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

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Public health
Research
Comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit
  1. Siofra Harrington1,
  2. Karen Breslin2,
  3. Veronica O'Dwyer1,
  4. Kathryn Saunders2
  1. 1 School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
  2. 2 School of Biomedical Sciences, Optometry and Vision Sciences, Ulster University, Coleraine, Northern Ireland, UK
  1. Correspondence to Mrs Siofra Harrington; siofra.harrington{at}dit.ie

Abstract

Objectives This study reports 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 This is a 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 aged 9–10 years old, 428 aged 15–16 years old).

Main outcome measures Monocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic autorefraction), 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 (two-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 participants aged 9–10 years old (1.3%, 95% CIs 0.4 to 3.6) and 3 of 428 participants aged 15–16 years old (0.7%, 95%CIs 0.2 to 2.2) were identified in NI. The corresponding numbers in Ireland were 40 of 898 participants aged 12–13 years old (4.5%, 95% CI 3.2 to 6.1). 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 among NI children compared with 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.

  • amblyopia
  • visual impairment
  • children
  • ireland
  • northern ireland

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031066

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    Footnotes

    • Contributors All authors (SH, KB, VO’D and KJS) contributed to the conception and design of this work. All authors were involved in drafting, critically reviewing and approval of the final version to be published.

    • Funding This work was supported by the College of Optometrists, UK, the Technological University Dublin Fiosraigh grant, the Opticians Board, and the Association of Optometrists Ireland

    • Disclaimer SH reports grants from Irish Opticians Board, grants from Association of Optometrists Ireland and grants from British College of Optometrists during the conduct of the study.

    • Competing interests The authors have read and understood British Medical Journal policy on declaration of interests and SH reports grants from Irish Opticians Board, grants from Association of Optometrists Ireland and grants from British College of Optometrists during the conduct of the study.

    • Patient and public involvement statement The study was supported by a patient advisory group which provided input to the programme of research. Parents/legal guardians of participants partnered with us for the design of the study, the informational material to support the data collection and participant and school involvement, and assess the burden of participation from the patient’s perspective. At the end of the study, results and findings were provided to all participants.

    • Patient consent for publication Not required.

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

    • Data availability statement No data are available.