What Are the Causes of Vision Loss? What Puts a Child at Risk? 

Some babies are born blind or with severe vision loss. This can be caused by many different things, including abnormalities in the development of the eye or injury to eye structures from things like prematurity related retinopathy or infections or by developmental problems or injury to the parts of the brain responsible for vision. Some of the factors placing an infant, toddler, or child at significant risk for visual impairment include:

  • Prematurity, low birth weight, needing to be treated with oxygen at birth, or bleeding in the brain
  • Family history of retinoblastoma, congenital cataracts, or metabolic or genetic disease
  • Infection of mother during pregnancy such as rubella, toxoplasmosis, cytomegalovirus, HIV, and some sexually transmitted infections including herpes, gonorrhea  and  chlamydia)
  • Problems with the central nervous system such as developmental delay, cerebral palsy, seizures, or hydrocephalus.
There are many causes of vision loss. Some cause more severe loss than others. One of the most common conditions is known as retinopathy of prematurity (ROP).

Retinopathy of prematurity (ROP): is an eye problem that occurs mainly in babies born before 31 weeks of pregnancy.  About 90 percent of all infants with ROP are in the milder category and do not need treatment. However, infants with more severe disease can develop impaired vision or even blindness. About 1,100-1,500 infants annually develop ROP that is severe enough to require surgical treatment. About 400-600 infants each year in the U.S. become legally blind from ROP. Some other conditions that cause vision loss at the time of birth or in infancy include:
  • Genetic or metabolic diseases
  • Defects or abnormalities in the eye itself (coloboma, glaucoma, cataracts)
  • Infections, such as cytomegalovirus (CMV)
  • Neurological Visual Impairment (NVI)
Neurological Visual Impairment: this is also known as cortical visual impairment or cortical blindness. Causes include anything that affects the visual pathways in the brain such as sustained congenital brain infections, traumatic and anoxic brain injury. The eyes are normal but the visual processing areas of the brain that interprets incoming visual information, is abnormal. This is the cause for visual impairment in up to 21% of children. Vision is affected in different ways and different visual tasks are affected in each individual case. Some improvement can occur in the first few years of life, and vision often fluctuates. There is no specific treatment other than vision and other early intervention services to optimize the child’s use of his residual vision. Some children develop vision problems after they are born. One of the most serious conditions – but fortunately rare – is called retinoblastoma.


Retinoblastoma: is a rare cancer of the retina. The retina is the innermost layer of the eye, located at the back of the eye that receives light and images necessary for vision. About 250 children in the US are diagnosed with this type of cancer each year. It mostly occurs in children under the age of 5; the highest incidence of the disease occurs between infancy and age 2. Both males and females are affected equally. Retinoblastoma can occur in either eye; however, in about 25 to 30 percent of the cases, the tumor is present in both eyes.

Other common conditions are milder and although they may cause some visual impairment, there are treatments which can help.

  • Amblyopia: is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye.  Amblyopia is best treated during the preschool years. If untreated, amblyopia can cause irreversible visual loss in the affected eye. This is why vision screening in the preschool years is critical.  Amblyopia is the most common cause of visual impairment in childhood. The condition affects approximately 2 to 3 out of every 100 children.
  • Strabismus: is a misalignment of the eyes; one or both eyes may turn in, out, up, or down. If the same eye is chronically misaligned, amblyopia may develop in that eye. With early detection, vision can be restored by patching the properly aligned eye, which forces the misaligned one to regain sight. Surgery or glasses are usually required to realign the eyes.
  • Common vision problems known as refractive errors: refractive errors mean that the shape of the eye doesn’t refract, or bend light properly, so images appear blurred (out of focus). These are the most common vision problems. Refractive errors also can cause eyestrain and/or amblyopia. Nearsightedness is the most common refractive error in older children; others include farsightedness and astigmatism. These refractive errors are usually easily treated with different types of glasses and contact lenses. These vision problems are seen in almost 20% of children.
        • Nearsightedness is poor distance vision (also called myopia), which is usually treated with glasses or contacts.
        • Farsightedness is poor near vision (also called hyperopia), which is usually treated with glasses or contacts.
        • Astigmatism is imperfect curvature of the front surface of the eye, which is usually treated with glasses if it causes blurred vision or discomfort.

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Resources:

Want to learn more about vision loss?

American Association for Pediatric Ophthalmology and Strabismus
www.aapos.org

FamilyConnect (For Parents of Children with Visual Impairments)
www.familyconnect.org

Prevent Blindness America
www.preventblindness.org

The Association for Retinopathy of Prematurity and Related Diseases
www.ropard.org