Lazy Eye in Children Could Predict Cardiovascular, Metabolic Risk Later in Life

Jugnoo Rahi, MBBS, PhD
Credit: University College London

Children with a “lazy eye” could be at an increased risk of cardiometabolic health complications later in life, according to a new study.

An analysis of the UK Biobank cohort, results of the study, which leveraged data from more than 67,000 pediatric patients with retinal imaging, concluded presence of amblyopia was associated with greater cardiometabolic dysfunction in adulthood, including diabetes, obesity, and cardiovascular disease. Still, investigators cautioned more research is needed before considering this evidence conclusive.¹

“Amblyopia is an eye condition affecting up to four in 100 children. In the UK, all children are supposed to have vision screening before the age of five, to ensure a prompt diagnosis and relevant ophthalmic treatment,” said Jugnoo Rahi, MBBS, PhD, an ophthalmologist and epidemiologist with UCL Great Ormond Street Institute for Child Health, UCL Institute of Ophthalmology and Great Ormond Street Hospital.² “It is rare to have a ‘marker’ in childhood that is associated with increased risk of serious disease in adult life, and also one that is measured and known for every child – because of population screening.”

A longitudinal study of more than 500,000 participants from the UK, the UK Biobank cohort provided investigators with data from 126,399 individuals who underwent an ocular examination. Among these, 67,321 individuals received retinal imaging and were included in the current study. The specific intent of Rahi and colleagues in the current study was to leverage these data to build on previous research examining associations between child amblyopia and long-term impact on psychosocial factors by shining light on potential associations with metabolic function.¹

The primary outcome of interest for the study was to estimate associations between amblyopia and multiple different components of metabolic syndrome and cardiometabolic disease. These included diabetes, high blood pressure, and cardio/cerebrovascular disease, namely angina, heart attack, stroke. Of note, investigators defined amblyopia self-reported amblyopia or treatment with any of the following corroborating evidence: strabismus, significant anisometropia, significant astigmatism, significant refractive error per se, less severe refractive error but visual impairment without any other underlying eye disease, and current emmetropia in participants who self-reported hypermetropia correction in childhood and at least mild visual impairment and no other eye disease.¹

Upon analysis, amblyopia was associated with a greater relative risk of having 1 (relative risk ratio [RRR], 1.22; 95% Confidence Interval [CI], 1.12 to 1.34;P <.01), 2 (RRR, 1.29; 95% CI, 1.13 to 1.48;P <.01), or 3 components of metabolic syndrome (RRR, 1.40; 95% CI, 1.00 to 1.95;P <.05), but investigators pointed out this was driven by associations with persisting amblyopia. Results of multivariable-adjusted regression models suggested the presence of persisting amblyopia was associated with an increased likelihood of obesity (adjusted Odds Ratio [OR], 1.16; 95% Confidence Interval [CI], 1.05 to 1.28), hypertension (aOR, 1.25; 95% CI, 1.13 to 1.38), and diabetes (aOR, 1.29; 95% CI, 1.04 to 1.59).¹

Further analysis revealed patients with amblyopia were at an increased risk of myocardial infarction (Hazard ratio [HR], 1.38; 95% CI, 1.11 to 1.72; P <.05) and all-cause mortality (HR, 1.36; 95% CI, 1.15 to 1.60; P <.01) but not stroke (HR, 1.20; 95% CI, 1.15 to 1.60).¹

Investigators called attention to multiple limitations within their study to consider when interpreting results. These included reliance on self-reported medical conditions, the observational nature of the study, and the inability to assess causal relationships.¹

“We emphasize that our research does not show a causal relationship between amblyopia and ill health in adulthood. Our research means that the ‘average’ adult who had amblyopia as a child is more likely to develop these disorders than the ‘average’ adult who did not have amblyopia. The findings don’t mean that every child with amblyopia will inevitably develop cardiometabolic disorders in adult life,” said Siegfried Wagner, PhD, MSc, UCL Institute of Ophthalmology and Moorfields Eye Hospital.²

References:

1. _{^{Wagner SK, Bountziouka V, Hysi P, et al. Associations between unilateral amblyopia in childhood and cardiometabolic disorders in adult life: A cross-sectional and longitudinal analysis of the UK Biobank. eClinicalMedicine. Published online March 7, 2024:102493. doi:10.1016/j.eclinm.2024.102493}}
2. _{^{University College London. Children with “Lazy eye” are at increased risk of serious disease in adulthood. UCL News. March 11, 2024. Accessed March 12, 2024. https://www.ucl.ac.uk/news/2024/mar/children-lazy-eye-are-increased-risk-serious-disease-adulthood.}}