Does amblyopia affect educational, health, and social outcomes? Findings from 1958 British birth cohort
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38751.597963.AE (Published 06 April 2006) Cite this as: BMJ 2006;332:820Data supplement
Table A Associations between mild or moderate/severe amblyopia and educational attainment, behaviour, social activities and accidents during childhood
Outcome
Education testsa
Vision status
n
Adjusted difference in scores
(normal vision - amblyopia)
95% CI
p value
At 7 years
Mathsb
normal
mild
mod/severe
6993
244
96
-0.10
0.10
-0.24
-0.11
0.03
0.32
0.133
0.344
Readingb
normal
mild
mod/severe
7021
244
97
-0.16
-0.09
-0.28
-0.28
-0.04
0.10
0.004
0.357
Copy-a-designb
normal
mild
mod/severe
6037
215
81
-0.06
0.08
-0.21
-0.15
0.08
0.32
0.394
0.485
Draw-a-man
normal
mild
mod/severe
5942
215
78
-0.74
-0.40
-1.76
-2.07
0.28
1.27
0.156
0.637
At 11 years
Mathsb
normal
mild
mod/severe
5894
194
79
0.02
-0.09
-0.10
-0.29
0.15
0.11
0.705
0.366
Readingb
normal
mild
mod/severe
5938
197
80
0.09
-0.14
-0.03
-0.14
0.20
0.24
0.151
0.600
Copy-a-designb
normal
mild
mod/severe
5622
186
76
0.14
-0.11
-0.02
-0.11
0.29
0.13
0.078
0.370
Verbal score on general ability test
normal
mild
mod/severe
5526
184
73
-0.34
-0.86
-1.70
-2.99
1.01
1.27
0.619
0.427
Non-verbal score on general ability test
normal
mild
mod/severe
5525
184
73
-0.27
-0.03
-1.38
-1.77
0.83
1.71
0.630
0.970
At 16 years
Mathsb
normal
mild
mod/severe
4648
156
62
0.08
-0.02
-0.03
-0.19
0.19
0.16
0.164
0.859
Readingb
normal
mild
mod/severe
4706
157
65
0.05
0.02
-0.04
-0.13
0.15
0.16
0.274
0.829
Behaviour
Vision status
number affected (%)
Adjusted Odds Ratio
(amblyopia vs normal vision)
95% CI
p value
At 7 yearsC
BSAG score, in upper decile
normal
mild
mod/severe
651 (9%)
24 (10%)
14 (15%)
1.00
1.20
1.73
0.77
0.92
1.88
3.23
0.419
0.087
Rutter score, in upper decile
normal
mild
mod/severe
665 (10%)
25 (11%)
13 (14%)
1.00
1.07
1.24
0.69
0.65
1.67
2.38
0.758
0.513
At 11 yearsC
BSAG score, in upper decile
normal
mild
mod/severe
580 (9%)
21 (10%)
9 (10%)
1.00
1.10
0.91
0.68
0.42
1.80
1.95
0.695
0.806
Rutter score, in upper decile
normal
mild
mod/severe
556 (10%)
19 (10%)
11 (14%)
1.00
0.99
1.23
0.60
0.59
1.64
2.53
0.984
0.581
Sport /outdoor gamesC
At 11 years - ‘Hardly ever’
normal
mild
mod/severe
667 (10%)
24 (11%)
9 (10%)
1.00
1.15
1.02
0.72
0.47
1.85
2.22
0.550
0.951
At 16 years - ‘Hardly ever’
normal
mild
mod/severe
1487 (26%)
53 (25%)
13 (18%)
1.00
0.99
0.75
0.69
0.38
1.42
1.46
0.964
0.393
Social activitiesC
Dancing/disco at 16 years –
‘Hardly ever’
normal
mild
mod/severe
1685 (29%)
74 (34%)
20 (27%)
1.00
1.32
0.86
0.96
0.49
1.82
1.53
0.086
0.611
Accidents requiring hospital careC
Inpatient care up to 16 years
normal
mild
mod/severe
1595 (24%)
71 (28%)
19 (22%)
1.00
1.17
0.76
0.86
0.44
1.59
1.33
0.319
0.334
Outpatient care aged 12 to 16 years
normal
mild
mod/severe
1644 (24%)
60 (23%)
25 (28%)
1.00
0.89
1.05
0.65
0.62
1.23
1.76
0.482
0.858
a adjusted for social class, sex, age at testing, family size, ever having strabismus, treatment for amblyopia, previous test scores where appropriate
b standardized education scores ie multiples of standard deviation
c adjusted for social class, sex, ever having strabismus, treatment for amblyopia
Table B Associations between mild or moderate/severe amblyopia and education, social activities, accidents, general and mental health, employment, ‘target’ occupation and social mobility in adult life.
