Date post: | 18-Feb-2017 |
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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