4Child - Analysis of 15 year trends and causes of vision loss in children
This project was an in-depth analysis of the vision loss cases recorded in 4Child over the 15 year period from 1984 to 1998. The aim was to study recent trends in the cumulative incidence of visual impairment in childhood and to assess progress against WHO goals for prevention. Data were extracted from 4Child for children with visual impairment (VI) and severe visual impairment/blindness (SVI/BL) born in 1984 to 1998. Causes of impairment were classified by anatomical site(s), probable timing of insult(s), and whether the visual impairment was potentially preventable or treatable. Of the 691 eligible children, 53% had VI and 47% SVI/BL. The cumulative incidence of VI to age 12 years was 7.1 per 10,000 live births (95%CI 6.4 to 7.8) and for SVI/BL was 6.2 per 10,000 live births (95%CI 5.6 to 6.9); the incidence of both had decreased significantly over time. The cumulative incidence results were in keeping with results from a national study carried out in 2000. There was an inverse relationship with gestational age and birth weight, although the risk of visual impairment associated with prematurity and low birth weight decreased substantially over time. Other associated impairments were common: 55% of children with VI and 77% of children with SVI/BL had other sensory or motor impairments. It was estimated that about a fifth of all cases were preventable or treatable. Nearly 20% of the children overall had subsequently died, with over half dying before their fifth birthday. The causes of VI and SVI/BL were numerous and complex and were often part of a wider picture of childhood disability.