Dr Amanda French graduated in 2007 with a Bachelor of Applied Science in Orthoptics, class 1 honours and the University medal. Amanda was funded through and Australian Postgraduate Award (APA) to undertake her doctoral studies and she completed her Doctor of Philosophy (PhD) degree in 2013. Her PhD investigated environmental risk factors associated with prevalent and incident refractive error in children, as part of the longitudinal Sydney Adolescent Vascular and Eye Disease Study (SAVES) of over 2,000 schoolchildren. Amanda has published a number of peer-reviewed papers in highly ranked international ophthalmic journals and presented at numerous national and international conferences. In addition to her involvement in research, Amanda has extensive experience in higher education teaching, having taught health and orthoptic students at both undergraduate and postgraduate levels of study.
Awards and Honours:
- 2013 Faculty of Health Sciences Dean’s Citation for Learning & Teaching Award, University of Sydney
- 2011 The Emmie Russell Prize 68th Annual Orthoptics Australia Conference, Canberra
- 2010 Young Alumni Award for Achievement, Faculty of Health Sciences, University of Sydney
- 2009 The Dean’s Prize, Faculty of Health Sciences, University of Sydney Conference
- 2009 The Emmie Russell Prize 66th Annual Orthoptics Australia Conference, Brisbane
- 2008 The Emmie Russell Prize 65th Annual Orthoptics Australia Conference, Melbourne
- 2007 The Orthoptic Association of Australia (NSW Branch) Prize
- 2007 The Patricia Lance Clinical Excellence Prize
- 2007 Graduated with Class 1 Honours and the University Medal
Scholarships and Funding:
- 2009 Dr. George Burniston Cumberland Foundation Fellowship
- 2009 The Gesine Mohn Travel Grant, Association for Research in Vision and Ophthalmology (ARVO) conference, Fort Lauderdale, Florida, US
- 2008 Australian Postgraduate Award
Amanda is a member of Orthoptics Australia and is registered with the Australian Orthoptic Board. She is also a member of the Orthoptics Australia NSW branch council.
Can supervise: YES
Research interests include the development and progression of refractive errors, particularly myopia (shortsightedness) and associated environmental risk factors such as time spent outdoors. Other areas of interest include orthoptic practice, in particular, vision testing methods and the epidemiology of eye related disorders such as; visual impairment, amblyopia and strabismus.
Evidence-based practice and health research
Ocular anatomy and physiology
Binocular vision and ocular motility
Neurological ocular conditions
Orthoptic professional practice
Health care systems
© International Centre for Eye Health, London School of Hygiene & Tropical Medicine. Increasing levels of myopia will pose particular challenges in low- or middleincome countries. Preventing or delaying myopia onset is crucial.
Morgan, IG, French, AN, Ashby, RS, Guo, X, Ding, X, He, M & Rose, KA 2018, 'The epidemics of myopia: Aetiology and prevention.', Progress in Retinal and Eye Research, vol. 62, pp. 134-149.View/Download from: Publisher's site
There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
Rose, KA, French, AN & Morgan, IG 2016, 'Environmental Factors and Myopia: Paradoxes and Prospects for Prevention.', Asia - Pacific Journal of Ophthalmology, vol. 5, no. 6, pp. 403-410.View/Download from: Publisher's site
The prevalence of myopia in developed countries in East and Southeast Asia has increased to more than 80% in children completing schooling, whereas that of high myopia has increased to 10%-20%. This poses significant challenges for correction of refractive errors and the management of pathological high myopia. Prevention is therefore an important priority. Myopia is etiologically heterogeneous, with a low level of myopia of clearly genetic origins that appears without exposure to risk factors. The big increases have occurred in school myopia, driven by increasing educational pressures in combination with limited amounts of time spent outdoors. The rise in prevalence of high myopia has an unusual pattern of development, with increases in prevalence first appearing at approximately age 11. This pattern suggests that the increasing prevalence of high myopia is because of progression of myopia in children who became myopic at approximately age 6 or 7 because age-specific progression rates typical of East Asia will take these children to the threshold for high myopia in 5 to 6 years. This high myopia seems to be acquired, having an association with educational parameters, whereas high myopia in previous generations tended to be genetic in origin. Increased time outdoors can counter the effects of increased nearwork and reduce the impact of parental myopia, reducing the onset of myopia, and this approach has been validated in 3 randomized controlled trials. Other proposed risk factors need further work to demonstrate that they are independent and can be modified to reduce the onset of myopia.
