Elsevier

The Lancet

Volume 362, Issue 9393, 25 October 2003, Pages 1359-1365
The Lancet

Articles
Severe visual impairment and blindness in children in the UK

https://doi.org/10.1016/S0140-6736(03)14631-4Get rights and content

Summary

Background

Prevention of visual impairment and blindness in childhood is an international priority. However, many countries do not have contemporary information about incidence and causes, from which the scope and priorities for prevention and treatment can be identified.

Methods

In the UK, children aged younger than 16 years newly diagnosed with severe visual impairment or blindness (SVI/BL, WHO criteria) during 2000 were identified through national active surveillance schemes in ophthalmology and paediatrics. From these data, we calculated yearly age-group specific incidence and cumulative incidence. Causes were classified by the anatomical site or sites affected and by timing of the insult or insults and causal factors, where known.

Findings

Of 439 newly diagnosed children, 336 (77%) had additional non-ophthalmic disorders or impairments (SVI/BL plus). Total yearly incidence was highest in the first year of life, being 4·0 (95% CI 3·6–4·5) per 10 000, with a cumulative incidence by 16 years of age of 5·9 (5·3–6·5) per 10 000. 10% (44) of all children died within 1 year of diagnosis of blindness. Prenatal causal factors affected 61% (268) of children, with perinatal or neonatal and childhood factors each affecting 18% (77). Incidence and causes varied with presence of non-ophthalmic impairments or disorders, birthweight, and ethnic orgin. At least 75% (331) of children had disorders that were neither potentially preventable nor treatable, with current knowledge.

Interpretation

Severe visual impairment and blindness in childhood in the UK is more common, occurs more frequently in the context of complex non-ophthalmic impairments, and has greater associated mortality, than previously assumed. An increased rate in children of low birthweight and from ethnic minority groups, together with the observed diversity and complexity of the causes, reflect recent secular changes in the population at risk, specific risk factors, and strategies available for treatment.

Section snippets

Background

Visual impairment in childhood affects the child's development, and education, and the care given by families and professionals. It also shapes the adult the child becomes, affecting employment and social prospects. Although less common than in adulthood,1 the associated life-long burden of disability is substantial and has high economic costs.2 The incidence and pattern of causes of visual impairment and blindness in children at a given time will reflect the prevailing balance between the

Participants

In the UK, ophthalmologists and paediatricians are involved in management of visually impaired children. To enhance ascertainment, eligible children were identified through both the British Ophthalmological3 and the British Paediatric4 Surveillance Units, whose reporting bases consist of all consultant ophthalmologists and paediatricians, respectively, participating in national active surveillance schemes5 that have facilitated successful studies of uncommon disorders in ophthalmology3 and

Procedures

For 12 months from January, 2000, active surveillance was undertaken, simultaneously but independently, through both units. Every month clinicians reported all children younger than 16 years who were newly diagnosed as severely visually impaired or blind (SVI/BL) as a result of any disorder. Such a definition included children with corrected distance visual acuity of worse than 6/60 (or equivalent using other optotypes) in the better eye–ie, SVI/BL (WHO international taxonomy6); those eligible

Results

During 2000, 439 children with newly diagnosed SVI/BL were reported to us by clinicians. Numerators are presented for individual analyses since some data were missing for a few cases. 54% (237 of 439) of all children were boys, 72% (298 of 413) were white, 24% (96 of 408) weighed less than 2500 g at birth, and 40% (166 of 411) were in the most deprived national quintile of the Carstairs index (figure 1). 77% (336 of 438) of children had SVI/BL plus. Those of low birthweight (<2500 g) were more

Discussion

At least four of every 10 000 children born in the UK will be diagnosed as severely visually impaired or blind by their first birthday, increasing to nearly six per 10 000 by the age of 16 years. Children of low birthweight and from ethnic minorities have the highest rates, with those from the most deprived socioeconomic groups over-represented. In more than three-quarters of children, visual loss occurs in the context of significant non-ophthalmic impairments or disorders, resulting in death

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