Outcome
Vision status
number affected (%)
Adjusted Odds Ratio
(amblyopia vs normal vision)
95% CI
P value
Higher educational attainment at 33 yearsa
normal
mild
mod/severe
4965
184
65
1.22
0.99
0.91
0.61
1.64
1.61
0.189
0.962
Employment
At 33 years, in paid employmentb
men
normal
mild
mod/severe
1861 (77%)
69 (77%)
22 (67%)
0.93
0.51
0.55
0.22
1.60
1.17
0.805
0.112
women
normal
mild
mod/severe
1667 (67%)
59 (65%)
16 (60%)
0.92
0.71
0.57
0.31
1.50
1.64
0.747
0.427
Sport and social functioning e
At 23 years, in the past month -
not done any sport
normal
mild
mod/severe
3408 (52%)
117 (149%)
41 (50%)
0.94
1.07
0.71
0.65
1.26
1.75
0.686
0.800
not been dancing
normal
mild
mod/severe
1685 (29%)
74 (34%)
20 (27%)
1.00
0.88
0.76
0.54
1.34
1.44
0.954
0.610
not been out with friends f
normal
mild
mod/severe
343 (5.2%)
15 (6.3%)
1.23
-
0.69
-
2.19
-
0.477
-
not been to the cinema
normal
mild
mod/severe
4325 (66%)
150 (63%)
49 (160%)
0.87
0.76
0.65
0.46
1.16
1.25
0.339
0.283
General health g
At 23 years –self report of poorer health
normal
mild
mod/severe
4712
159
62
1.48
0.81
1.10
0.49
2.01
1.32
0.011
0.389
At 33 years – self-report of poorer health
normal
mild
mod/severe
3579
121
51
1.04
1.12
0.73
0.64
1.49
1.95
0.839
0.700
At 41 years – self-report of poorer health
normal
mild
mod/severe
4159
145
51
1.06
0.69
0.76
0.39
1.48
1.22
0.718
0.201
Mental healthh
At 33 years – depression, seen GP/specialist in past 10 years
normal
mild
mod/severe
440 (12%)
21 (18%)
8 (16%)
1.54
1.61
0.93
0.74
2.56
3.53
0.093
0.233
At 41 years – depression, seen GP/specialist in past 8 years
normal
mild
mod/severe
747 (19%)
25 (17%)
8 (17%)
0.69
0.90
0.44
0.40
1.10
2.04
0.123
0.806
At 23 years – psychological distress
(Malaise Inventory score >7)
normal
mild
mod/severe
263 (9%)
6 (7%)
2 (15%)
0.74
0.59
0.31
0.14
1.77
2.56
0.501
0.484
At 33 years – psychological distress
normal
mild
mod/severe
287 (8%)
9 (8%)
4 (8%)
0.88
1.29
0.41
0.44
1.90
3.79
0.754
0.649
At 41 years – psychological distress
normal
mild
mod/severe
576 (17%)
14 (11%)
6 (7%)
0.65
0.25
0.35
0.07
1.20
0.91
0.165
0.035
Accidentse
Inpatient care aged 17 to 33 years
normal
mild
mod/severe
736 (14%)
33 (17%)
9 (13%)
1.56
1.09
1.03
0.50
2.38
2.40
0.037
0.826
Outpatient care aged 17 to 33 years
normal
mild
mod/severe
2930 (55%)
104 (53%)
44 (61%)
0.90
1.04
0.65
0.60
1.24
1.82
0.517
0.882
Accident as driver aged 17 to 33 years
normal
mild
mod/severe
915 (17%)
39 (20%)
22 (31%)
1.28
2.33
0.87
1.29
1.89
4.20
0.210
0.005
Accident at work aged 17 to 33 years
normal
mild
mod/severe
1292 (24%)
39 (20%)
17 (24%)
0.78
0.76
0.52
0.40
1.17
1.45
0.226
0.408
a ordinal regression - odds of achieving a higher level of education, independent of actual level considered, adjusted for sex, social class, marital status, ever having strabismus, treatment for amblyopia
b adjusted for highest educational attainment, social class, ever having strabismus, treatment for amblyopia
c adjusted for highest educational attainment, marital status, accommodation, ever having strabismus, treatment for amblyopia
d adjusted for highest educational attainment, marital status, downward mobility, ever having strabismus, treatment for amblyopia
e adjusted for sex, social class, ever having strabismus, treatment for amblyopia
