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Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps
Jianqi Chen1, Yingting Zhu1, Linling Li2
1State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, 510060, China.
Insights
The global burden of vision impairment from retinopathy of prematurity (ROP) has risen, particularly in developed nations. While inequalities between countries are decreasing, targeted interventions are crucial for prevention and care.
Area of Science:
- Ophthalmology and Public Health
- Global Health Epidemiology
- Neonatal Care Research
Background:
- Retinopathy of prematurity (ROP) is a leading cause of preventable childhood vision loss.
- Increasing survival rates of premature infants globally are expected to exacerbate the ROP burden.
- Understanding ROP trends and inequalities is vital for improving neonatal care systems.
Purpose of the Study:
- To comprehensively assess global trends in ROP-related visual impairment burden from 1990 to 2019.
- To evaluate cross-country inequalities in ROP burden based on sociodemographic index (SDI).
- To identify performance gaps in neonatal care systems for ROP management.
Main Methods:
- Utilized data from the Global Burden of Disease 2019 study.
- Employed joinpoint regression for trend analysis of age-standardized prevalence rates.
- Applied health equity and data envelopment analyses to assess inequalities and identify improvement gaps.
Main Results:
- Worldwide age-standardized prevalence of ROP-related visual impairment significantly increased between 1990 and 2019, notably in developed regions.
- Significant cross-country inequalities in ROP burden were observed, though they generally decreased over the study period.
- Some less-developed countries demonstrated better performance than expected given their resources, while some high-SDI countries lagged.
Conclusions:
- The global burden of ROP-related visual impairment has steadily increased, with a disproportionate concentration in less-developed countries.
- Persistent cross-country inequalities highlight the need for tailored preventive and intervention strategies.
- Addressing the rising ROP burden requires integration into global and national health agendas with evidence-based interventions.
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.
