Abstract
Background
Limited evidence exists around health inequalities in amblyopia therapy. This cohort study explores amblyopia therapy outcomes and socioeconomic scores by postcode, across two boroughs within Greater Manchester.
Methods
All available orthoptic records for school vision screening referrals from the academic year 2017–2018 were reviewed by one Research Orthoptist, to identify children diagnosed with unilateral amblyopia. Clinical data were extracted and the proportion amblyopia deficit corrected and appointment attendance rates over 1 year of therapy were calculated. Home postcodes were used to identify socioeconomic situation for each patient, by Index of Multiple Deprivation (IMD) 2019 and Townsend Deprivation Index 2011.
Results
From 730 school screening referrals, 512 orthoptic records were accessible and 42 cases of unilateral amblyopia were identified. The median proportion amblyopia deficit corrected in 1 year was 51.0% (IQR 22.6–72.9). The median attendance rate was 87.5% (IQR 67.9–100.0); 47.6% of patients attended every appointment. No statistically significant relationships were found between socioeconomic score and the proportion amblyopia deficit corrected in a year (IMD: unstandardised beta coefficient 1.782, 95% CI −1.877 to 5.441, p = 0.331) or orthoptic clinic attendance rates (IMD: unstandardised beta coefficient −0.479, 95% CI −2.492 to 1.534, p = 0.633). A positive relationship was found between attendance rate and proportion amblyopia deficit corrected (unstandardised beta coefficient 0.743, 95% CI 0.213 to 1.274, p = 0.007).
Conclusion
In two Greater Manchester community orthoptic services, amblyopia therapy outcome and clinic attendance rate were not related to individual socioeconomic scores by postcode. A positive relationship between orthoptic clinic attendance rate and amblyopia therapy outcome was found.
Data availability
The datasets generated during and analysed during the current study are not publicly available as the privacy of research participants could be compromised.
References
Fu Z, Hong H, Su Z, Lou B, Pan CW, Liu H. Global prevalence of amblyopia and disease burden projections through 2040: a systematic review and meta-analysis. Br J Ophthalmol. 2019;104:1164–70.
Solebo AL, Rahi JS. Childhood vision screening External review against programme appraisal criteria for the UK National Screening Committee. 2019. https://view-health-screening-recommendations.service.gov.uk/document/452/download.
Taylor K, Powell C, Hatt SR, Stewart C. Interventions for unilateral and bilateral refractive amblyopia. The Cochrane Database of Systematic Reviews. 2012. https://www.ncbi.nlm.nih.gov/pubmed/22513928.
Taylor K, Elliott S. Interventions for strabismic amblyopia. Cochrane Database Syst Rev. 2014. https://pubmed.ncbi.nlm.nih.gov/25051925/.
Stewart CE, Moseley MJ, Stephens DA, Fielder AR. Treatment dose-response in amblyopia therapy: the Monitored Occlusion Treatment of Amblyopia Study (MOTAS). Invest Opthalmol Vis Sci. 2004;45:3048–54.
Stewart CE, Moseley MJ, Fielder AR. Defining and measuring treatment outcome in unilateral amblyopia. Br J Ophthalmol. 2003;87:1229–31.
Simons K, Preslan M. Natural history of amblyopia untreated owing to lack of compliance. Br J Ophthalmol. 1999;83:582–7.
Stewart CE, Stephens DA, Fielder AR, Moseley MJ. Objectively monitored patching regimens for treatment of amblyopia: randomised trial. BMJ. 2007;335:707–13.
Le T, Örge F. Treatment compliance in amblyopia: a mini-review and description of a novel online platform for compliance tracking. Surv Ophthalmol. 2022;67:1685–97.
Loudon SE, Fronius M, Looman CWN, Awan M, Simonsz B, van der Maas PJ, et al. Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. Invest Opthalmol Vis Sci. 2006;47:4393–400.
Wallace MP, Stewart CE, Moseley MJ, Stephens DA, Fielder AR. Compliance with occlusion therapy for childhood amblyopia. Invest Opthalmol Vis Sci. 2013;54:6158–66.
Newsham D. A randomised controlled trial of written information: the effect on parental non-concordance with occlusion therapy. Br J Ophthalmol. 2002;86:787–91.
Searle A, Norman P, Harrad R, Vedhara K. Psychosocial and clinical determinants of compliance with occlusion therapy for amblyopic children. Eye. 2002;16:150–5.
Al-Yahya A, Al-Odan K, Allam K, Al-Onazi B, Mousa A, A. Al-Saleh A. Compliance to patching in the treatment of amblyopia. Saudi J Ophthalmol. 2012;26:305–7.
Lamnisos D, Lambrianidou G, Middleton N. Small-area socioeconomic deprivation indices in Cyprus: development and association with premature mortality. BMC Public Health 2019;19:627.
Ministry of Housing, Communities and Local Government. Statistical Release. 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/835115/IoD2019_Statistical_Release.pdf.
National Centre for Research Methods. Townsend deprivation index. 2007. https://www.restore.ac.uk/geo-refer/36229dtuks00y19810000.php.
