Dr Alison Bruce Bradford Teaching Hospitals NHS Foundation Trust

Funding Acknowledgement: Dr Alison Bruce is funded by the National Institute for Health Research Post-doctoral fellowship Programme (NIHR PDF).

This presentation presents independent research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Normal vision

Untreated Amblyopia

Vision age 1

Vision age 7

Age in years

Treated Amblyopia

Bruce and Outhwaite Br Ir Orth J 2013

“Need for more precise estimates of the prevalence of amblyopia”

Evidence of impact on everyday life

What factors associated with amblyopia? What are the reasons for failing to attend? What impact of amblyopia on educational attainment ?

Study nested in“Born in Bradford Cohort”

Bradford 5th largest 8th most deprived city in UK Children born 2007 – 2010 Approx 13,000 60% children born 50% South Asian origin

Predictor of reading ability & educational attainment

Letter identification & decoding essential prior to reading

Woodcock Reading Mastery Tests: Letter ID

Household income

Mothers education

Spoken Language

School screening

Visual outcome

BiB

profile of non-

attenders

Eye clinics

Attendance rates

BiB epidemiological data (mothers & babies) (n=11000)

Vision screening in school @ 4-5 years (n=17000)

Literacy (BiB Starting Schools programme) (n=6000)

Summary of datac = complete cohort, s = subgroup

  Pregnancy Birth 4-5yrs

Ethnicity C Mothers SE class C Mothers education C Housing tenure C Money problems C

Smoked in pregnancy C Alcohol in pregnancy C Gestational age C Birth weight C

Visual acuity (logMAR) CStrabismus C

Auto-refraction CLiteracy (letter identification) S

Cognitive ability (receptive vocabulary) S

Impact of vision on literacy FACTOR FULLY ADJUSTED MODEL*** (n=2025)

PVA - difference in literacy score per 1 line (0.1 log unit)  -1.65 (-2.17 to -1.13)        p<0.001   BPVS - difference in literacy score per 1 unit 0.25 (0.21 to 0 .28)           p<0.001Ethnicity (ref - White British)    Pakistani -0.14 (-1.86 to 1.58)         p=  0.872  Other  2.85 (0.88 to 4.82)           p=0.005    Sex at birth (ref – Male)  Female 3.06 (2.09 to 4.04)            p<0.001Birth weight (g) 0.001 (0.0001 to 0.002)   p=0.036Gestational age (weeks) -0.01 (-0.37 to 0.34)         p=0.937Questionnaire Language (ref – English)    Other language -1.61 (-3.18 to -0.04)        p= 0.045UK born (ref – No)       Yes -0.97 (-0.49 to 2.43)         p= 0.192Receiving Benefits        Yes -1.03 (-2.04 to -0.03)        p=0.045     Level of Education (ref – Low)  Medium (5 GCSE & A level equivalent) 1.13 (-0.04 to 2.3)             p=0.059High        (higher than A-level) 3.20 (1.71 to 4.70)            p<0.001Smoked in pregnancy (ref – No)        Yes -1.82 (0.25 to 3.39)           p=0.023

Impact of vision on literacy FACTOR FULLY ADJUSTED MODEL*** (n=2025)

PVA - difference in literacy score per 1 line (0.1 log unit)  -1.65 (-2.17 to -1.13)        p<0.001   BPVS - difference in literacy score per 1 unit 0.25 (0.21 to 0 .28)           p<0.001Ethnicity (ref - White British)    Pakistani -0.14 (-1.86 to 1.58)         p=  0.872  Other  2.85 (0.88 to 4.82)           p=0.005    Sex at birth (ref – Male)  Female 3.06 (2.09 to 4.04)            p<0.001Birth weight (g) 0.001 (0.0001 to 0.002)   p=0.036Gestational age (weeks) -0.01 (-0.37 to 0.34)         p=0.937Questionnaire Language (ref – English)    Other language -1.61 (-3.18 to -0.04)        p= 0.045UK born (ref – No)       Yes -0.97 (-0.49 to 2.43)         p= 0.192Receiving Benefits        Yes -1.03 (-2.04 to -0.03)        p=0.045     Level of Education (ref – Low)  Medium (5 GCSE & A level equivalent) 1.13 (-0.04 to 2.3)             p=0.059High        (higher than A-level) 3.20 (1.71 to 4.70)            p<0.001Smoked in pregnancy (ref – No)        Yes -1.82 (0.25 to 3.39)           p=0.023

Impact of vision on literacy FACTOR FULLY ADJUSTED MODEL*** (n=2025)

