Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Trends in paediatric visual impairment in England and Wales: a retrospective study (2009–2022)

Eye volume 39, pages 2815–2821 (2025)Cite this article

Subjects

Abstract

Introduction

The Certifications of Visual Impairment (VI) system was implemented to quantify and classify the incidence of visual impairment amongst the England and Wales population. This retrospective study investigates the trend in the certification of VI amongst children aged <16 years old.

Methods

CVI data provided by the Certifications Office, was extracted and assessed to identify the various causes of mild-moderate (SI) and severe (SSI) visual impairment between 2009–2022. The data was classified into 11 broad groups which were similar in pathology. Incidence data was calculated using the official Census data. Byar’s method was used to calculate confidence intervals to determine significant changes in the number of new registrations in 4 early intervals amongst conditions that recorded >5 registrations in every year or the study.

Results

Between 2009–2022 there were 18,387 new registrations (10,915 SI and 7472 SSI). Disorders of the CNS (4145), retinal disorders (2990), and congenital abnormalities of the eye (4491) made up nearly 2/3 of the registrations. Amongst SI registrations, there was a significant increase in these 3 groups over the 13-year period excluding the first year of the Covid pandemic. However, there was a significant decrease in SSI registrations for congenital abnormalities.

Conclusions

Overall, there is an increasing number of children registered SI/SSI in England and Wales. The main causes are: disorders of the CNS, retinal disorders and congenital abnormalities of the eye. This may be due to increasing awareness, early screening and advancements in genomic testing.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Full dataset not available to be published at the request of the CVI committee due to the sensitive nature and low numbers of certain paediatric condition groups. Therefore, we have not made the full dataset available in order to preserve patient confidentiality and anonymity. Confidentiality for study involvement is given prospectively on completion of CVI forms by parents which allows for the retrospective use of data in studies such as this which investigate visual impairment. This study was cleared by the director of Research & Development at the CVI committee.

References

  1. Bunce C, Zekite A, Wormald R, Bowman R. Is there evidence that the yearly numbers of children newly certified with sight impairment in England and Wales has increased between 1999/2000 and 2014/2015? A cross-sectional study. BMJ Open. 2017;7:e016888 https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-016888.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bunce C, Evans J, Fraser S, Wormald R. BD8 certification of visually impaired people. Br J Ophthalmol. 1998;82:72–6. https://bjo.bmj.com/lookup/doi/10.1136/bjo.82.1.72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rahman F, Zekite A, Bunce C, Jayaram H, Flanagan D. Recent trends in vision impairment certifications in England and Wales. Eye [Internet]. 2020;34:1271–8. https://www.nature.com/articles/s41433-020-0864-6.

    Article  PubMed  Google Scholar 

  4. Bunce C, Wormald R. Causes of blind certifications in England and Wales: April 1999–March 2000. Eye. 2008;22:905–11. https://www.nature.com/articles/6702767.

    Article  CAS  PubMed  Google Scholar 

  5. RNIB. The criteria for certification. RNIB. 2014. Available from: https://www.rnib.org.uk/your-eyes/navigating-sight-loss/registering-as-sight-impaired/the-criteria-for-certification/.

  6. Department of Health and Social Care. Certificate of vision impairment explanatory notes for consultant ophthalmologists and hospital eye clinic staff in England. Department of Health and Social Care. 2017. Available from: https://assets.publishing.service.gov.uk/media/5a74fffbed915d3c7d5299be/CVI_guidance.pdf

  7. Department of Health and Social Care. Certificate of Vision Impairment for people who are sight impaired (partially sighted) or severely sight impaired (blind). Department of Health and Social Care. 2018. Available from: https://assets.publishing.service.gov.uk/media/6318b725d3bf7f77d2995a5c/certificate-of-vision-impairment-form.pdf

  8. Office for National Statistics (ONS). Population estimates for the UK, England, Wales, Scotland, and Northern Ireland: mid-2023. 2024. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/latest#cite-this-statistical-bulletin