f all moderate / severe amblyopes reported going out with friends, in the previous month
g ordinal regression - odds of self-report of poorer health, independent of level, adjusted for highest educational attainment, marital status, home behaviour at 16 years, sex, school adjustment at 16 years, previous mental health, change in social class in previous 10 years
h adjusted for highest educational attainment, marital status, home behaviour at 16 years, sex, school adjustment at 16 years, previous mental health, change in social class in previous 10 years
Table C Associations between resolved amblyopia and educational attainment, behaviour, social activities and accidents during childhood
Outcome
Education testsa
Vision status
number affected (%)
Adjusted difference in scores
(normal vision - resolved amblyopia)
95% CI
p value
At 7 years
Mathsb
normal
resolved
6993
90
-0.01
-0.27
0.24
0.920
Readingb
normal
resolved
7021
92
-0.18
-0.40
0.04
0.116
Copy-a-designb
normal
resolved
6118
81
0.16
-0.11
0.43
0.242
Draw-a-man
normal
resolved
5942
82
-1.30
-2.80
0.20
0.090
At 11 years
Mathsb
normal
resolved
5894
78
0.15
-0.10
0.40
0.228
Readingb
normal
resolved
5938
82
-0.02
-0.27
0.23
0.884
Copy-a-designb
normal
resolved
5622
78
0.24
-0.03
0.52
0.078
Verbal score on general ability test
normal
resolved
5526
78
-0.13
-2.54
2.27
0.914
Non-verbal score on general ability test
normal
resolved
5525
76
0.52
-1.44
2.49
0.601
At 16 years
Mathsb
normal
resolved
4648
60
-0.28
-0.28
0.26
0.952
Readingb
normal
resolved
4706
61
-0.27
-0.27
0.24
0.887
Behaviour
Adjusted Odds Ratio
(resolved amblyopia vs normal vision)
95% CI
p value
At 7 yearsC
BSAG score, in upper decile
normal
resolved
651 (9%)
11 (13%)
1.90
0.90
4.02
0.092
Rutter score, in upper decile
normal
resolved
665 (9.5%)
11 (12.5%)
0.89
0.40
1.97
0.768
At 11 yearsC
BSAG score, in upper decile
normal
resolved
580 (9%)
8 (9%)
1.16
0.49
2.71
0.739
Rutter score, in upper decile
normal
resolved
556 (10%)
19 (22%)
2.27
1.20
4.30
0.012
Sport /outdoor gamesC
At 11 years - ‘Hardly ever’
normal
resolved
667 (10%)
13 (15%)
1.68
0.75
3.79
0.208
At 16 years - ‘Hardly ever’
normal
resolved
1487 (26%)
16 (24%)
0.95
0.46
1.95
0.886
Co-ordination c
at 16 years - marked clumsiness
normal
resolved
12 (0.2%)
2 (2.5%)
Social activitiesC
Dancing/disco at 16 years - ‘Hardly ever’
normal
resolved
1685 (29%)
26 (38%)
1.41
0.74
2.69
0.295
Accidents requiring hospital careC
Up to the age of 7 years
normal
resolved
1289 (18%)
17 (18%)
0.98
0.50
1.90
0.952
Between 7 and 11 years
normal
resolved
539 (8%)
5 (5%)
0.33
0.12
0.89
0.029
Inpatient care for accident, 12 to 16 years
normal
resolved
270 (4%)
3 (4%)
1.66
0.33
8.50
0.538
Outpatient care for accident, 12 to 16 years
normal
resolved
1644 (24%)
19 (23%)
0.65
0.35
1.22
0.178
a adjusted for social class, sex, age at testing, family size, ever having strabismus, treatment for amblyopia, previous test scores where appropriate
b standardized education scores ie multiples of standard deviation
c adjusted for social class, sex, ever having strabismus, treatment for amblyopia
Table D Associations between resolved amblyopia and education, social activities, accidents, general and mental health, employment, ‘target’ occupation and social mobility in adult life.