PVA - difference in literacy score per 1 line (0.1 log unit)  -1.65 (-2.17 to -1.13)        p<0.001   BPVS - difference in literacy score per 1 unit 0.25 (0.21 to 0 .28)           p<0.001Ethnicity (ref - White British)    Pakistani -0.14 (-1.86 to 1.58)         p=  0.872  Other  2.85 (0.88 to 4.82)           p=0.005    Sex at birth (ref – Male)  Female 3.06 (2.09 to 4.04)            p<0.001Birth weight (g) 0.001 (0.0001 to 0.002)   p=0.036Gestational age (weeks) -0.01 (-0.37 to 0.34)         p=0.937Questionnaire Language (ref – English)    Other language -1.61 (-3.18 to -0.04)        p= 0.045UK born (ref – No)       Yes -0.97 (-0.49 to 2.43)         p= 0.192Receiving Benefits        Yes -1.03 (-2.04 to -0.03)        p=0.045     Level of Education (ref – Low)  Medium (5 GCSE & A level equivalent) 1.13 (-0.04 to 2.3)             p=0.059High        (higher than A-level) 3.20 (1.71 to 4.70)            p<0.001Smoked in pregnancy (ref – No)        Yes -1.82 (0.25 to 3.39)           p=0.023

Impact of vision on literacy FACTOR FULLY ADJUSTED MODEL*** (n=2025)

PVA - difference in literacy score per 1 line (0.1 log unit)  -1.65 (-2.17 to -1.13)        p<0.001   BPVS - difference in literacy score per 1 unit 0.25 (0.21 to 0 .28)           p<0.001Ethnicity (ref - White British)    Pakistani -0.14 (-1.86 to 1.58)         p=  0.872  Other  2.85 (0.88 to 4.82)           p=0.005    Sex at birth (ref – Male)  Female 3.06 (2.09 to 4.04)            p<0.001Birth weight (g) 0.001 (0.0001 to 0.002)   p=0.036Gestational age (weeks) -0.01 (-0.37 to 0.34)         p=0.937Questionnaire Language (ref – English)    Other language -1.61 (-3.18 to -0.04)        p= 0.045UK born (ref – No)       Yes -0.97 (-0.49 to 2.43)         p= 0.192Receiving Benefits        Yes -1.03 (-2.04 to -0.03)        p=0.045     Level of Education (ref – Low)  Medium (5 GCSE & A level equivalent) 1.13 (-0.04 to 2.3)             p=0.059High        (higher than A-level) 3.20 (1.71 to 4.70)            p<0.001Smoked in pregnancy (ref – No)        Yes -1.82 (0.25 to 3.39)           p=0.023

Impact of vision on literacy FACTOR FULLY ADJUSTED MODEL*** (n=2025)

PVA - difference in literacy score per 1 line (0.1 log unit)  -1.65 (-2.17 to -1.13)        p<0.001   BPVS - difference in literacy score per 1 unit 0.25 (0.21 to 0 .28)           p<0.001Ethnicity (ref - White British)    Pakistani -0.14 (-1.86 to 1.58)         p=  0.872  Other  2.85 (0.88 to 4.82)           p=0.005    Sex at birth (ref – Male)  Female 3.06 (2.09 to 4.04)            p<0.001Birth weight (g) 0.001 (0.0001 to 0.002)   p=0.036Gestational age (weeks) -0.01 (-0.37 to 0.34)         p=0.937Questionnaire Language (ref – English)    Other language -1.61 (-3.18 to -0.04)        p= 0.045UK born (ref – No)       Yes -0.97 (-0.49 to 2.43)         p= 0.192Receiving Benefits        Yes -1.03 (-2.04 to -0.03)        p=0.045     Level of Education (ref – Low)  Medium (5 GCSE & A level equivalent) 1.13 (-0.04 to 2.3)             p=0.059High        (higher than A-level) 3.20 (1.71 to 4.70)            p<0.001Smoked in pregnancy (ref – No)        Yes -1.82 (0.25 to 3.39)           p=0.023

@BiBresearch, @BiBparents Conference #BiB15

Born in Bradford

Registered charity no: 1061753

Prevalence of PVA

1.0 (6/60)

2 % 0.8 (6/36)

0.5 (6/24)

2 % 0.4 (6/18) 0.3 (6/12)

4 % 0.2 (6/9)

92 % 0.0 (6/6)

Reduced vision effects early literacy (score 2% every 1 line reduction in vision: CI -2.17 to -1.13 p<0.001)

2% children “poor vision”

2% children “visual impaired”

Better understanding of amblyopia Evidence of effect on early literacy in

children Proposed service re-design to improve

uptake Platform for further research

Insight from parents & carers

Develop interventions Trial

Acknowledgments

•Orthoptic Dept. Bradford Teaching Hospitals NHS Trust

•Born in Bradford

•Institute for Effective Education - University of York

alison.bruce@bthft.nhs.uk