to Ireland. Uncorrected anisometropia, compliance with spectacle wear and socioeconomic disadvantage were contributing factors in Ireland. Children without obvious visible eye defects were less likely to access eye-care in Ireland resulting in missed opportunities for intervention where necessary.
LanguageEnglish
JournalBMJ Open
Publication statusAccepted/In press - 24 Jul 2019

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Northern Ireland
Amblyopia
Ireland
Cross-Sectional Studies
Population
Confidence Intervals
Refractive Errors
Ocular Refraction
Anisometropia
Mydriatics
Visual Acuity
Observational Studies
Therapeutics
Outcome Assessment (Health Care)

Keywords

  • amblyopia
  • public health
  • children
  • refractive error

Cite this

@article{aa7c36f65fd043b0bbe1fba5078e042d,
title = "A comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit",
abstract = "Objectives: Report the prevalence of persistent amblyopia (post-traditional treatment age), in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems. Design: Population-based observational study of amblyopia and refractive error. Setting: Recruitment and testing in primary and post-primary schools in Ireland and NI. Participants: Two groups identified through random cluster sampling to represent the underlying population; Ireland 898 participants (12-13-years-old) and NI 723 participants (295 9-10-year-olds, 428 15-16-year-olds). Main outcome measures: Monocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic auto-refraction), ocular alignment (cover test) and history of previous eye-care. These metrics were used to determine prevalence and type of amblyopia and treatment histories. Results: Children examined in NI between 2009 and 2011 had a significantly lower amblyopia prevalence than children examined in Ireland between 2016 and 2018 (2-sample test of proportions, p<0.001). Using a criteria of pinhole acuity 0.2logMAR (6/9.5 Snellen) plus an amblyogenic factor, 4 of 295 9-10-year-old (1.3{\%}, 95{\%} confidence intervals (CIs):0.4 to 3.6) and 3 of 428 15-16-year-old (0.7{\%}, 95{\%}CIs: 0.2 to 2.2) participants were identified in NI. The corresponding numbers in Ireland were 40 of 898 12-13-year-old (4.5{\%}, 95{\%}CI: 3.2 to 6.1) participants. In NI strabismic amblyopia was the most prevalent type of persistent amblyopia, whereas anisometropic was predominant in Ireland. In Ireland, amblyopia was associated with socioeconomic disadvantage (OR=2.2, 95{\%}CIs: 1.4 to 3.6, p=0.002), and poor spectacle compliance (OR: 2.5 95{\%}CIs 2.0 to 3.2, p<0.001). Conclusions: Amblyopia prevalence persisting beyond traditional treatment ages, was significantly lower amongst NI children compared to Ireland. Uncorrected anisometropia, compliance with spectacle wear and socioeconomic disadvantage were contributing factors in Ireland. Children without obvious visible eye defects were less likely to access eye-care in Ireland resulting in missed opportunities for intervention where necessary.",
keywords = "amblyopia, public health, children, refractive error",
author = "Siofra Harrington and Karen Breslin and Veronica O'Dwyer and Saunders, {Kathryn J}",
year = "2019",
month = "7",
day = "24",
language = "English",
journal = "BMJ Open",
issn = "2044-6055",

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TY - JOUR

T1 - A comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit

AU - Harrington, Siofra

AU - Breslin, Karen

AU - O'Dwyer, Veronica

AU - Saunders, Kathryn J

PY - 2019/7/24

Y1 - 2019/7/24

N2 - Objectives: Report the prevalence of persistent amblyopia (post-traditional treatment age), in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems. Design: Population-based observational study of amblyopia and refractive error. Setting: Recruitment and testing in primary and post-primary schools in Ireland and NI. Participants: Two groups identified through random cluster sampling to represent the underlying population; Ireland 898 participants (12-13-years-old) and NI 723 participants (295 9-10-year-olds, 428 15-16-year-olds). Main outcome measures: Monocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic auto-refraction), ocular alignment (cover test) and history of previous eye-care. These metrics were used to determine prevalence and type of amblyopia and treatment histories. Results: Children examined in NI between 2009 and 2011 had a significantly lower amblyopia prevalence than children examined in Ireland between 2016 and 2018 (2-sample test of proportions, p<0.001). Using a criteria of pinhole acuity 0.2logMAR (6/9.5 Snellen) plus an amblyogenic factor, 4 of 295 9-10-year-old (1.3%, 95% confidence intervals (CIs):0.4 to 3.6) and 3 of 428 15-16-year-old (0.7%, 95%CIs: 0.2 to 2.2) participants were identified in NI. The corresponding numbers in Ireland were 40 of 898 12-13-year-old (4.5%, 95%CI: 3.2 to 6.1) participants. In NI strabismic amblyopia was the most prevalent type of persistent amblyopia, whereas anisometropic was predominant in Ireland. In Ireland, amblyopia was associated with socioeconomic disadvantage (OR=2.2, 95%CIs: 1.4 to 3.6, p=0.002), and poor spectacle compliance (OR: 2.5 95%CIs 2.0 to 3.2, p<0.001). Conclusions: Amblyopia prevalence persisting beyond traditional treatment ages, was significantly lower amongst NI children compared to Ireland. Uncorrected anisometropia, compliance with spectacle wear and socioeconomic disadvantage were contributing factors in Ireland. Children without obvious visible eye defects were less likely to access eye-care in Ireland resulting in missed opportunities for intervention where necessary.

AB - Objectives: Report the prevalence of persistent amblyopia (post-traditional treatment age), in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems. Design: Population-based observational study of amblyopia and refractive error. Setting: Recruitment and testing in primary and post-primary schools in Ireland and NI. Participants: Two groups identified through random cluster sampling to represent the underlying population; Ireland 898 participants (12-13-years-old) and NI 723 participants (295 9-10-year-olds, 428 15-16-year-olds). Main outcome measures: Monocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic auto-refraction), ocular alignment (cover test) and history of previous eye-care. These metrics were used to determine prevalence and type of amblyopia and treatment histories. Results: Children examined in NI between 2009 and 2011 had a significantly lower amblyopia prevalence than children examined in Ireland between 2016 and 2018 (2-sample test of proportions, p<0.001). Using a criteria of pinhole acuity 0.2logMAR (6/9.5 Snellen) plus an amblyogenic factor, 4 of 295 9-10-year-old (1.3%, 95% confidence intervals (CIs):0.4 to 3.6) and 3 of 428 15-16-year-old (0.7%, 95%CIs: 0.2 to 2.2) participants were identified in NI. The corresponding numbers in Ireland were 40 of 898 12-13-year-old (4.5%, 95%CI: 3.2 to 6.1) participants. In NI strabismic amblyopia was the most prevalent type of persistent amblyopia, whereas anisometropic was predominant in Ireland. In Ireland, amblyopia was associated with socioeconomic disadvantage (OR=2.2, 95%CIs: 1.4 to 3.6, p=0.002), and poor spectacle compliance (OR: 2.5 95%CIs 2.0 to 3.2, p<0.001). Conclusions: Amblyopia prevalence persisting beyond traditional treatment ages, was significantly lower amongst NI children compared to Ireland. Uncorrected anisometropia, compliance with spectacle wear and socioeconomic disadvantage were contributing factors in Ireland. Children without obvious visible eye defects were less likely to access eye-care in Ireland resulting in missed opportunities for intervention where necessary.

KW - amblyopia

KW - public health

KW - children

KW - refractive error

M3 - Article

JO - BMJ Open

T2 - BMJ Open

JF - BMJ Open

SN - 2044-6055

ER -