Skip to main content
SpringerLink
Log in

Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps

  • RESEARCH
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensively assess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems. We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI). Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairment significantly increased worldwide (average annual percentage change: 0.23 [95% confidence interval, 0.21–0.26] among males and 0.26 [0.25–0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance.

  Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures.

What is Known:

• Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment.

• The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants.

What is New:

• The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities.

• The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data supporting the findings of this study are publicly available from the GBD 2019 study on the Institute for Health Metrics and Evaluation website (https://vizhub.healthdata.org/gbd-results/).

Abbreviations

AAPC:

Average annual percentage change

APC:

Annual percentage change

ASPR:

Age-standardised prevalence rate

CI:

Confidence interval

GBD 2019:

Global burden of disease 2019 study

SDI:

Sociodemographic index

ROP:

Retinopathy of prematurity

References

  1. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB, Tung B; Cryotherapy For Retinopathy of Prematurity Cooperative Group (2020) Incidence and early course of retinopathy of prematurity. Ophthalmology 127:S84–S96. https://doi.org/10.1016/j.ophtha.2020.01.034

    Article  Google Scholar 

  2. Gilbert C (2008) Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev 84:77–82. https://doi.org/10.1016/j.earlhumdev.2007.11.009

    Article  PubMed  Google Scholar 

  3. Marlow N, Stahl A, Lepore D, Fielder A, Reynolds JD, Zhu Q, Weisberger A, Stiehl DP, Fleck B, RAINBOW investigators group, (2021) 2-year outcomes of ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW extension study): prospective follow-up of an open label, randomised controlled trial. Lancet Child Adolesc Health 5(10):698–707. https://doi.org/10.1016/S2352-4642(21)00195-4

    Article  CAS  PubMed  Google Scholar 

  4. Msall ME, Phelps DL, DiGaudio KM, Dobson V, Tung B, McClead RE, Quinn GE, Reynolds JD, Hardy RJ, Palmer EA (2000) Severity of neonatal retinopathy of prematurity is predictive of neurodevelopmental functional outcome at age 5.5 years. Behalf of the cryotherapy for retinopathy of prematurity Cooperative Group. Pediatrics 106:998–1005. https://doi.org/10.1542/peds.106.5.998

    Article  CAS  PubMed  Google Scholar 

  5. Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF, Trial of Indomethacin Prophylaxis in Preterms (TIPP) Investigators, (2003) Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 289:1124–1129. https://doi.org/10.1001/jama.289.9.1124

    Article  PubMed  Google Scholar 

  6. Cryotherapy for Retinopathy of Prematurity Cooperative Group (2002) Multicenter trial of cryotherapy for retinopathy of prematurity: natural history ROP: ocular outcome at 5(1/2) years in premature infants with birth weights less than 1251 g. Arch Ophthalmol 120:595–599. https://doi.org/10.1001/archopht.120.5.595

    Article  Google Scholar 

  7. Fielder A, Blencowe H, O’Connor A, Gilbert C (2015) Impact of retinopathy of prematurity on ocular structures and visual functions. Arch Dis Child Fetal Neonatal Ed 100:F179–F184. https://doi.org/10.1136/archdischild-2014-306207

    Article  PubMed  Google Scholar 

  8. Painter SL, Wilkinson AR, Desai P, Goldacre MJ, Patel CK (2015) Incidence and treatment of retinopathy of prematurity in England between 1990 and 2011: database study. Br J Ophthalmol 99:807–811. https://doi.org/10.1136/bjophthalmol-2014-305561

    Article  PubMed  Google Scholar 

  9. Institute for Health Metrics and Evaluation (2023) GBD2019. http://ghdx.healthdata.org/gbd-results-tool. Accessed 1 Jun 2023

  10. GBD (2019) Diseases and Injuries Collaborators (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9

    Article  Google Scholar 

  11. NIH National Cancer Institute (2023) Joinpoint trend analysis software. https://surveillance.cancer.gov/joinpoint/. Accessed 27 May 2023

  12. World Health Organization (2013) Handbook on health inequality monitoring, with a special focus on low- and middle-income countries. World Health Organization, Geneva

    Google Scholar 

  13. Mújica ÓJ, Moreno CM (2019) Da retórica à ação: mensurar as desigualdades em saúde para não deixar ninguém atrás [From words to action: measuring health inequalities to “leave no one behind”]. Rev Panam Salud Publica 43:e12. https://doi.org/10.26633/RPSP.2019.12

  14. Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T, Maddukuri G, Tsai CY, Floyd T, Al-Aly Z (2018) Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 94:567–581. https://doi.org/10.1016/j.kint.2018.04.011

  15. Quinn GE, Barr C, Bremer D, Fellows R, Gong A, Hoffman R, Repka MX, Shepard J, Siatkowski RM, Wade K et al (2016) Changes in course of retinopathy of prematurity from 1986 to 2013: comparison of three studies in the United States. Ophthalmology 123:1595–1600. https://doi.org/10.1016/j.ophtha.2016.03.026