  9. Stats Wales. National level population estimates by year, age and UK country: POPU0003. 2024. Available from: https://statswales.gov.wales/catalogue/population-and-migration/population/estimates/nationallevelpopulationestimates-by-year-age-ukcountry

  10. Public Health England. Technical Guide: Confidence Intervals. 2018.

  11. Breslow NE, Day NE Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. IARC Sci Publ. 1987;1–406. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3329634

  12. Mitry D, Bunce C, Wormald R, Leamon S, Simkiss P, Cumberland P, et al. Causes of certifications for severe sight impairment (blind) and sight impairment (partial sight) in children in England and Wales. Br J Ophthalmol. 2013;97:1431–6. http://bjo.bmj.com/content/97/11/1431.abstract.

    Article  CAS  PubMed  Google Scholar 

  13. Wood M, Gray J, Raj A, Gonzalez-Martin J, Yeo DCM. The impact of the first peak of the COVID-19 pandemic on a paediatric ophthalmology service in the United Kingdom: experience from Alder Hey Children’s Hospital. Br Ir Orthopt J. 2021;17:56–61. http://www.ncbi.nlm.nih.gov/pubmed/34278219.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bouthour W, Biousse V, Newman NJ. Diagnosis of optic disc oedema: fundus features, ocular imaging findings, and artificial intelligence. Neuroophthalmology. 2023;47:177–92. http://www.ncbi.nlm.nih.gov/pubmed/37434667.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dyer C Court overturns optometrist’s conviction for gross negligence manslaughter. BMJ. 2017 Aug 3;j3749. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.j3749

  16. McNicholl C, Gill A, Harrison R, Atan D. Impact of the COVID-19 pandemic and Honey Rose case on hospital attendances of patients suspected to have papilloedema. Eye. 2023;37:2157–9. http://www.ncbi.nlm.nih.gov/pubmed/36443496 Jul Available from.

    Article  PubMed  Google Scholar 

  17. Poostchi A, Awad M, Wilde C, Dineen RA, Gruener AM. Spike in neuroimaging requests following the conviction of the optometrist Honey Rose. Eye. 2018;32:489–90. https://www.nature.com/articles/eye2017274 Mar 8Available from.

    Article  CAS  PubMed  Google Scholar 

  18. Sarkar S, Tripathy K Cortical Blindness. StatPearls. 2024; Available from: https://www.ncbi.nlm.nih.gov/books/NBK560626/

  19. Chang MY, Borchert MS. Advances in the evaluation and management of cortical/cerebral visual impairment in children. Surv Ophthalmol. 2020;65:708–24. https://linkinghub.elsevier.com/retrieve/pii/S0039625720300497.

    Article  PubMed  Google Scholar 

  20. Tuohy GP, Megaw RA. Systematic review and meta-analyses of interventional clinical trial studies for gene therapies for the inherited retinal degenerations (IRDs). Biomolecules. 2021;11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/34069580

  21. Kumaran N, Michaelides M, Smith AJ, Ali RR, Bainbridge JWB. Retinal gene therapy. Br Med Bull. 2018;126:13–25. http://www.ncbi.nlm.nih.gov/pubmed/29506236.

    Article  CAS  PubMed  Google Scholar 

  22. Jacobson SG, Cideciyan AV, Ratnakaram R, Heon E, Schwartz SB, Roman AJ, et al. Gene therapy for leber congenital amaurosis caused by RPE65 mutations: safety and efficacy in 15 children and adults followed up to 3 years. Arch Ophthalmol. 2012;130:9–24. http://www.ncbi.nlm.nih.gov/pubmed/21911650 Jan Available from.

