Retinopathy of prematurity in middle-income countries

doi:10.1016/S0140-6736(97)01107-0

The Lancet

Volume 350, Issue 9070, 5 July 1997, Pages 12-14

https://doi.org/10.1016/S0140-6736(97)01107-0 Get rights and content

Summary

Background

In the 1940s and 1950s retinopathy of prematurity (ROP) was the single commonest cause of blindness in children in many industrialised countries; it now accounts for only 6–18% of blindness registrations. It is not known what proportion of blindness is due to ROP in countries that do not have blindness registers. Information on blindness in children in these countries can be obtained by examining children in schools for the blind.

Methods

Between 1991 and 1996, 4121 children in 23 countries with a visual acuity in the better eye of less than 6/60 were examined with a standard method.

Findings

The proportion of severe visual impairment or blindness due to ROP ranged from 0% in most African countries to 38·6% in Cuba.

Interpretation

These data suggest that ROP is becoming a major cause of potentially preventable blindness among children in middle-income countries that have introduced neonatal intensive-care services for preterm and low-birthweight babies.

Introduction

Retinopathy of prematurity (ROP) became the major cause of blindness in children in Europe¹ and North America during the late 1940s and 1950s after the introduction of intensive neonatal care with unmonitored supplemental oxygen for preterm and low-birthweight babies (the “first epidemic”). Since then, increased awareness of the importance of monitoring blood gases has resulted in a lower incidence of potentially blinding ROP, except in extremely low-birthweight babies, less than 1000 g at birth—ie in whom the “second epidemic” is occurring. Data from industrialised countries suggest that up to 8% of extremely low-birthweight infants become blind from ROP.2, 3

A multicentre clinical trial of peripheral retinal cryotherapy for threshold, Stage III plus disease showed the effectiveness of this treatment. Progression to retinal detachment in acute cases was almost halved, and at 5 1/2-years follow-up there was a 24% reduction in poor visual outcome in treated eyes compared with untreated eyes, and a 41% reduction in poor structural outcome.⁴ As a result of improved intensive neonatal care, and screening and treatment of threshold disease in preterm, low-birthweight and extremely low-birthweight babies, ROP now accounts for 6–18% of registered blindness in children in industrialised countries and is no longer a major cause of blindness.5, 6, 7, 8, 9, 10 Population-based data on the causes of blindness in children, which would allow accurate monitoring of trends, requires either compulsory blindness registration, comprehensive surveillance systems, birth cohort studies, or large population-based longitudinal studies. Such information is difficult to obtain from developing countries, and many such countries outside Europe do not have blindness registers. In these circumstances, examination of children enrolled in special education can provide data on the causes of blindness.

Section snippets

Participants and methods

Between 1991 and 1996, studies in schools for the blind were undertaken in 23 countries in four regions of the world by nine ophthalmologists (table). In each study, standard definitions, methods of examination, proformas, and statistical packages were used. Medical records were reviewed when available, and additional information on past medical history and family history was obtained from teachers and parents, if available.

Visual acuity was measured in each eye with a Snellen E chart to

Results

Data for 4121 children with SVI/BL and the proportion due to ROP in each country are shown in the table.12, 13, 14, 15, 16, 17, 18, 19, 20 In all African countries, except South Africa, there were virtually no children with SVI/BL from ROP. Retinopathy of prematurity was responsible for 0–16·9% of SVI/BL in Asian countries, 0–25·9%% in eastern European countries, and 4·1–38·6% in Latin America.

The figure shows the proportion of SVI/BL due to ROP in each country plotted against the infant

Discussion

In some countries, not all children with SVI/BL have access to special education, and facilities for blind children with additional disabilities may also be limited. In countries with low levels of health-care provision, blind children with additional handicaps are likely to have higher mortality rates than blind children who are otherwise normal. Data to support these assumptions are, however, difficult to obtain. Children blind from ROP often have other disabilities² such as cerebral palsy,

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Cited by (396)