Afsari, S, Rose, KA, Gole, GA, Philip, K, Leone, JF, French, A & Mitchell, P 2013, 'Prevalence of anisometropia and its association with refractive error and amblyopia in preschool children.', The British journal of ophthalmology, vol. 97, no. 9, pp. 1095-1099.View/Download from: Publisher's site
AIM: To determine the age and ethnicity-specific prevalence of anisometropia in Australian preschool-aged children and to assess in this population-based study the risk of anisometropia with increasing ametropia levels and risk of amblyopia with increasing anisometropia. METHODS: A total 2090 children (aged 6-72 months) completed detailed eye examinations in the Sydney Paediatric Eye Disease Study, including cycloplegic refraction, and were included. Refraction was measured using a Canon RK-F1 autorefractor, streak retinoscopy and/or the Retinomax K-Plus 2 autorefractor. Anisometropia was defined by the spherical equivalent (SE) difference, and plus cylinder difference for any cylindrical axis between eyes. RESULTS: The overall prevalence of SE and cylindrical anisometropia ≥1.0 D were 2.7% and 3.0%, for the overall sample and in children of European-Caucasian ethnicity, 3.2%, 1.9%; East-Asian 1.7%, 5.2%; South-Asian 2.5%, 3.6%; Middle-Eastern ethnicities 2.2%, 3.3%, respectively. Anisometropia prevalence was lower or similar to that in the Baltimore Pediatric Eye Disease Study, Multi-Ethnic Pediatric Eye Disease Study and the Strabismus, Amblyopia and Refractive error in Singapore study. Risk (OR) of anisometropic amblyopia with ≥1.0 D of SE and cylindrical anisometropia was 12.4 (CI 4.0 to 38.4) and 6.5 (CI 2.3 to 18.7), respectively. We found an increasing risk of anisometropia with higher myopia ≥-1.0 D, OR 61.6 (CI 21.3 to 308), hyperopia > +2.0 D, OR 13.6 (CI 2.9 to 63.6) and astigmatism ≥1.5 D, OR 30.0 (CI 14.5 to 58.1). CONCLUSIONS: In this preschool-age population-based sample, anisometropia was uncommon with inter-ethnic differences in cylindrical anisometropia prevalence. We also quantified the rising risk of amblyopia with increasing SE and cylindrical anisometropia, and present the specific levels of refractive error and associated increasing risk of anisometropia.
Recent epidemiological evidence suggests that children who spend more time outdoors are less likely to be, or to become myopic, irrespective of how much near work they do, or whether their parents are myopic. It is currently uncertain if time outdoors also blocks progression of myopia. It has been suggested that the mechanism of the protective effect of time outdoors involves light-stimulated release of dopamine from the retina, since increased dopamine release appears to inhibit increased axial elongation, which is the structural basis of myopia. This hypothesis has been supported by animal experiments which have replicated the protective effects of bright light against the development of myopia under laboratory conditions, and have shown that the effect is, at least in part, mediated by dopamine, since the D2-dopamine antagonist spiperone reduces the protective effect. There are some inconsistencies in the evidence, most notably the limited inhibition by bright light under laboratory conditions of lens-induced myopia in monkeys, but other proposed mechanisms possibly associated with time outdoors such as relaxed accommodation, more uniform dioptric space, increased pupil constriction, exposure to UV light, changes in the spectral composition of visible light, or increased physical activity have little epidemiological or experimental support. Irrespective of the mechanisms involved, clinical trials are now underway to reduce the development of myopia in children by increasing the amount of time they spend outdoors. These trials would benefit from more precise definition of thresholds for protection in terms of intensity and duration of light exposures. These can be investigated in animal experiments in appropriate models, and can also be determined in epidemiological studies, although more precise measurement of exposures than those currently provided by questionnaires is desirable.
French, AN, Morgan, IG, Burlutsky, G, Mitchell, P & Rose, KA 2013, 'Prevalence and 5- to 6-year incidence and progression of myopia and hyperopia in Australian schoolchildren.', Ophthalmology, vol. 120, no. 7, pp. 1482-1491.View/Download from: Publisher's site
PURPOSE: To determine the prevalence, incidence, and change in refractive errors for Australian schoolchildren and examine the impact of ethnicity and sex. DESIGN: Population-based cohort study. PARTICIPANTS: The Sydney Adolescent Vascular and Eye Study, a 5- to 6-year follow-up of the Sydney Myopia Study, examined 2760 children in 2 age cohorts, 12 and 17 years. Longitudinal data were available for 870 and 1202 children in the younger and older cohorts, respectively. METHODS: Children completed a comprehensive examination, including cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1). Myopia was defined as ≤-0.50 diopters (D) and hyperopia as ≥+2.00 D right eye spherical equivalent refraction. MAIN OUTCOME MEASURES: Baseline and follow-up refraction. RESULTS: Prevalence of myopia increased between baseline and follow-up for both the younger (1.4%-14.4%; P<0.0001) and older cohorts (13.0%-29.6%; P<0.0001). The annual incidence of myopia was 2.2% in the younger cohort and 4.1% in the older. Children of East Asian ethnicity had a higher annual incidence of myopia (younger 6.9%, older 7.3%) than European Caucasian children (younger 1.3%, older 2.9%; all P<0.0001). The prevalence of myopia in European Caucasian children almost doubled between the older (4.4%; 95% confidence interval [CI], 3.0-5.8) and younger samples (8.6%; 95% CI, 6.7-10.6) when both were aged 12 years. Children with ametropia at baseline were more likely to have a significant shift in refraction (hyperopia: odds ratio [OR], 3.4 [95% CI, 1.2-9.8]; myopia: OR, 6.3 [95% CI, 3.7-10.8]) compared with children with no refractive error. There was no significant difference in myopia progression between children of European Caucasian and East Asian ethnicity (P = 0.7). CONCLUSIONS: In Sydney, myopia prevalence (14.4%, 29.6%) and incidence (2.2%, 4.1%) was low for both age cohorts, compared with other locations. However, in European Caucasian children at age 12, the significantly higher prevalence of...
