Catherine S. Peckham

Does amblyopia affect educational, health, and social outcomes? Findings from 1958 British birth cohort

Abstract Objective To determine any association of amblyopia with diverse educational, health, and social outcomes in order to inform current debate about population screening for this condition. Design, setting, and participants Comparison of 8432 people with normal vision in each eye with 429 (4.8%) people with amblyopia (childhood unilateral reduced acuity when tested with correction and unaccounted for by eye disease) from the 1958 British birth cohort, with respect to subsequent health and social functioning. Results No functionally or clinically significant differences existed between people with and without amblyopia in educational outcomes, behavioural difficulties or social maladjustment, participation in social activities, unintended injuries (school, workplace, or road traffic accidents as driver), general or mental health and mortality, paid employment, or occupation based social class trajectories. Conclusions It may be difficult to distinguish, at population level, between the lives of people with amblyopia and those without, in terms of several important outcomes. A pressing need exists for further concerted research on what it means to have amblyopia and, specifically, how this varies with severity and how it changes with treatment, so that screening programmes can best serve those who have the most to gain from early identification.

Visual Function in Working-Age Adults: Early Life Influences and Associations with Health and Social Outcomes

PURPOSE To investigate how visual function in mid-adult life is associated with health and social outcomes and, using life-course epidemiology, whether it is influenced by early life biological and social factors. DESIGN Population-based cohort study. PARTICIPANTS Nine thousand three hundred thirty members of the 1958 British birth cohort at age 44 or 45 years. METHODS Distance, near, and stereo vision were assessed as part of a broader biomedical examination. Logistic, multinomial, and proportional odds ordinal logistic regression were used, as appropriate, to assess the association between these vision functions and both key early life influences and health and social outcomes in mid-adult life. MAIN OUTCOME MEASURES Distance, near, and stereo acuities and health and social outcomes. RESULTS In mid-adult life, vision function (across the full spectrum of both type and level of function) is associated with unemployment resulting from permanent sickness, lower socioeconomic status, and poorer general health (for example, for blindness; odds ratios were 2.5, 2.6, and 1.2, respectively). Also, impaired visual functions in mid-adult life are associated with a low birthweight, being small for gestational age, maternal smoking in pregnancy, and markers of socioeconomic deprivation in childhood (for example, for impaired distance acuity; odds ratios were 1.4, 1.3, 1.02, and 1.1, respectively). CONCLUSIONS Although relatively uncommon in working-age adults, impaired vision can have important adverse consequences, which highlights the value of investigating visual function in the broader context of health and social functioning. In addition, visual function in adult life may be influenced directly by key prenatal and childhood biological and social determinants of general health. Thus, application of life-course epidemiology to complex chronic ophthalmic diseases of adult life such as glaucoma or macular degeneration is likely to prove valuable in elucidating whether and how biological, social, and lifestyle factors contribute to the cause.

Visual impairment due to undiagnosed refractive error in working age adults in Britain

Background: Detection and treatment of undiagnosed refractive error (RE), with its attendant functional consequences, is a priority of VISION 2020, the global initiative against avoidable visual disability. The authors investigated the frequency of visual impairment due to undiagnosed RE and its associations with vision-related quality of life (VRQOL), general health and social circumstances in a contemporary and nationally representative population of British working-age adults. Methods: 9271 members of the 1958 British birth cohort had visual acuity and VRQOL assessed at 44/45 years. The authors compared those with undiagnosed RE with those with diagnosed RE, defining undiagnosed RE as ⩾0.2 logMAR units/2 lines acuity improvement in both eyes with pinhole in individuals without current or prior optical treatment or ophthalmic history. Results: 144/9271 (1.6%) individuals had undiagnosed and 3513/9271 (37.9%) diagnosed RE. 18% (24/144) of those with undiagnosed RE were classifiable as visually impaired. Individuals with undiagnosed RE were more likely to have a manual (vs non-manual) occupation and to be separated, divorced or widowed, and less likely to be in social or professional organisations. There is also some evidence that they are more likely to express concern, embarrassment and frustration about their eyesight and worry about coping with life. Conclusion: A significant proportion of working age adults in Britain appear to have undiagnosed but visually significant RE. Improvements in existing opportunities for detecting RE in adults could benefit these individuals during their working lives and avoid the serious adverse consequences associated with vision impairment in later life.

UK Mother-to-Child HIV Transmission Rates Continue to Decline: 2012–2014

Authors: Helen Peters, UCL Great Ormond Street Institute of Child Health, London, UK Kate Francis, UCL Great Ormond Street Institute of Child Health, London, UK Rebecca Sconza, UCL Great Ormond Street Institute of Child Health, London, UK Anna Horn, UCL Great Ormond Street Institute of Child Health, London, UK Catherine Peckham, UCL Great Ormond Street Institute of Child Health, London, UK Pat A Tookey, UCL Great Ormond Street Institute of Child Health, London, UK Claire Thorne, UCL Great Ormond Street Institute of Child Health, London, UK

Breastfeeding and Transmission of Viruses Other than HIV-1

The risk of HIV-1 transmission from mother to infant through breastfeeding is well established, but less attention has been paid to the implications of other viruses present in breast milk. Acquisition of human immunodeficiency virus type 2 (HIV-2) through breastfeeding has been reported, but the risk of transmission appears to be lower than for HIV-1. For other viruses, such as cytomegalovirus (CMV) and human T-cell lymphotropic virus type 1 (HTLV-1), transmission through breastfeeding is common and well documented, and infection can result in short- or long-term consequences in the infant. For hepatitis B and C viruses, although mother-to-child transmission occurs, breastfeeding does not appear to be a major route of transmission. In this chapter, the implications of these viruses identified in breast milk are described.

Blindness certification of children 1 year after diagnosis: findings from the British Childhood Vision Impairment Study

Established in Britain in the 19th century, the sight impairment register has been the sole means of routinely monitoring the frequency and causes of visual impairment in children to plan services and prioritise research.1 Although not a prerequisite, certification and consequent registration is often the catalyst for statutory assessment of special educational needs. It is also often the portal for accessing social services.2 Certification remains voluntary in the UK, by contrast with similar registers elsewhere. However, considerable effort has recently been directed to addressing previous concerns about incomplete reporting of information and underascertainment of eligible individuals.1 2 We have previously reported incidence and causes of severe visual impairment (SVI) or blindness (BL) and associated mortality3 in a nationally representative group of children with SVI/BL in the UK. We now report on the BL certification status of these children 1 year after diagnosis. Active surveillance was undertaken, simultaneously but independently, through the British Ophthalmological4 and British Paediatric5 Surveillance Units, whose reporting bases comprise all consultant ophthalmologists and paediatricians, respectively, in the UK. Every month for 1 year (2000), clinicians reported all children aged <16 years who were newly diagnosed as having SVI/BL due to any disorder. Children were eligible if they had a corrected distance visual acuity of worse than LogMAR 1.0 (Snellen 6/60 or equivalent) in the better eye, that is, SVI/BL using the WHO international taxonomy.6 Children were also considered eligible if their acuity could not be measured formally but they had clinical features …