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Published on: February 11, 2014
Changes in causes of low vision between 1988 and 2009 in a Dutch population of children
Nienke Boonstra1, Hans Limburg, Nel Tijmes
1Bartiméus Institute for the Visually Impaired, Zeist, The Netherlands. nboonstra@bartimeus.nl
Insights
Causes of childhood low vision in the Netherlands have shifted, with treatable conditions decreasing and complex genetic disorders like cerebral visual impairment (CVI) increasing. This trend highlights the need for updated intervention strategies for pediatric low vision.
Area of Science:
- Ophthalmology and Public Health
- Pediatric Low Vision Epidemiology
Background:
- The etiological landscape of pediatric low vision in the Netherlands may have evolved over the past two decades.
- Understanding these epidemiological shifts is crucial for effective public health interventions and resource allocation.
Purpose of the Study:
- To analyze trends in the causes of low vision among children in the Netherlands over a 21-year period (1988-2009).
- To identify significant changes in the prevalence of specific ophthalmic diagnoses and associated factors.
Main Methods:
- Retrospective analysis of socio-demographic, medical, and ophthalmic data for 2843 children (0-21 years) with low vision.
- Inclusion of data from a Dutch low vision institute (Bartiméus) spanning 1988-2009.
- Trend analyses using logistic regression models for the 19 most common diagnoses, reporting odds ratios (OR) per decade.
Main Results:
- Cerebral visual impairment (CVI) was the most common diagnosis (27.2%), often associated with mental impairment (97%).
- Significant increases observed in nystagmus (OR=1.42), retinitis pigmentosa (OR=1.61), cone-rod dystrophy (OR=1.98), and hyperopia (OR=3.66).
- Significant decreases noted in cataract (OR=0.64), aniridia (OR=0.42), and retinopathy of prematurity (ROP) (OR=0.45); genetic disorders (OR=1.49) and co-occurring mental impairment (OR=1.16) increased.
Conclusions:
- Treatable/preventable causes of low vision (cataract, ROP) have declined, replaced by complex, untreatable conditions like CVI.
- Increased survival of preterm/low birth weight infants and improved diagnostics contribute to the rise in complex genetic disorders.
- Data on low vision prevalence and trends are vital for informing policy and developing targeted intervention strategies.
Purpose:
Causes of low vision in the Netherlands may have changed over time. The purpose of this study is to assess trends over the last two decades.
Methods:
Socio-demographic and medical data, including ophthalmic diagnosis and inheritance patterns for 2843 children with low vision (0-21 years; 50% representation) referred to a Dutch institute for low vision (Bartiméus) over a 21-year period between 1988 and 2009, were included in the analysis. For the 19 most common diagnoses, inheritance and presence of mental impairment, trend analyses were performed with logistic regression models; odds ratios (OR) for a 10-year time span were reported.
Results:
Cerebral visual impairment (CVI) was found in 27.2% (97% mental impairment), albinism in 8.0%. Over time, nystagmus (6.6%; OR = 1.42), retinitis pigmentosa (2.9%; OR = 1.61), cone-rod dystrophy (2.6%; OR = 1.98) and hyperopia (2.0%; OR = 3.66) increased significantly. Cataract (4.9%; OR = 0.64), aniridia (1.6%; OR = 0.42) and retinopathy of prematurity (ROP; 2.0%; OR = 0.45) decreased significantly. There was a significant increase in genetic disorders (41.0%; OR = 1.49) and in co-occurrence of mental impairment (52.2% OR = 1.16).
Conclusion:
In the last two decades, treatable or preventable disorders (such as cataract and ROP) have become a less common cause of low vision in children. However, the prevalence of complex (genetic) and untreatable disorders (CVI) has taken its place, as a result of increased survival of preterm and low birth weight children and improved diagnostic possibilities. Knowledge of the prevalence of low vision, its causes and trends over time may help policy makers to define effective intervention strategies and to monitor its impact.