French, AN, Morgan, IG, Mitchell, P & Rose, KA 2013, 'Patterns of myopigenic activities with age, gender and ethnicity in Sydney schoolchildren.', Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), vol. 33, no. 3, pp. 318-328.View/Download from: Publisher's site
PURPOSE: To examine the patterns of myopigenic activity (high near work, low time outdoors) in children growing up in Sydney, Australia, by age, ethnicity and gender. METHODS: The Sydney Adolescent Vascular and Eye Study (SAVES) re-examined children from the two age cohorts (6 and 12 years at baseline) from the Sydney Myopia Study (SMS). At 5-6 year follow-up, 863 in the younger cohort and 1196 in the older cohort had complete refraction data. Cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1) was measured at baseline and follow-up. Children who became myopic (≤-0.50 dioptres spherical equivalent refraction) were those classified as non-myopic at baseline and myopic at follow-up. A detailed questionnaire was administered to measure weekly activities, including time spent outdoors and near work at both baseline and follow-up examination. RESULTS: Overall, 128 (14.8%) children in the younger cohort and 210 (17.6%) in the older cohort became myopic. At follow-up, for both cohorts, children had significantly reduced the amount of time spent outdoors (younger cohort, p = 0.001, older cohort, p < 0.0001) and increased near work time (younger cohort, p < 0.0001, older cohort, p = 0.006). Children of East Asian ethnicity spent significantly less time outdoors by more than 7 h per week (both cohorts at baseline and follow-up, all p < 0.0001) and more time in near work activities by close to 3 h compared to European Caucasian children at all ages examined (both cohorts at baseline and follow-up all, p < 0.03). The average pattern of activity for girls differed from that of boys in a similar way (both cohorts at baseline and follow-up all, p < 0.0001). The two independent samples of 12 year-old children provided by follow-up in the younger cohort and baseline in the older cohort gave very similar answers to the questionnaire, with significant differences only evident for computer use (p = 0.001) and books read (p < 0.0001). CONCLUSIONS: Answers to the activity ques...
French, AN, Morgan, IG, Mitchell, P & Rose, KA 2013, 'Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study.', Ophthalmology, vol. 120, no. 10, pp. 2100-2108.View/Download from: Publisher's site
PURPOSE: To examine the risk factors for incident myopia in Australian schoolchildren. DESIGN: Population-based, longitudinal cohort study. PARTICIPANTS: The Sydney Adolescent Vascular and Eye Study (SAVES) was a 5- to 6-year follow-up of the Sydney Myopia Study (SMS). At follow-up, 2103 children were reexamined: 892 (50.5%) from the younger cohort and 1211 (51.5%) from the older cohort. Of these, 863 in the younger cohort and 1196 in the older cohort had complete refraction data. METHODS: Cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1; Canon, Tokyo, Japan) was measured at baseline and follow-up. Myopia was defined as a spherical equivalent refraction of ≤-0.50 diopters (D). Children were classified as having incident myopia if they were nonmyopic at baseline and myopic in either eye at follow-up. A comprehensive questionnaire determined the amount of time children spent outdoors and doing near work per week at baseline, as well as ethnicity, parental myopia, and socioeconomic status. MAIN OUTCOME MEASURES: Incident myopia. RESULTS: Children who became myopic spent less time outdoors compared with children who remained nonmyopic (younger cohort, 16.3 vs. 21.0 hours, respectively, P<0.0001; older cohort, 17.2 vs. 19.6 hours, respectively, P=0.001). Children who became myopic performed significantly more near work (19.4 vs. 17.6 hours; P=0.02) in the younger cohort, but not in the older cohort (P=0.06). Children with 1 or 2 parents who were myopic had greater odds of incident myopia (1 parent: odds ratio [OR], 3.2, 95% confidence interval [CI], 1.9-5.2; both parents: OR, 3.3, 95% CI, 1.6-6.8) in the younger but not the older cohort. Children of East Asian ethnicity had a higher incidence of myopia compared with children of European Caucasian ethnicity (both P<0.0001) and spent less time outdoors (both P<0.0001). A less hyperopic refraction at baseline was the most significant predictor of incident myopia. The addition of time outdoors, near work, parent...
