Retinopathy of prematurity may account for a large proportion of childhood blindness in the United States

1. In a cross-sectional study using a large clinical registry, retinopathy of prematurity was the most common cause of blindness among about 1,000 children in the United States with visual acuity of 20/200 or worse.

2. A majority (52.4%) of cases of blindness were due to treatable causes.

Evidence Rating Level: 2 (Good)

Study Rundown: The epidemiology of blindness differs significantly in children as compared to adults, and has wide-ranging and long-term effects on physical, social, and neurological development. This study aimed to characterize the rate and causes of blindness in children under 18 in the United States using cross-sectional analysis of a large database. Among about 80,000 included children, 961 had blindness as defined as visual acuity of 20/200 or worse, yielding a prevalence of 1.2%. Retinopathy of prematurity was the most common cause of blindness, accounting for 31.3% of these cases. Other common causes of blindness were nystagmus, accounting for 8.1%, cataracts, accounting for 6.7%, and optic nerve atrophy, accounting for 6.5%. Most cases, 52.4%, were caused by treatable diseases, including retinopathy of prematurity, retinal detachment, cataract, and glaucoma. This study reported a higher proportion of blindness due to retinopathy of prematurity and a much lower proportion due to cortical visual impairment than a previous US study based on surveys. Capture of all children with blindness is likely incomplete in both study designs, but this database study has the advantage of reflecting a large proportion of eye care in the US. The fact that blindness had a treatable cause in a majority of cases highlights the importance of prevention via early vision screening and access to consistent ophthalmologic care.

Click to read the study in Ophthalmology

Relevant Reading: Epidemiology of blindness in children

In-Depth [cross-sectional study]: Study data were drawn from the Intelligent Research in Sight (IRIS) Registry. All patients 18 years old or younger with visual acuity recorded within the database were included. Blindness was defined as logMAR visual acuity of 1.0 or greater in the better-seeing eye. The primary cause of blindness was agreed upon by two ophthalmologists in cases with multiple possible causes. Children with blindness were significantly younger and more likely to be male, Hispanic, and Black than other children in the registry. Cortical visual impairment was the cause of blindness in 2.4% of cases. The retina was primarily affected in 47.7% of cases of blindness, and the optic nerve in 11.6%.

Image: PD

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