Dr Van Lansingh & Andrea Zin describe initiatives that are being put into place to reduce the rate of retinopathy of prematurity in Latin America; a disease that is unnecessarily robbing 24% of the region's children of their sight
There are approximately 1.7 million blind persons in Latin America and the Caribbean (excluding Cuba).1 The percentage of these people who suffer from preventable blindness varies across the continent, but is high everywhere: in wealthy, urban areas of Argentina and Brazil, preventable blindness accounts for 52–57% of all blindness; in socially disadvantaged areas of countries such as Peru and Guatemala, the percentage of blindness that is preventable is as high as 89–94%.2
The scale of the problem
There are many reasons for this growth: principally, although the number of neonatal intensive care units has increased in recent years, the provision of healthcare for newborn infants in the region, proportionally, has not kept pace. For instance, there continues to be a lack of specialist neonatal doctors and nurses, oxygen equipment, training and coordination of neonatal staff with ophthalmologists, infrastructure, and funding.7,8
The cost of ROP
The cost of blindness and low vision to the Latin American and Caribbean economies is US$3.2 billion.9 As most blindness is preventable, this figure is a good approximation, but is likely to be an underestimation.
The cost of early-stage treatment for ROP varies tremendously from country-to-country because there are many factors in this cost to consider: neonatal care; provision of the required treatment equipment, such as diode lasers; cost of the ophthalmologist's time to perform treatment, and so on. In addition to this, it must be borne in mind that intensive neonatal care is more expensive than intermediate care.
In the Cryotheraphy for Retinopathy of Prematurity (CRYO-ROP) study,10 babies were randomized for treatment at a mean age of 37.7 weeks. Many infants have already been moved to intermediate care or are even discharged at this age, and hence, for many, there will be a need to return to intensive care in order to perform the treatment, which requires general anaesthesia or, at the very least, analgesia and sedation.
Many ophthalmologists working on the anti-ROP programmes in Latin America do so on a volunteer, pro bono basis. This situation is, however, not sustainable in the long-term. Neonatal care in the majority of Latin American countries is the responsibility of the government sector. For this reason, a national policy which includes ophthalmologists among the neonatal health team, and accounts for the added expense of this resource, is needed urgently.
VISION 2020: coordinating the multidisciplinary effort
VISION 2020, the campaign to eliminate the main causes of avoidable blindness by 2020 and to prevent the projected doubling of avoidable vision impairment between 1990 and 2020, is working to reduce the incidence of childhood blindness from ROP in Latin America. Achieving this goal requires the coordinated effort of a multidisciplinary team.