French, AN, O'Donoghue, L, Morgan, IG, Saunders, KJ, Mitchell, P & Rose, KA 2012, 'Comparison of refraction and ocular biometry in European Caucasian children living in Northern Ireland and Sydney, Australia.', Investigative ophthalmology & visual science, vol. 53, no. 7, pp. 4021-4031.View/Download from: Publisher's site
PURPOSE: To compare refraction and ocular biometry in European Caucasian children aged 6 to 7 years and 12 to 13 years, living in Sydney, Australia, and Northern Ireland. METHODS: All children had a comprehensive eye examination, including cycloplegic (cyclopentolate 1%) autorefraction and ocular biometry. Hyperopia was defined as a right spherical equivalent refraction (SER) of ≥+2.00 diopters (D), myopia as ≤-0.50 D, and astigmatism as a cylindrical error of ≥1.00 D. RESULTS: The mean SER was similar at age 6 to 7 years (P = 0.9); however, at 12 to 13 years, children in Northern Ireland had a significantly less hyperopic mean SER (+0.66 D) than children in Sydney (+0.83 D, P = 0.008). The prevalence of myopia, hyperopia, and astigmatism was significantly greater in Northern Ireland than Sydney at both ages (all P < 0.03). The distribution of refraction was highly leptokurtic in both samples, but less so in Northern Ireland (kurtosis: 6-7 years of age, 7.2; 12-13 years of age, 5.9) than Sydney (kurtosis: 6-7 years of age, 15.0; 12-13 years of age, 19.5). CONCLUSIONS: European Caucasian children in Northern Ireland have a greater prevalence of myopia, hyperopia, and astigmatism when compared to children living in Sydney. Risk factors for myopia such as parental myopia, parental education, and educational standards do not appear to explain the differences. Further work on levels of near work and time spent outdoors is required.
Morgan, IG, French, AN & Rose, K 2017, 'SCHOOL SYSTEMS WITH A HIGH PREVALENCE OF MYOPIA DOMINATE INTERNATIONAL COMPARISONS IN MATHS AND SCIENCE', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology Annual Meeting, Association for Research in Vision and Ophthalmology, Baltimore, MD.
French, AN, Morgan, IG & Rose, K 2016, 'Risk factors for longitudinal biometric and refractive change in Australian schoolchildren', Investigative Ophthalmology & Visual Science, Association for Research in Vision and Ophthalmology Annual Meeting, Association for Research in Vision and Ophthalmology, Seattle, Washington.
Adinanto, FC, French, AN & Rose, KA 2016, 'The prevalence of strabismus: A systematic literature review', INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), ASSOC RESEARCH VISION OPHTHALMOLOGY INC, Seattle, WA.
Moafa, M, French, A, Heard, R & Rose, KA 2015, 'Development of myopia among adolescents: a validation of instrument study', INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), ASSOC RESEARCH VISION OPHTHALMOLOGY INC, Denver, CO.
French, AN, Rose, K, Mitchell, P & Morgan, IG 2014, 'Longitudinal change in ocular biometry: relationship to refractive development in children and adolescents', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology Annual Meeting, Association for Research in Vision and Ophthalmology.
Rose, K, French, AN, Mitchell, P & Morgan, I 2013, 'The role of time outdoors on the progression of refractive error in Australian children', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology Annual Meeting, Association for Research in Vision and Ophthalmology.
Rose, K, French, AN, Morgan, I & Mitchell, P 2012, 'Incidence of myopia in Australian adolescents: the Sydney Childhood Eye Study (SCES)', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology Annual Meeting, Association for Research in Vision and Ophthalmology.
Afsari, S, Rose, K, French, AN, Pai, A, Leone, J, Fotedar, R, Burlutsky, G & Mitchell, P 2011, 'Reliability of Stereoacuity Tests for the Detection of Ocular Conditions in Pre-School Children: the Sydney Pediatric Eye Disease Study', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology Annual Meeting, Association for Research in Vision and Ophthalmology.
Rose, K, French, AN, Morgan, I & Mitchell, P 2011, 'School-based Variation In The Prevalence Of Myopia: The Sydney Myopia Study', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology, Association for Research in Vision and Ophthalmology.
French, AN, Rose, K, Burlutsky, G & Mitchell, P 2009, 'Does Correction of Hyperopia Affect the Pattern of Children's Activities, and Does This Differ From That in Emmetropic Children?', Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology Annual Conference, Association for Research in Vision and Ophthalmology.