Visual impairment, severe visual impairment, and blindness in children in Britain (BCVIS2): a national observational study.
Visual impairment, severe visual impairment, and blindness in children in Britain (BCVIS2): a national observational study.
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英国儿童视力障碍、严重视力障碍和失明（BCVIS2）：一项全国性观察性研究。
DOI：
10.1016/s2352-4642(20)30366-7
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发表时间：
2021-03
影响因子：
36.4
通讯作者：
Rahi, Jugnoo S.
中科院分区：
文献类型：
--
作者：
Teoh, Lucinda J.;Solebo, Ameenat Lola;Rahi, Jugnoo S.
世卫组织于2000年发起的2020年远景全球抗盲倡议，将儿童视力残疾列为优先事项，旨在到2020年结束本可避免的儿童失明。然而，由于全球缺乏有关儿童视力障碍的流行病学数据，进展受到阻碍。英国儿童视力损害和失明研究2(BCVIS2)就是为了解决这一证据差距而进行的。BCVIS2是一项在全英国范围内进行的前瞻性、横断面、观察性研究，旨在建立新诊断为视力障碍的儿童的初始队列。眼科医生和儿科医生报告了来自英国89家医院和社区中心的病例。我们包括了在2015年10月1日至2016年11月1日期间，年龄在18岁或以下的儿童，他们新诊断出的任何疾病都会导致每只眼睛的视力下降到0.5logMAR或更差(比6/18 Snellen更差)，或者通过标准定性指标评估的同等视力。符合条件的儿童由其管理眼科医生和儿科医生通过两个国家主动监测计划--英国眼科监测股和英国儿科监测股--同时但独立地通知。在诊断时和一年后收集关于检测、管理和治疗的标准化详细的人口学、社会经济学和临床数据。我们根据关键的社会人口学因素计算发病率估计值和相对率。我们对潜在的眼科疾病和非眼科并发症进行了描述性分析。在最初通知的845名合格儿童中，有61名(7%)在随访时因治疗后视力改善而不合格。因此，研究样本包括784名患有永久性新诊断的全因视力障碍、严重视力障碍或失明的儿童。在778名儿童中，有559名(72%)有临床上显著的非眼部损害或疾病。在784名儿童中，有28名(4%)在被诊断为视力残疾后一年内死亡(所有儿童都有潜在的全身疾病)。1岁时视力残疾发生率为5·19/10,000 (95%可信区间为4·71~5·72)，几乎是1~4岁儿童的10倍，是年龄组的20~100倍。视力损害、严重视力损害或失明的总累积发生率(或终生风险)为每10,000名 儿童(9·35-10·76)10·03。任何少数民族、社会经济地位最低的五分之一，以及早产儿或低出生体重者的发病率都较高。784名儿童中有345名(44%)只有一个受影响的解剖部位。784名儿童中有378名(48%)受到大脑和视觉通路障碍的影响。BCVIS2提供了与高收入国家儿童视力残疾相关的异质性、多种发病率和脆弱性的当代快照。这些发现有助于开发和提供卫生保健以及规划干预研究。我们的发现强调了将儿童视力障碍作为全球儿童健康倡议的哨兵事件和衡量标准的重要性。为视力而战，国家健康研究所和Ulverscroft基金会。
The WHO VISION 2020 global initiative against blindness, launched in 2000, prioritised childhood visual disability by aiming to end avoidable childhood blindness by 2020. However, progress has been hampered by the global paucity of epidemiological data concerning childhood visual disability. The British Childhood Visual Impairment and Blindness Study 2 (BCVIS2) was done to address this evidence gap. BCVIS2 was a prospective UK-wide, cross-sectional, observational study to establish an inception cohort of children newly diagnosed with visual impairment. Ophthalmologists and paediatricians reported cases from 89 hospitals and community centres across the UK. We included children aged 18 years or younger who were newly diagnosed with any condition causing impaired visual acuity to a level of 0·5 logMAR or worse (worse than 6/18 Snellen) in each eye, or equivalent vision as assessed by standard qualitative measures, between Oct 1, 2015, and Nov 1, 2016. Eligible children were notified simultaneously but independently by their managing ophthalmologists and paediatricians via the two national active surveillance schemes, the British Ophthalmological Surveillance Unit and the British Paediatric Surveillance Unit. Standardised detailed demographic, socioeconomic, and clinical data about detection, management, and treatment were collected at diagnosis and 1 year later. We calculated incidence estimates and relative rates by key sociodemographic factors. We did descriptive analyses of underlying ophthalmic disorders and non-ophthalmic comorbidities. 61 (7%) of 845 eligible children initially notified were ineligible at follow-up because of improved vision after treatment. Thus, the study sample comprised 784 children with permanent newly-diagnosed all-cause visual impairment, severe visual impairment, or blindness. 559 (72%) of 778 children had clinically significant non-ophthalmic impairments or conditions. 28 (4%) of 784 children died within a year after diagnosis of visual disability (all had underlying systemic disorders). Incidence of visual disability in the first year of life was 5·19 per 10 000 children (95% CI 4·71–5·72), almost ten times higher than among 1-to-4-year-olds and between 20 times and 100 times higher than in the older age groups. The overall cumulative incidence (or lifetime risk) of visual impairment, severe visual impairment, or blindness was 10·03 per 10 000 children (9·35–10·76). Incidence rates were higher for those from any ethnic minority group, the lowest quintile of socioeconomic status, and those born preterm or with low birthweight. 345 (44%) of 784 children had a single affected anatomical site. Disorders of the brain and visual pathways affected 378 (48%) of 784 children. BCVIS2 provides a contemporary snapshot of the heterogeneity, multi-morbidity, and vulnerability associated with childhood visual disability in a high-income country. These findings could facilitate developing and delivering health care and planning of interventional research. Our findings highlight the importance of including childhood visual disability as a sentinel event and metric in global child health initiatives. Fight for Sight, National Institute for Health Research, and Ulverscroft Foundation.