A global analysis of retinopathy of prematurity (ROP) reveals ongoing disparities in vision loss among premature infants, with emerging trends pointing to increasing visual impairment in middle-income regions despite overall progress in neonatal care.

The study, published online in JAMA Ophthalmology this week, examined data from 8.79 million cases of ROP-related visual loss recorded between 1990 and 2021 across 204 countries. Researchers found that, although total cases of visual impairment tied to ROP have stabilized globally, the prevalence of ROP-related visual loss is rising in high-middle and middle Social Demographic Index (SDI) regions—underscoring a shifting burden of disease that warrants urgent public health attention. 

Key Findings

  • Stable but Unequal Global Burden: Overall numbers of ROP-related blindness and visual loss remained relatively constant over the three decades studied, but the bulk of cases in 2021 were still concentrated in low and low-middle SDI countries. 

  • Rising Prevalence in Middle-Income Regions: Since the early 2000s, high-middle SDI countries have seen increasing rates of all grades of visual impairment due to ROP, with projections suggesting this trend will continue through 2050 if interventions aren’t implemented. 

  • Socioeconomic and Health System Drivers: Regression analyses identified several systemic risk factors linked with higher rates of ROP visual loss, including:

    • Lower rates of primary education completion

    • Higher out-of-pocket health care costs

    • Limited social insurance coverage

    • Reduced prenatal screening reach

    • Lower nursing staff density in neonatal care settings 

These findings suggest that gaps in health infrastructure and equitable access to prenatal and neonatal care contribute significantly to ROP outcomes.

The researchers recommend:

  • Universal ROP screening programs regardless of socioeconomic setting

  • Expanded prenatal care access and education

  • Strengthened neonatal workforce capacity

  • Health financing reforms to reduce out-of-pocket expenses for families