Retinopathy of prematurity in middle-income countries

Background In the 1940s and 1950s retinopathy of prematurity (ROP) was the single commonest cause of blindness in children in many industrialised countries; it now accounts for only 6–18% of blindness registrations. It is not known what proportion of blindness is due to ROP in countries that do not have blindness registers. Information on blindness in children in these countries can be obtained by examining children in schools for the blind. Methods Between 1991 and 1996, 4121 children in 23 countries with a visual acuity in the better eye of less than 6/60 were examined with a standard method. Findings The proportion of severe visual impairment or blindness due to ROP ranged from 0% in most African countries to 38·6% in Cuba. Interpretation These data suggest that ROP is becoming a major cause of potentially preventable blindness among children in middle-income countries that have introduced neonatal intensive-care services for preterm and low-birthweight babies.