Blindness Secondary to Retinopathy of Prematurity in Sub-Saharan Africa

ABSTRACT

Purpose

Retinopathy of Prematurity (ROP) has been suggested to be increasing in Africa. However, it was only previously documented as a cause of blindness in 8 of 48 (16.7%) sub-Saharan African countries. The purpose of this study was to better understand the magnitude and breadth of blindness from ROP in sub-Saharan Africa.

Methods

A questionnaire was sent to 455 ophthalmologists practicing in sub-Saharan Africa; the questionnaire was available in English, French and Portuguese.

Results

Responses were received from 132 of 455 (29%) ophthalmologists to whom the survey was sent. Eighty-three respondents were identified as ROP-involved ophthalmologists and were from 26 of 48 (54%) sub-Saharan African countries. Ophthalmologists in 23 countries reported that they examined at least one child who was blind from ROP during the last 5 years. Sixteen of these countries had not previously reported cases of blindness from ROP in the literature. The perceived occurrence of Type 1 or more severe ROP was reported to be increasing by 31 of 77 (40%) ROP-involved ophthalmologists. ROP-involved pediatric ophthalmologists and retinal surgeons reported the number of infants they examined annually with Type 1 or more severe ROP increased from a median of 1 (range: 0–15) to a median of 4 (range: 0–40) from 2015 to 2019. ROP was estimated to be the cause of blindness for 10% of all blind children examined by ROP-involved pediatric ophthalmologists and retinal surgeons during 2019.

Conclusions

ROP is becoming a more important and widespread cause of childhood blindness in sub-Saharan Africa.

KEYWORDS:

• Retinopathy of Prematurity
• Childhood Blindness
• sub-Saharan Africa
• Blindness
• Children

Acknowledgments

The survey was translated into French by Charlotte Tibi and into Portuguese by Ruth Baptista.

Disclosure of Interest

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Literature search

The literature was searched between April 27-June 1, 2020. Google Scholar and PubMed were the primary databases used. The search was conducted systematically for each of the 48 sub-Saharan African countries. Search items included a combination of terms such as “retinopathy of prematurity,” “ROP,” “childhood blindness,” and “pediatric blindness” in conjunction with a specific country in sub-Saharan Africa. Where relevant, search terms were translated into French or Portuguese. Reports in French or Portuguese were translated using Google Translate in order to extract relevant information. Additional studies were located through the snowball method. A subsequent search was conducted in Embase on September 16, 2020. Search terms included “retinopathy of prematurity,” “ROP,” and “Africa.” Only studies reporting at least one child blind from ROP and conducted within the last 10 years were included. Studies were considered to have participants blind due to ROP if indicated in the text, or if stage 4 and 5 ROP was reported.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

Supported by grant P30 EY026877 from the National Institutes of Health (Bethesda, MD), Research to Prevent Blindness, and time support from Brigham Young University College of Life Sciences; Brigham Young University.