Neighborhood Factors May Explain Vision Differences in Children With Amblyopia

The quality of resources and conditions within a neighborhood may affect visual acuity in children with amblyopia, according to an investigation published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus. While these differences do not appear to be clinically significant, they may highlight health disparities experienced among individuals residing in lower opportunity neighborhoods. 

Researchers included 1050 pediatric patients (37% non White; 19% Hispanic; 44% with public insurance) who were diagnosed with amblyopia at an urban hospital between 2010 and 2014. The team assessed patient demographics and used the childhood opportunity index (COI), a tool using a 100-point scale to measure neighborhood quality (<20, very low opportunity; ≥80, very high opportunity), to examine associations between amblyopia and neighborhood environment. The primary outcome measure was visual acuity in both the best- and worst-seeing eye at presentation.   

The COI identified 12% of participants as living in very low opportunity neighborhoods compared with 47% living in very high opportunity neighborhoods. Children who lived in the highest opportunity neighborhoods demonstrated better visual acuity in their best-seeing eye compared with children residing in the lowest opportunity neighborhoods (2-letter logarithm of the minimum angle of resolution [logMAR] difference). Each 20-point increase in COI score correlated with an improvement in logMAR visual acuity of the better-seeing eye (β=-0.0090; 95% CI, -0.0172 to -0.0008; P =.031), according to the report. No significant differences were noted for visual acuities in the worse-seeing eyes among children from the highest and lowest opportunity neighborhoods. 

“COI is a versatile tool that can provide insight into the neighborhood-level factors associated with visual impairment,” according to the researchers. “Physicians could use COI to better understand the healthcare needs of their patient population and to provide a data-driven approach to guide screening efforts and resource allocation. In amblyopia, efforts to focus initiatives in low-resource areas may help to identify children at greatest risk of vision loss from diagnostic delay, and to optimize treatment regimens to improve long-term visual outcomes.”

Study limitations include a retrospective nature, single center design, and variability in visual acuity testing methods.