Outcome
Vision status
number affected (%)
Adjusted Odds Ratio
(amblyopia vs normal vision)
95% CI
P value
Higher educational attainment at 33 yearsa
normal
resolved
4965
63
0.85
0.49
1.48
0.575
Employment / occupation
At 33 years, in paid employmentb men
normal
resolved
1861 (77%)
26 (79%)
1.07
0.38
3.05
0.898
women
normal
resolved
1667 (67%)
19 (63%)
0.99
0.39
2.47
0.977
Downward occupation-based social class trajectory (men), from birth to 33 years c
normal
resolved
366 (24%)
5 (28%)
1.11
0.31
3.95
0.874
At 33 years, men working in ‘target' job (men) d
normal
resolved
95 (65)
1 (6%)
1.48
0.12
18.43
0.760
Sport and social functioning e
At 23 years, in the past month -
not done any sport
normal
resolved
3408 (52%)
40 (51%)
1.05
0.59
1.86
0.870
not been dancing
normal
resolved
1685 (29%)
26 (38%)
0.94
0.54
1.65
0.836
not been out with friends
normal
resolved
343 (5%)
3 (4%)
1.31
0.28
6.04
0.733
not been to the cinema
normal
resolved
4325 (66%)
58 (73%)
1.47
0.79
2.74
0.220
General health f
At 23 years –self report of poorer health
normal
resolved
4712
65
1.32
0.81
2.13
0.264
At 33 years – self-report of poorer health
normal
resolved
3579
59
0.98
0.58
1.66
0.941
At 41 years – self-report of poorer health
normal
resolved
4159
59
1.06
0.64
1.76
0.809
Mental healthf
At 33 years – depression, seen GP/specialist in past 10 years
normal
resolved
440 (12%)
8 (15%)
1.23
0.55
2.74
0.610
At 41 years – depression, seen GP/specialist in past 8 years
normal
resolved
747 (19%)
10 (22%)
1.05
0.49
2.28
0.897
At 23 years – psychological distress
(Malaise Inventory score >7)
normal
resolved
263 (9%)
5 (10%)
1.12
0.42
2.95
0.820
At 33 years – psychological distress
normal
resolved
287 (8%)
6 (11%)
1.23
0.46
3.27
0.681
At 41 years – psychological distress
normal
resolved
576 (16.5%)
8 (15%)
0.76
0.33
1.75
0.517
Accidents e
Inpatient care for accident, 17 to 23 years
normal
resolved
616 (9%)
6 (8%)
2.13
0.62
7.31
0.227
Outpatient care for accident, 17 to 23 years
normal
resolved
2634 (40%)
31 (39%)
0.71
0.39
1.29
0.264
Inpatient care for accident, 24 to 33 years
normal
resolved
390 (7%)
2 (3%)
0.50
0.10
2.53
0.405
Outpatient care for accident, 24 to 33 years
normal
resolved
1984 (37%)
23 (36%)
1.19
0.62
2.32
0.599
Accident as driver up to 23 years of age
normal
resolved
796 (12%)
11 (14%)
2.30
0.90
5.90
0.082
Accident as driver 24 to 33 years of age
normal
resolved
465 (9%)
5 (8%)
0.77
0.26
2.30
0.637
Accident at work up to 23 years of age
normal
resolved
1107 (17%)
13 (16%)
0.72
0.34
1.55
0.405
Accident at work up to 24 to 33 years of age
normal
resolved
816 (15%)
8 (13%)
0.76
0.30
1.94
0.572
a odds of achieving a higher level of education, independent of actual level considered, adjusted for sex, social class, marital status, ever having strabismus, treatment for amblyopia
b adjusted for highest educational attainment, social class, ever having strabismus, treatment for amblyopia
c adjusted for highest educational attainment, marital status, accommodation, ever having strabismus, treatment for amblyopia
d adjusted for highest educational attainment, marital status, downward mobility, ever having strabismus, treatment for amblyopia
e adjusted for sex, social class, ever having strabismus, treatment for amblyopia
f adjusted for highest educational attainment, marital status, home behaviour at 16 years, sex, school adjustment at 16 years, previous mental health, change in social class in previous 10 years
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