    Article  PubMed  Google Scholar 

  16. Chan-Ling T, Gole GA, Quinn GE, Adamson SJ, Darlow BA (2018) Pathophysiology, screening and treatment of ROP: a multi-disciplinary perspective. Prog Retin Eye Res 62:77–119. https://doi.org/10.1016/j.preteyeres.2017.09.002

    Article  CAS  PubMed  Google Scholar 

  17. Early Treatment For Retinopathy Of Prematurity Cooperative Group (2003) Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 121:1684–1694. https://doi.org/10.1001/archopht.121.12.1684

    Article  Google Scholar 

  18. Hellström A, Hård AL, Engström E, Niklasson A, Andersson E, Smith L, Löfqvist C (2009) Early weight gain predicts retinopathy in preterm infants: new, simple, efficient approach to screening. Pediatrics 123:e638–e645. https://doi.org/10.1542/peds.2008-2697

    Article  PubMed  Google Scholar 

  19. Wu C, Löfqvist C, Smith LE, VanderVeen DK, Hellström A; WINROP Consortium (2012) Importance of early postnatal weight gain for normal retinal angiogenesis in very preterm infants: a multicenter study analyzing weight velocity deviations for the prediction of retinopathy of prematurity. Arch Ophthalmol 130:992–999. https://doi.org/10.1001/archophthalmol.2012.243

    Article  Google Scholar 

  20. Binenbaum G, Tomlinson LA (2017) Postnatal growth and retinopathy of prematurity study: rationale, design, and subject characteristics. Ophthalmic Epidemiol 24:36–47. https://doi.org/10.1080/09286586.2016.1255765

    Article  PubMed  Google Scholar 

  21. Binenbaum G, Ying GS, Quinn GE, Huang J, Dreiseitl S, Antigua J, Foroughi N, Abbasi S (2012) The CHOP postnatal weight gain, birth weight, and gestational age retinopathy of prematurity risk model. Arch Ophthalmol 130:1560–1565. https://doi.org/10.1001/archophthalmol.2012.2524

    Article  PubMed  Google Scholar 

  22. Gurwin J, Tomlinson LA, Quinn GE, Ying GS, Baumritter A, Binenbaum G; Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study Group and the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Cooperative Group (2017) A tiered approach to retinopathy of prematurity screening (TARP) using a weight gain predictive model and a telemedicine system. JAMA Ophthalmol 135:131–136

    Article  Google Scholar 

  23. Norman M, Hellström A, Hallberg B, Wallin A, Gustafson P, Tornqvist K, Håkansson S, Holmström G (2019) Prevalence of severe visual disability among preterm children with retinopathy of prematurity and association with adherence to best practice guidelines. JAMA Netw Open 2:e186801. https://doi.org/10.1001/jamanetworkopen.2018.6801

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank all members of the Institute for Health Metrics and Evaluation, the University of Washington group, and all other groups involved in the GBD 2019 study.

Funding

This work was supported by the National Key R&D Project of China (2020YFA0112701), National Natural Science Foundation of China (82171057), Science and Technology Program of Guangzhou, China (202206080005), and Major Science and Technology Project of Zhongshan City (2022A1007). The study funders had no role in the study design; collection, analysis, and interpretation of data; writing of the report; or in the decision to submit the paper for publication.

Author information

Author notes

  1. Jianqi Chen, Yingting Zhu, Linling Li and Juan Lv contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China

    Jianqi Chen, Yingting Zhu, Zhidong Li, Xuhao Chen, Xiaohong Chen, Shaofen Huang, Rui Xie, Yuan Zhang, Guitong Ye, Ruiyu Luo, Xinyue Shen & Yehong Zhuo

  2. Shenzhen Maternal and Child Health Care Hospital, Shenzhen, 518000, China

    Linling Li, Juan Lv & Min Fu

Authors
  1. Jianqi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yingting Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linling Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhidong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xuhao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiaohong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shaofen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rui Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Guitong Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ruiyu Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Xinyue Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Min Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yehong Zhuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualisation, MF and YeZ; methodology, JC, YiZ, LL, JL, MF, and YeZ; data verification, ZL, XuC, XiC, SH, RX, YuZ, GY, RL, and XS; writing—original draft, JC, YiZ, LL, and JL; writing—review and editing, MF and YeZ. All authors critically reviewed the manuscript for important intellectual content and approved the final submitted version. YeZ had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Min Fu or Yehong Zhuo.

Ethics declarations

Ethics approval

The study was approved by the Medical Ethics Committee of the Zhongshan Ophthalmic Center at Sun Yat-sen University, Guangzhou, China (approval number: 2023KYPJ095).

Consent to participate

Since GBD data are anonymised, aggregated, and publicly available on its website, the requirement for obtaining informed consent was waived.

Consent to publish

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 297 KB)

Supplementary file2 (PDF 512 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, J., Zhu, Y., Li, L. et al. Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps. Eur J Pediatr 183, 1891–1900 (2024). https://doi.org/10.1007/s00431-024-05450-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-024-05450-5

Keywords

Search

Navigation