    Article  CAS  PubMed  Google Scholar 

  23. Russell S, Bennett J, Wellman JA, Chung DC, Yu Z-F, Tillman A, et al. Efficacy and safety of voretigene neparvovec (AAV2-hRPE65v2) in patients with RPE65-mediated inherited retinal dystrophy: a randomised, controlled, open-label, phase 3 trial. Lancet. 2017;390:849–60. http://www.ncbi.nlm.nih.gov/pubmed/28712537.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bonkowsky JL, Keller S, AAP Section on Neurology, Council on Genetics. Leukodystrophies in children: diagnosis, care, and treatment. Pediatrics. 2021;148. Available from: http://www.ncbi.nlm.nih.gov/pubmed/34426533

  25. Keller SR, Mallack EJ, Rubin JP, Accardo JA, Brault JA, Corre CS, et al. Practical approaches and knowledge gaps in the care for children with leukodystrophies. J Child Neurol. 2021;36:65–78. http://www.ncbi.nlm.nih.gov/pubmed/32875938.

    Article  PubMed  Google Scholar 

  26. Yang Y, Muzny DM, Reid JG, Bainbridge MN, Willis A, Ward PA, et al. Clinical whole-exome sequencing for the diagnosis of mendelian disorders. N Engl J Med. 2013;369:1502–11. http://www.ncbi.nlm.nih.gov/pubmed/24088041.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Salzman R, Kemp S. Newborn Screening. Adrenoleuodystrophy.info. 2024. Available from: https://adrenoleukodystrophy.info/clinical-diagnosis/ald-newborn-screening.

  28. Watson MS, Mann MY, Lloyd-Puryear PR, Rodney Howel R. Newborn screening: toward a uniform screening panel and system. Genet Med. 2006;8:1S–252S. http://www.ncbi.nlm.nih.gov/pubmed/16783161.

    Article  Google Scholar 

  29. Harris CM, Owen J, Sanders J. Arguments for the Adoption of a Nystagmus Care Pathway. Br Ir Orthopt J [Internet]. 2019;15:82–8. http://www.bioj-online.com/articles/10.22599/bioj.126/.

    Article  PubMed  Google Scholar 

  30. Aychoua N, Schiff E, Malka S, Tailor VK, Chan HW, Oluonye N, et al. Prospective study of pediatric patients presenting with idiopathic infantile nystagmus—Management and molecular diagnostics. Front Genet. 2022;13. Available from: https://www.frontiersin.org/articles/10.3389/fgene.2022.977806/full

  31. The Royal College of Ophthalmologists. Managing Nystagmus in Childhood. 2023. Available from: https://www.rcophth.ac.uk/wp-content/uploads/2023/04/Managing-Nystagmus-in-Childhood.pdf

  32. Gummer SL, Evans M, Cygan A, Osborne D, Griffiths HJ, Lee H, et al. Evaluating the impact of information and support for people with nystagmus in the digital age: a patient and carer questionnaire study. Curr Eye Res. 2020;45:713–7. https://www.tandfonline.com/doi/full/10.1080/02713683.2019.1696978.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was sought.

Author information

Authors and Affiliations

  1. Royal Berkshire Hospital NHS Foundation Trust, London Rd, Reading, United Kingdom

    Matthew Feyissa

  2. Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom

    Richard Bowman

  3. Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, United Kingdom

    Maria Theodorou

Authors
  1. Matthew Feyissa
    View author publications

    Search author on:PubMed Google Scholar

  2. Richard Bowman
    View author publications

    Search author on:PubMed Google Scholar

  3. Maria Theodorou
    View author publications

    Search author on:PubMed Google Scholar

Contributions

MF and MT designed the research protocol, analysed the data, wrote and edited the manuscript. RB edited the manuscript.

Corresponding author

Correspondence to Matthew Feyissa.

Ethics declarations

Competing interests

The authors declare no competing interests

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feyissa, M., Bowman, R. & Theodorou, M. Trends in paediatric visual impairment in England and Wales: a retrospective study (2009–2022). Eye 39, 2815–2821 (2025). https://doi.org/10.1038/s41433-025-03979-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41433-025-03979-9

Search

Advanced search

Quick links