Image Analysis–Based Machine Learning for the Diagnosis of Retinopathy of Prematurity: A Meta-analysis and Systematic Review
2024, Ophthalmology Retina
To evaluate the performance of machine learning (ML) in the diagnosis of retinopathy of prematurity (ROP) and to assess whether it can be an effective automated diagnostic tool for clinical applications.
Early detection of ROP is crucial for preventing tractional retinal detachment and blindness in preterm infants, which has significant clinical relevance.
Web of Science, PubMed, Embase, IEEE Xplore, and Cochrane Library were searched for published studies on image-based ML for diagnosis of ROP or classification of clinical subtypes from inception to October 1, 2022. The quality assessment tool for artificial intelligence–centered diagnostic test accuracy studies was used to determine the risk of bias (RoB) of the included original studies. A bivariate mixed effects model was used for quantitative analysis of the data, and the Deek’s test was used for calculating publication bias. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation.
Twenty-two studies were included in the systematic review; 4 studies had high or unclear RoB. In the area of indicator test items, only 2 studies had high or unclear RoB because they did not establish predefined thresholds. In the area of reference standards, 3 studies had high or unclear RoB. Regarding applicability, only 1 study was considered to have high or unclear applicability in terms of patient selection. The sensitivity and specificity of image-based ML for the diagnosis of ROP were 93% (95% confidence interval [CI]: 0.90–0.94) and 95% (95% CI: 0.94–0.97), respectively. The area under the receiver operating characteristic curve (AUC) was 0.98 (95% CI: 0.97–0.99). For the classification of clinical subtypes of ROP, the sensitivity and specificity were 93% (95% CI: 0.89–0.96) and 93% (95% CI: 0.89–0.95), respectively, and the AUC was 0.97 (95% CI: 0.96–0.98). The classification results were highly similar to those of clinical experts (Spearman’s R = 0.879).
Machine learning algorithms are no less accurate than human experts and hold considerable potential as automated diagnostic tools for ROP. However, given the quality and high heterogeneity of the available evidence, these algorithms should be considered as supplementary tools to assist clinicians in diagnosing ROP.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Causes of Childhood Blindness in the United States Using the IRIS® Registry (Intelligent Research in Sight)
2023, Ophthalmology
To investigate causes of childhood blindness in the United States using the IRIS® Registry (Intelligent Research in Sight).
Cross-sectional study.
Patients ≤ 18 years of age with visual acuity (VA) 20/200 or worse in their better-seeing eye in the IRIS Registry during 2018.
Causes of blindness were classified by anatomic site and specific diagnoses.
Percentages of causes of blindness.
Of 81 164 children with 2018 VA data in the IRIS Registry, 961 (1.18%) had VA 20/200 or worse in their better-seeing eye. Leading causes of blindness were retinopathy of prematurity (ROP) in 301 patients (31.3%), nystagmus in 78 patients (8.1%), and cataract in 64 patients (6.7%). The retina was the leading anatomic site (47.7%) followed by optic nerve (11.6%) and lens (10.0%). A total of 52.4% of patients had treatable causes of blindness.
This analysis offers a unique cross-sectional view of childhood blindness in the United States using a clinical data registry. More than one-half of blind patients had a treatable cause of blindness.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Retinopathy of prematurity in preterm infants: A prospective study of prevalence and predictors in Northern India
2023, Clinical Epidemiology and Global Health
To determine the prevalence and predictors of Retinopathy of prematurity (ROP) and severe ROP.
A prospective observational study (April 2019–May 2020) was conducted at a tertiary care center in preterm newborns with; 1) birth-weight <2000 g or gestation <34 weeks and 2) gestation 34–36 weeks with risk factors that predispose to ROP.
A total of 340 preterm newborns were screened. ROP was diagnosed in 63 (18.5%), of which 8 (2.4%) had severe ROP. 30.2%, 63.5%, and 9.5% babies had stage 1, 2, and 3 ROP, respectively. Perinatal risk factors for ROP were assessed using univariate analysis. In the binary logistic regression analysis, birth-weight<1250 g, gestation<30 weeks, weight-gain proportion at 4, 5 and 6 weeks, respiratory distress syndrome (RDS), surfactant administration, need for oxygen were significantly associated with ROP while birth-weight<1250 g, apnea, surfactant administration and oxygen duration≥80 h were associated with severe ROP (p < 0.005). Infants with poor postnatal weight-gain were found to be at risk for ROP. ROC plot depicted an absolute weight gain of 535 g at 6-weeks of age had a sensitivity of 58.7% and specificity of 32.9% for predicting ROP.
The prevalence of ROP was 18.5%. Birth-weight<1250 g, gestation <30 weeks, weight-gain proportion at 4, 5 and 6 weeks, RDS, surfactant administration, need for oxygen were independent predictors for ROP, however birth-weight<1250 g, apnea, surfactant administration and oxygen duration ≥80 h were independent predictors for severe ROP. Preterm newborns with poor postnatal weight-gain are at risk for ROP.
Dysregulated genomic and coding-transcriptomic factors in retinopathy of prematurity
2022, Gene Reports
Retinopathy of prematurity (ROP) is a type of vitreous retinopathy in premature children that leads to visual impairment and blindness at early ages. ROP is a lifetime disease that can impose a tremendous economic and psychological burden on the government and society. ROP is characterized by abnormal neovascularization in the retina. ROP is a multifactorial disease that means many factors are involved in the pathogenesis of ROP, such as low birth weight, short gestational age as a primary risk factor for ROP, anemia, intraventricular hemorrhage, inflammation, sepsis, underlying diseases, maternal preeclampsia, and other factors. Some studies suggest that genetic factors play an essential role in ROP pathogenesis and development. In addition, monitoring genetic factors such as genetic polymorphism may pave the way for diagnosis and prognosis ROP, leading to prevention and stopping disease progression in time. Understanding the genomics of diseases opened a new door for treatment. Genetic-based therapeutic approaches are preventive strategies that can effectively prevent the progression of ROP and improve infants' lives. In this study, we reviewed some genetic factors involved in ROP pathogenesis and development, and in the following, we survey some new genetic-based therapeutic approaches for treating ROP in preterm infants.
Retinal detachment
2024, Nature Reviews Disease Primers
Retinopathy of Prematurity—Targeting Hypoxic and Redox Signaling Pathways
2024, Antioxidants

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ArticlesRetinopathy of prematurity in middle-income countries

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Participants and methods

Results

Discussion

Outcome to five years of age of children born at 24–26 weeks' gestational age in Victoria

Med J Aust

Incidence of retinopathy of prematurity in New Zealand

Arch Dis Child

Multicenter trial of cryotherapy for retinopathy of prematurity. Snellen visual acuity and structural outcome at 5 1/2 years after randomisation

Arch Ophthalmol

Childhood blindness in the Republic of Ireland: a national survey

Br J Ophthalmol

Visual impairment in Nordic children. III Diagnoses

Acta Ophthalmologica

An etiological study on 6–14 year-old children with severe visual handicap in Hungary

Acta Paediatr Hungarica

Diagnostic survey at Yamanashi school for blind: importance of heredity

Jpn J Ophthalmol

Causes of visual impairment in children

Doc Ophthalmologica