Overview of the Research
Aim: To provide high quality research into Amblyopia (poor vision) and related eye conditions to better understand and improve eye healthcare.
Orthoptics and Low Vision services at Bradford Teaching Hospitals are a department allied to Ophthalmology. We specialise in the investigation and treatment of defects of binocular vision, visual development and eye movement in all age groups.
As part of a busy hospital eye care team, we also provide low vision aid, Glaucoma and visual fields clinics and orthoptic assessment of adults with learning disability. In addition, a comprehensive primary school screening programme for visual defects is run by the Department.
As a result of our diverse skill mix and experience, we have research interests ranging from epidemiology, quality of life and genetics to applied health research. We are currently running our own research studies and also participate and recruit to multi-centre studies.
- The impact of amblyopia on health and literacy
The initial school years are a crucial time for the development of these key literacy skills it is therefore important to understand the impact of non-adherence to spectacle wear on visual outcome and educational attainment. Low educational attainment is associated with socioeconomic deprivation which makes the investigation of the relationship between visual acuity and literacy difficult, as in order to account for potential confounding factors, comprehensive epidemiological data are required. By linking separately-collected vision and literacy data in children in the BiB cohort, we had the opportunity to explore the association between VA, spectacle wear and literacy development whilst taking into account the effects of potential confounders. The first aim of the study is to examine the impact of adherence to spectacle wear on early developing VA and literacy skills in children during their first three years of school.
Most young children with refractive error or amblyopia do not demonstrate obvious signs or symptoms, making it difficult for parents to identify. Vision screening is recommended in the United Kingdom at age 4-5 years however early detection programmes can only be effective if those identified with poor vision are appropriately treated. Around 30% fail to attend follow up and studies have shown poor adherence to spectacle wear therefore a high proportion of children with identified needs do not access ophthalmic services and subsequent treatment. Socioeconomic factors have been reported to influence access to children’s eye care and adherence with spectacle wear. This study examines the factors associated with non-attendance and additionally using qualitative methodology explores in depth parents’ experiences and understanding of their children’s eye care in order to better comprehend why there is relatively low uptake of services and variable adherence to treatment.
For further information contact Dr Alison Bruce – Chief Investigator
This summary presents independent research funded by the National Institute for Health Research (NIHR) under the NIHR Post-Doctoral Fellowship Award (PDF-2013-06-050).
The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
- Genetic studies of complex and common strabismus and their associated anomalies.
Collaboration with the University of Leicester(UK) and Harvard University (USA).
- Refractive Adaptation and Feedback studies (EUPATCH).
Collaboration with the University of Leicester (UK).
Treatment of amblyopia includes glasses wearing and patching of the better eye. Currently 30% of children treated for amblyopia do not reach normal vision after a year or more of treatment. One of the major problems identified in treatment has been adherence to patching and glasses wearing which may potentially account for the poor outcomes achieved through this treatment regime.
The aim of this study is to perform a parallel two-armed randomised controlled trial to determine whether giving feedback on adherence to spectacles and patching to parents/ guardians and children can improve compliance to amblyopia therapy. We are using electronic monitors (occlusion dose monitors and glasses dose monitors) to measure how many hours children wear their glasses and patch each day and determine how feedback from these devices relates to improvement in compliance. This trial should clarify whether feedback given to parents/ guardians and children on the adherence to glasses and patching can improve compliance to amblyopia therapy and in turn improve treatment outcomes.
Effect of amblyopia treatment on suppression study.
Collaboration with the University of Liverpool (UK).
Occlusion has been proven to be an effective treatment of amblyopia and is the most commonly used treatment option in the UK. Though the treatment has very few side effects, a complication of intractable diplopia can occur in patients with strabismus where binocular vision is absent and the ability to suppress is lost due a reduction in the density of suppression following amblyopia treatment. The very nature of intractable diplopia means that it cannot be eliminated by surgical realignment of the eyes or correcting the angle with prisms and presents important quality of life issues for the individuals affected.
Clinicians currently base their decisions on anecdotal evidence from prior experience or local consensus. This absence of evidence based practice could lead to intractable diplopia if the risk has not been established or interpreted appropriately or alternatively may mean that older children/adults will be denied treatment due to the reluctance of clinicians to treat high risk cases.The aims of this study were to determine to what extent the density of suppression (in patients with strabismus) is reduced by occlusion treatment and to determine if the reduction in the density of suppression is associated with the visual acuity of the amblyopic eye at the start of treatment, the age of the patient or the size/type of strabismus.
Update of a picture test to measure visual acuity in children.
Collaboration with the University of Liverpool (UK).
The measurement of visual acuity is critical to the diagnosis of many conditions in young children, and serial measures are required to monitor any changes in response to treatment. Therefore in the early 1980’s a new test called Kay picture test was designed specifically for the 2-3 year age group and subsequently has been widely used both clinically and in research. It has been 25 years since the original Kay picture test was designed therefore a review of the whole test, in particular the choice of pictures, is required to ensure the optimum accuracy. This phase of the study was to determine whether children are able to correctly identify the pictures and the age at which this occurs.
The structural integrity of eyes diagnosed with amblyopia.
NIHR Doctoral Fellowship based in University of Bradford.
This study examined the structure of the retina in both amblyopes (children and adults) and visually normal controls using the detailed scanning technique of optical coherence tomography (OCT). Amblyopia is traditionally noted as being a mainly unilateral condition, related to strabismus (squint) or refractive error (need for glasses), reducing the visual acuity of the affected eye. The findings however revealed structural symmetry of retinal structure in both the eyes of amblyopes. Bilateral thickening at the fovea (site of greatest concentration of cone cells, providing maximum visual acuity) was demonstrated in amblyopes compared to the eyes of the visually normal controls.
A cohort of amblyopic children who were receiving occlusion therapy (wearing an eye patch) were followed up. Not only was bilateral thickening of the fovea demonstrated in the amblyopes but, children who failed to achieve a successful outcome from the occlusion, had foveal thickness significantly greater than those children who achieved a successful outcome. The bilateral foveal thickening may be an indicator for the onset of amblyopia, suggesting that early treatment may be more effective.
Radio broadcast highlighting the research investigating spectacle wear in young children, broadcast as part of the Born in Bradford update on Radio 4. June 2017
Individual impact REF Case study cited in “Transforming healthcare through clinical academic roles in nursing, midwifery and allied health professions. A practical resource for healthcare provider organisations.” 2016.
Case study ‘2’ in “AHP’s into Action” Using Allied Health Professionals to transform health, care and wellbeing. NHS England 2017.
NIHR fellowship 10 year anniversary blog
Blog for National Eye Health Week 2017.