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Global and Regional Trends in Retinopathy of Prematurity
Emily S Wong1,2,3, Richard W Choy1,2, Yuzhou Zhang1
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
Insights
Retinopathy of prematurity (ROP) causes significant childhood vision loss, especially in lower-income nations. Addressing socioeconomic disparities and improving neonatal care are crucial to reduce the global burden of ROP-related visual impairment.
Area of Science:
- Ophthalmology
- Public Health
- Global Health
Background:
- Retinopathy of prematurity (ROP) is a major cause of childhood blindness, with increasing prevalence linked to advancements in neonatal care.
- The global burden of ROP-related vision loss necessitates updated analyses and targeted interventions.
Purpose of the Study:
- To analyze global trends in ROP-related visual impairment from 1990 to 2021.
- To identify socioeconomic and healthcare risk factors associated with ROP-related visual loss.
- To forecast future trends in ROP-related visual impairment.
Main Methods:
- Utilized the Global Burden of Disease 2021 dataset for a cross-sectional analysis of ROP-related visual outcomes in 204 countries (1990-2021).
- Incorporated socioeconomic and healthcare indicators to identify risk factors.
- Employed machine-learning models for outcome forecasting up to 2050.
Main Results:
- Between 1990-2021, 8.79 million cases of ROP-related visual loss were documented, with stable global numbers.
- Low and low-middle Social Demographic Index (SDI) countries bore the majority of cases in 2021.
- Lower primary completion rates, higher out-of-pocket health expenses, and reduced social insurance and prenatal screening coverage were associated with higher visual loss prevalence.
Conclusions:
- Persistent disparities in ROP-related visual loss exist across socioeconomic contexts, particularly concerning blindness.
- Targeted interventions addressing socioeconomic factors, enhancing neonatal care, and implementing universal ROP screening are vital.
- Without intervention, the burden of ROP-related visual impairment is projected to escalate, especially in middle-income regions.
Importance:
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness, particularly in low- and middle-income countries. With advancements in neonatal care, a projected rising trend and burden of ROP-related vision loss necessitates attention.
Objective:
To analyze global trends in ROP-related visual impairment from 1990 to 2021 and identify risk factors for increased prevalence of visual loss.
Design, Setting, And Participants:
This cross-sectional study used the Global Burden of Disease 2021 dataset to identify ROP-related visual outcomes across 204 countries from 1990 to 2021. Socioeconomic and health care indicators were incorporated to identify risk factors for increased prevalence of visual loss, and machine-learning models were used for outcome forecasting until 2050. This analysis was conducted between January 1 and March 30, 2025.
Exposure:
Premature birth.
Main Outcome And Measures:
The main outcome was global prevalence of ROP-related visual impairment, stratified by severity of visual impairment and the associated factors.
Results:
A total of 8.79 million cases of ROP-related visual loss were documented between 1990 and 2021 (4.57 million male and 4.22 million female patients), and the number of cases globally remained stable during this time. Countries with a low social demographic index (SDI) (536 899 cases; 95% uncertainty interval [UI], 418 860-655 140 cases) and low-middle SDI (802 078 cases; 95% UI, 590 539-1 032 465 cases) accounted for the majority of ROP-related visual loss cases in 2021. Despite a sharp decline since the 2000s, prevalence of ROP-related blindness remains disproportionately high in low and low-middle SDI countries. The prevalence pattern shows a shifting burden of ROP-related visual impairment, with high-middle SDI countries in particular experiencing an increasing prevalence rate in all-grade visual loss related to ROP. Multivariable regression analysis found that a lower primary completion rate (estimate, -2.33 [95% CI, -3.11 to 1.55] cases per 100 000 people), higher out-of-pocket health care expense (estimate, 2.61 [95% CI, 1.86 to 3.35] cases per 100 000 people), lower social insurance coverage (estimate, -2.79 [95% CI, -3.76 to 1.82] cases per 100 000 people), lower prenatal screening coverage (estimate, -3.91 [95% CI, -4.63 to 3.19] cases per 100 000 people) and nursing staff density (estimate, -2.07 [95% CI, -3.03 to 1.11] cases per 100 000 people) were associated with higher visual loss prevalence. Projections indicate that without targeted interventions, the burden of ROP-related visual impairment will continue to escalate, particularly in high-middle and middle SDI regions.
Conclusions And Relevance:
This cross-sectional study found that persistent disparities in ROP-related visual loss burden remain between socioeconomic contexts and SDI groups, especially in terms of ROP-related blindness. Addressing socioeconomic disparities, enhancing neonatal care access, and implementing universal ROP screening and follow up programs might reduce the magnitude of the burden of future ROP-related visual loss.