Dymond-Green N. How can we calculate levels of deprivation or poverty in the UK? (part 1) – Data Impact Blog. 2020. http://blog.ukdataservice.ac.uk/deprived-or-live-in-poverty-1/.
O’Colmain U, Low L, Gilmour C, MacEwen CJ. Vision screening in children: a retrospective study of social and demographic factors with regards to visual outcomes. Br J Ophthalmol. 2015;100:1109–13.
England L, O’Connor A. Do Socioeconomic inequalities exist within ophthalmology and orthoptics in the UK?: A scoping review. Br Ir Orthopt J. 2024;20:31–47.
Majeed M, Williams C, Northstone K, Ben-Shlomo Y. Are there inequities in the utilisation of childhood eye-care services in relation to socio-economic status? Evidence from the ALSPAC cohort. Br J Ophthalmol. 2008;92:965–9.
Williams C, Northstone K, Howard M, Harvey I, Harrad RA, Sparrow JM. Prevalence and risk factors for common vision problems in children: data from the ALSPAC study. Br J Ophthalmol. 2008;92:959–64.
Delpisheh A, Kelly Y, Rizwan S, Brabin BJ. Socio-economic status, smoking during pregnancy and birth outcomes: an analysis of cross-sectional community studies in Liverpool (1993–2001). J Child Health Care. 2006;10:140–8.
Public Health England. Characteristics of women who stop smoking in pregnancy. 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1019945/Analysis_characteristics_of_women_who_stop_<div class="pi">show [QJ]smoking_in_pregnancy.pdf.
O’Colmain U, Neo YN, Gilmour C, MacEwen CJ. Long-term visual and treatment outcomes of whole-population pre-school visual screening (PSVS) in children: a longitudinal, retrospective, population-based cohort study. Eye. 2020;34:2315–21.
Hudak DT, Magoon EH. Poverty predicts amblyopia treatment failure. J Am Assoc Pediatr Ophthalmol Strabismus. 1997;1:214–5.
Hawn S, Yuan SM, Lee AR, Culican SM. Visual acuity outcomes and loss to follow-up in the treatment of amblyopia in children from lower socioeconomic backgrounds. J Pediatr Ophthalmol Strabismus. 2022;59:110–7.
Manchester City Council. Manchester City Council download - Deprivation Reports | The Council and democracy | Statistics and intelligence. 2019. https://secure.manchester.gov.uk/downloads/download/414/research_and_<div class="pi">show [QJ]intelligence_population_publications_deprivation.
Holmes J, Lazar E, Melia B, Astle W, Dagi L, Donahue S, et al. Effect of age on response to amblyopia treatment in children. Arch Ophthalmol. 2011;129:1451–7.
Ministry of Housing, Communities & Local Government. English indices of deprivation 2019: Postcode Lookup. 2019. https://imd-by-postcode.opendatacommunities.org/imd/2019.
UK Data Service. 2011 UK Townsend Deprivation Scores - LSOA Scores - UK Data Service CKAN. https://statistics.ukdataservice.ac.uk/dataset/2011-uk-townsend-deprivation-scores/resource/51e32107-9e2f-4a30-9e58-92f80c8ec10e.
Smith LK, Thompson JR, Woodruff G, Hiscox F. Factors affecting treatment compliance in amblyopia. J Pediatr Ophthalmol Strabismus. 1995;32:98–9.
Rudge GM, Mohammed MA, Fillingham SC, Girling A, Sidhu K, Stevens AJ. The combined influence of distance and neighbourhood deprivation on emergency department attendance in a large English Population: A Retrospective Database Study. PLoS ONE 2013;8:e67943.
Woodruff G, Hiscox F, Thompson JR, Smith LK. Factors affecting the outcome of children treated for amblyopia. Eye. 1994;8:627–31.
Acknowledgements
The authors would like to thank Matilda Blythe, Maggie Wan, Sian Hughes and the community Orthoptic teams at Manchester University NHS Foundation Trust (MFT) for guidance on study design and assistance with data collection. Thanks also to: Danielle Marrochia, Marianne Stewart and the Research and Innovation team at MFT for guidance; MFT for sponsorship; and the Orthoptic department at Manchester Royal Eye Hospital for support.
Funding
This research was sponsored by Manchester University NHS Foundation Trust and funded by Fight for Sight and the British and Irish Orthoptic Society.
Author information
Authors and Affiliations
Contributions
LE co-designed and wrote the protocol, collected all data, conducted some of the data analysis and produced the write up. AO’C co-designed the study and protocol, provided guidance and advised on the write up. CF co-designed the study and protocol, lead on statistical analysis and advised on the write up. JM and KH commented on the study design, protocol and write up.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
England, L., Fullwood, C., Mehta, J. et al. Are amblyopia therapy outcomes related to socioeconomic situation for children in Greater Manchester?. Eye (2026). https://doi.org/10.1038/s41433-026-04280-z
Received:
Revised:
Accepted:
Published:
Version of record:
DOI: https://doi.org/10.1038/s41433-026-04280-z
