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Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the
Lisanne Andra Gitsels1,2, Mario Cortina-Borja1, Jugnoo Sangeeta Rahi1,2,3,4
1Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
Insights
Amblyopia (lazy eye) does not significantly impact early cognitive skills, though strabismic amblyopia is linked to lower school readiness. This suggests population-wide screening for amblyopia may not be justified by educational outcomes.
Area of Science:
- Ophthalmology
- Developmental Neuroscience
- Pediatric Health
Background:
- Amblyopia, a neurodevelopmental condition causing reduced vision, is screened for in global child populations.
- The functional impact of amblyopia and the value of screening remain debated due to limited evidence.
Purpose of the Study:
- To investigate the association between amblyopia and school readiness.
- To determine if amblyopia affects early cognitive performance and developmental trajectories.
Main Methods:
- Prospective cohort study of 13,967 UK children followed to age 7.
- Classification of eye conditions: no eye conditions, strabismus alone, refractive amblyopia, or strabismic/mixed amblyopia.
- Assessment of school readiness (Bracken School Readiness Assessment) and cognitive function (British Ability Scale II Naming Vocabulary, Pattern Construction).
Main Results:
- Strabismic/mixed amblyopia was associated with increased risk of poor school readiness (OR=2.04).
- No clinically significant differences in cognitive test scores (Naming Vocabulary, Pattern Construction) were found for children with any type of amblyopia.
- Cognitive developmental trajectories did not differ between children with and without amblyopia.
Conclusions:
- Amblyopia is not significantly associated with adverse early cognitive performance or developmental trajectories.
- While strabismic amblyopia links to poor school readiness, this does not translate to cognitive deficits.
- Findings suggest the educational impact of amblyopia may not justify universal child vision screening programs.
Background:
Amblyopia is a neurodevelopmental condition causing reduced vision, for which programmes of whole population child vision screening exist throughout the world. There is an ongoing debate about the value of screening due to the lack of evidence about meaningful functional impacts of amblyopia. Our objective was to determine whether amblyopia is associated with school readiness and early cognitive performance.
Methods And Findings:
Data from the prospective Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 7 years (n = 13,967). Using parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into no eye conditions, strabismus alone, refractive amblyopia, or strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were poor school readiness using Bracken School Readiness Assessment <25th percentile (age 3); and cognitive tests and their age-related trajectories using British Ability Scale II Naming Vocabulary (ages 3/5) and Pattern Construction (ages 5/7). Multivariable analyses showed that compared to children without any eye conditions, only those with strabismic/mixed amblyopia had an increased risk of poor school readiness (OR = 2.04, 95%CI 1.09-3.82). Small differences in mean scores for NV and PC of children with amblyopia (all types) compared to those without any eye condition were not clinically significant (>10 points) irrespective of whether treatment had already started. The age-related cognitive trajectories of children with amblyopia did not differ from those without any eye conditions for either NV (p = 0.62) or PC (p = 0.51). These associations are at population rather than individual level, so it might be that some individuals with amblyopia did experience significant adverse outcomes that are not captured by summary statistics.
Conclusions:
Amblyopia is not significantly associated with adverse cognitive performance and trajectories in early schooling and there is no evidence that this is due to a mediating effect of treatment. Although amblyopia combined with strabismus is associated with poor school readiness, this is not translated into poor cognitive performance. These novel findings may explain the lack of association reported between amblyopia and educational outcomes in adult life and suggest that the impact of amblyopia on education is not of itself a justification for whole population child vision screening aimed at detecting this disorder.
