Amblyopia, retinal diseases primary causes of low vision in children
Key takeaways:
- Errors of refraction and strabismic amblyopia were the most common causes of low vision.
- Retinal diseases most frequently caused severe vision loss.
- Income and insurance type were not linked to outcomes.
Among children, errors of refraction and strabismic amblyopia were the most common causes of low vision, with retinal diseases most often causing severe vision loss, according to a study.
Further, the results, published in Journal of the American Association for Pediatric Ophthalmology and Strabismus, showed that severity of vision loss was associated with type and number of eye surgeries. However, social determinants of health were not linked to outcomes.
“There is insufficient information about the prevalence and effects of childhood visual impairment in the United States, which has not been sufficiently studied at the population level,” Suzie Kim, resident at Wilmer Eye Institute at Johns Hopkins University, and colleagues wrote, adding that they specifically sought to examine the demographic, social and clinical characteristics of children with low vision.
Kim and colleagues performed a single-center cross-sectional retrospective study of 47,571 children aged 3 to 18 years examined at Cleveland Clinic between 2014 and 2019; 882 (48.8% girls; 69.8% white; mean age at visit, 10.07 ± 5.24 years) had at least one eye with best corrected visual acuity of 20/70 or worse (average BCVA for worse eye, 20/174), with 25.9% having bilateral vision loss.
Patient characteristics collected included demographics, type of insurance and ophthalmic history, with patient ZIP codes used to estimate mean gross income.
Of the patients with low vision in at least one eye, most were aged 13 to 18 years (50.5%) and had private insurance (52.8%). More than half had moderate vision loss (57.5%), 22.7% had mild vision loss, 9.9% had severe vision loss, and 10% were blind in at least one eye.
The most common causes of low vision were errors of refraction or anisometropic amblyopia (34.5%), followed by strabismus or strabismic amblyopia (10.1%). Severe vision loss, defined as BCVA less than 20/200, was mostly caused by retinal dystrophy (18.4%), whereas blindness was primarily caused by retinal detachment (14.3%).
Regarding eye surgeries, 34% of patients with low vision underwent at least one ophthalmic surgery at an average age of 6.19 ± 4.99 years for the first surgery. Forty-one percent were surgeries of the vitreous, retina and posterior segment. Mildly affected eyes typically underwent extraocular muscle procedures (43%), and moderately affected, severely affected and blind eyes underwent posterior segment surgeries.
Notably, as visual loss severity increased, the frequency of surgery increased (at least one surgery: mild eyes, 23%; severe eyes, 44%; blind eyes, 57%; P < .001).
There were no significant differences in average BCVA, diagnosis categories, incidence of ophthalmic surgery, or frequency and type of surgery between patients with public or private insurance. A similar observation was made regarding average income, although there was a significant difference in average income between the mild and severe categories (P = .03).
The researchers noted several study limitations, including inconsistencies in coding and documentation, limited generalizability of the results because the cohort came from one referral center and homogeneity of the population in terms of income.
“Our findings reinforce the significant impact of amblyopia and demonstrate the severity of retinal diseases in children. The latter contribute to an increased surgical burden,” Kim and colleagues wrote. “Additional investigations into different proxies for social determinants of health, such as social worker involvement, parental education level or environmental factors (eg, access to grocery stores, air quality) may be warranted.”
Perspective
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This article explains the crucial relationship between demography, health disparities and surgical intervention in pediatric patients with impaired vision. The study, carried out at an academic eye center over a 5-year period, revealed that among the thousands of children analyzed, a substantial percentage had poor vision, with the most common causes being strabismic and refractive amblyopia. Both the frequency and kind of ophthalmic techniques were closely correlated with the degree of visual impairment, highlighting the requirement of targeted surgical intervention in more severely suffering cases, especially those with retinal diseases. It is interesting to note that the study found no significant relationship between income and insurance coverage with best corrected visual acuity and surgical needs. This may indicate a need to consider how additional variables, such as parental education level and social worker involvement, may contribute to these children’s difficulties. This insight highlights how crucial it is to understand the multifaceted nature of low vision in children and supports comprehensive care approaches that reflect medical necessities without being controlled by socioeconomic factors. To summarize, the study unwraps an important relationship between the percentage of pediatric patients with poor vision with strabismic and refractive amblyopia.
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