Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study

Lisanne Andra Gitsels; Mario Cortina-Borja; Jugnoo Sangeeta Rahi

doi:10.1371/journal.pone.0234414

Peer Review History

Original SubmissionApril 14, 2020
15 May 2020 Decision Letter - Ahmed Awadein, Editor Transfer Alert This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present. PONE-D-20-10720 Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study PLOS ONE Dear Professor Rahi, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. AE-1 Please address as a limitation to the study that the main variables studied such as amblyopia, and strabismus were self reported. AE-2 Please provide some details about the Bracken School Readiness Assessment Revised (BSRA-R) and the British Ability Scale. We would appreciate receiving your revised manuscript by Jun 29 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. 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We look forward to receiving your revised manuscript. Kind regards, Ahmed Awadein, MD, Ph.D, FRCS Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The study explored whether amblyopia is associated with school readiness and early cognitive performance based on the data from the prospective Millennium Cohort Study of children born in the United Kingdom. The paper is well written and conclusions are sound. Questions: Line 101. "Children with any other eye conditions were excluded". Which eye conditions were excluded and what impact it could have had on the findings of the study. Line 154 "white, English-speaking, higher qualified, and richer families are moderately overrepresented in the complete-data samples" Why are samples not representative of the UK population. What impact it could have on the findings of the study. Were white ethnicity, higher birth order, lower maternal educational level, English not as main household language, and lower household income associated with amplyopia? Reviewer #2: Dear Authors, thank you for your work. I appreciate the effort of conducting and finalizing such an interesting and useful study for Pediatric Ophthalmologists. The study results fit in my long practice experience results and conclusions. Best wishes, Daniela Cioplean ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Daniela Eleonora Cioplean [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0234414.r001
Revision 1
19 May 2020 Author Response Dear Prof Awadein, Thank you for the expert review of our manuscript titled “Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study” (manuscript ID PONE-D-20-10720). We appreciate your comments and that of the two external reviewers. The comments and our response after each comment in italics are provided below. A clean revised manuscript and a marked-up copy of the changes made in the original manuscript and supplementary file are submitted as part of the revision. Academic editor AE-1 Please address as a limitation to the study that the main variables studied such as amblyopia, and strabismus were self reported. Thank you for your comment. We have put more emphasis on the limitation that the classification of eye conditions was based on parental self-report, please see page 12 lines 284-286: “Although a limitation of the study was reliance on parental self-report for the classification of eye conditions, the interview questions were carefully constructed at the outset by ophthalmologists and all coding was undertaken by us and has been validated (9,10). As the frequencies of both amblyopia and strabismus in MCS align closely with similar population studies in the UK (2) and the pattern of age at starting treatment by type of amblyopia aligns with clinical expectations, there is unlikely to be meaningful misclassification bias of eye conditions.” AE-2 Please provide some details about the Bracken School Readiness Assessment Revised (BSRA-R) and the British Ability Scale. We added more information on the outcomes, please see page 5 lines 124-129: “The composite of the BSRA-R consists of six subtests that assess educationally relevant concepts needed for early formal education (14). These subtests comprise knowledge of colours, letters, shapes, numbers and counting and the child’s ability to describe, match and compare objects. […] The BAS II is a standardised cognitive test battery in the UK to evaluate the developmental and learning abilities of children (15).” Reviewer #1 The study explored whether amblyopia is associated with school readiness and early cognitive performance based on the data from the prospective Millennium Cohort Study of children born in the United Kingdom. The paper is well written and conclusions are sound. Questions: Line 101. "Children with any other eye conditions were excluded". Which eye conditions were excluded and what impact it could have had on the findings of the study. Thank you for your comment. The aim of our study was to investigate the specific impact of amblyopia – which most commonly causes unilateral impairment of vision with often only mildly or moderately reduced acuity in the affected eye but generally some impairment of stereo vision. We therefore deliberately excluded all children who would have conditions that caused visual impairment or blindness (by definition disorders affecting both eyes) as we know that significantly impaired vision in both eyes is definitely associated with challenges in the educational setting. Therefore we excluded children with any visual impairment or blindness due to any cause including cerebral visual impairment and the following ocular conditions: nystagmus, ptosis, anophthalmos, glaucoma, anterior segment abnormality, craniofacial disorders, corneal opacity and dystrophy, cataract, retinal detachment, retinal dystrophy, albinism, retinopathy of prematurity, retinal haemorrhage, retinal coloboma, retinitis, coloboma, aniridia, uveal tumour, and uveitis, optic nerve hypoplasia, secondary atrophy, optic neuropathy/neuritis, optic nerve tumour, coloboma, and ocular trauma to the eye. We added this information to Table S1 in the Supplementary File and refer to it in the Manuscript on page 5 line 115. As written in the Discussion Section on page 12 lines 282-283, the exclusion of children with any other eye conditions ensured investigation specifically of the impact of amblyopia. If these children were to be included with the control group, it would have diluted the impact of amblyopia compared to normal vision associated with school readiness and cognitive abilities. Line 154 "white, English-speaking, higher qualified, and richer families are moderately overrepresented in the complete-data samples" Why are samples not representative of the UK population. What impact it could have on the findings of the study. All statistical analyses used survey weights to correct for the unequal probabilities of selection that resulted from the stratified cluster survey design and loss to follow-up across sweeps. However, they do not correct for partial missing information. In this study, there were missing data in the outcomes (up to 10%), resulting in some characteristics being moderately overrepresented in the complete-data samples. Ethnicity, language, maternal education and income were associated with missingness, but more importantly, amblyopia and/or strabismus status was not, therefore unbiased estimates of amblyopia and/or strabismus status associated with the outcomes could still be obtained when adjusting for the other factors. Were white ethnicity, higher birth order, lower maternal educational level, English not as main household language, and lower household income associated with amplyopia? Indeed ethnicity and household income were associated with amblyopia, however birth order and maternal education were not. These results can be seen in Table 1 on page 9 and the significant ones were reported on page 7 lines 175-177. Reviewer #2 Dear Authors, thank you for your work. I appreciate the effort of conducting and finalizing such an interesting and useful study for Pediatric Ophthalmologists. The study results fit in my long practice experience results and conclusions. Best wishes, Daniela Cioplean Thank you for the compliment. We are grateful for the work you and the reviewers have conducted to improve our manuscript. We hope that we have addressed all the concerns raised and that our paper could be published in your journal. We are looking forward to hearing from you. Sincerely, Jugnoo Rahi Professor of Ophthalmic Epidemiology and Honorary Consultant Ophthalmologist Population, Policy and Practice Research and Teaching Department University College London Great Ormond Street Institute of Child Health 30 Guilford Street, London, WC1N 1EH, UK Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0234414.r002
27 May 2020 Decision Letter - Ahmed Awadein, Editor Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study PONE-D-20-10720R1 Dear Dr. Rahi, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Ahmed Awadein, MD, Ph.D, FRCS Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0234414.r003
Formally Accepted
10 Jun 2020 Acceptance Letter - Ahmed Awadein, Editor PONE-D-20-10720R1 Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study Dear Dr. Rahi: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ahmed Awadein Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0234414.r004

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