Advancing vision care in children – bridging science, policy, and practice

Abstract

Pediatric vision health is a cornerstone of child development, learning, and social well-being. This editorial synthesizes current advances, challenges, and emerging frontiers in childhood vision care as reflected in this collection, emphasizing equity, innovation, and integration in pediatric ophthalmology.

Introduction: why pediatric vision matters

Vision is a primary sensory modality through which children interact with the world. Visual impairments in childhood not only hinder sensory perception but also cascade into lifelong educational, developmental, and socio-economic disadvantages. With the increasing survival of premature infants and the growing digitalization of childhood, pediatric eye health demands renewed focus across clinical, research, and policy domains [1]. This collection of BMC Pediatrics brings together multidisciplinary studies addressing the biology, epidemiology, interventions, and humanistic dimensions of pediatric vision disorders.

Recent advances and state-of-the-art insights

One of the cornerstones of this collection is the exploration of genetic underpinnings of pediatric eye disorders. Wang et al. examined ocular manifestations in tumor suppressor gene mutations (e.g., RB1, NF1, VHL), emphasizing how early ocular signs can be harbingers of systemic disease. This reinforces the need for pediatricians and ophthalmologists to collaborate closely in recognizing syndromic associations for timely diagnosis and genetic counseling [2]. In parallel, the protocol by Hellström et al. introduces the DROPROP trial, a multicenter investigation into dexamethasone eye drops to prevent proliferative retinopathy of prematurity (ROP). As ROP remains a major cause of childhood blindness, especially in low-birth-weight infants, the shift toward pharmacologic prevention exemplifies innovation in neonatal ophthalmology [3]. Salari et al.’s systematic review further captures the global epidemiologic transition in pediatric myopia, implicating increased digital screen use as a key modifiable factor. Their meta-analysis underscores how early-onset myopia has become a pandemic in its own right, demanding school-based screening, environmental reforms, and public health interventions [4].

Challenges: disparities, delays, and systemic gaps

The collection also highlights enduring disparities in pediatric vision care access. While developed countries are refining therapeutic strategies, many low- and middle-income regions lack basic screening infrastructure, contributing to delayed diagnoses and irreversible visual morbidity. Moreover, even within high-income nations, vulnerable populations—especially premature infants and children with disabilities—face disproportionate barriers to equitable eye care. For example, Misic et al. provide a qualitative lens into nurses’ perceptions of preterm eye exams, uncovering psychosocial stresses, infrastructural challenges, and ethical dilemmas in neonatal screening practices. Their phenomenographic approach adds a human-centered dimension to a predominantly clinical field, reminding us that empathy and family-centered care are as vital as diagnostic accuracy [5].

Early biomarkers and systemic consequences of childhood vision disorders

An important contribution to this collection is the retrospective analysis by Kong et al., which explores the association between hematocrit levels within the first two hours of life (HCT2h) and the subsequent development of retinopathy of prematurity (ROP). Using data from the DRYAD database at Santa Clara Valley Medical Center, the authors evaluated 326 very preterm infants born at or before 34 weeks’ gestation. Their findings demonstrate that lower HCT2h values were significantly associated with both the occurrence and severity of ROP. Notably, higher HCT2h emerged as an independent protective factor against ROP after multivariate adjustment, and subgroup analysis revealed that among infants born at ≥ 28 weeks’ gestation, each 1% increase in HCT2h was associated with a 17% reduction in ROP risk. These results are clinically meaningful, as they highlight HCT2h as a readily available, early-life biomarker that could enhance neonatal risk stratification and inform individualized screening strategies. Importantly, this work reinforces the concept that systemic hematologic status in the immediate postnatal period may influence retinal vascular development, opening avenues for preventive approaches alongside established ROP surveillance protocols [6].

Broadening the scope beyond neonatal care, Drews-Botsch and Harrington provide a compelling population-based perspective on the long-term systemic implications of early childhood vision problems. Using longitudinal data from the Growing Up in Ireland cohort, the authors examined the relationship between early vision problems, obesity, and physical activity in over 6,600 children. Their analysis revealed that children with vision problems reported at ages 3 or 5 experienced greater increases in body mass index by age 9 and had significantly higher odds of developing excess weight compared to peers without early vision issues. These findings suggest that visual impairment in early childhood may indirectly influence lifestyle behaviors, including reduced physical activity and increased sedentary time, thereby predisposing affected children to obesity. This study underscores an often-overlooked dimension of pediatric vision disorders—their intersection with general health, physical activity, and long-term cardiometabolic risk [7].

Together, these two studies exemplify the expanding boundaries of pediatric vision research. While Kong et al. emphasize early biological markers and precision risk prediction in vulnerable preterm infants, Drews-Botsch and colleagues draw attention to the broader developmental and public health consequences of childhood vision impairment. Collectively, they reinforce the need for integrated care models that extend beyond ocular outcomes alone, encompassing neonatal systemic health, early intervention, lifestyle counseling, and long-term follow-up. Such evidence strengthens the argument that pediatric vision care is not an isolated specialty concern, but a central component of holistic child health and development.

Emerging themes and research directions

Several themes emerge from this collection that are poised to shape the next generation of pediatric vision research. Emerging themes in pediatric vision research reflect a shift toward precision, prevention, and accessibility in care delivery. One such domain is translational genomics, which has gained prominence through studies involving tumor suppressor gene mutations affecting ocular development. By expanding gene panels and integrating detailed ocular phenotyping, researchers and clinicians can now diagnose pediatric vision disorders earlier and more accurately. This approach fosters the growth of precision pediatrics, allowing for targeted interventions and improved prognostic counseling [8]. Another crucial area is preventive ophthalmology, exemplified by trials such as DROPROP, which investigates the prophylactic use of dexamethasone drops to prevent proliferative retinopathy of prematurity (ROP). These initiatives signal a paradigm shift from reactive treatments to anticipatory, less invasive care strategies in neonatal intensive care units (NICUs). As adjunct pharmacologic therapies evolve, they may reduce reliance on traditional laser photocoagulation and improve long-term visual outcomes. Simultaneously, technology and teleophthalmology are revolutionizing pediatric eye care. The proliferation of smartphone-based screening platforms and AI-assisted fundus imaging tools holds immense potential for reaching under-resourced regions. These innovations are particularly valuable in detecting conditions such as ROP and myopia, enabling earlier intervention and reducing the burden on tertiary care centres. Lastly, the future of pediatric vision care hinges on interdisciplinary models of care. Stronger collaboration among pediatricians, neonatologists, nurses, geneticists, and ophthalmologists is essential. Developing shared care protocols, promoting cultural competency, and embedding family-centered rehabilitation services will ensure that vision care is comprehensive, equitable, and contextually responsive [9].

Impact on quality of life and child development

Vision impairments significantly influence early cognitive, language, and socio-emotional development. Delayed diagnosis of refractive errors, amblyopia, or congenital cataracts can have irreversible consequences on visual cortex maturation. Moreover, children with vision loss face elevated risks of academic underperformance, social isolation, and mental health issues. Evidence from the issue—especially on the burden of myopia—reaffirms that school health policies must integrate vision screening, particularly in the digital age where children spend hours on screens. Parent education, outdoor activity promotion, and early optometric referrals are low-cost yet impactful strategies [10].

Toward equitable, evidence-based vision health

While pediatric eye care is advancing, access and outcomes remain deeply unequal. The UN’s Sustainable Development Goals (SDGs) and the WHO’s World Report on Vision call for universal health coverage of eye care, particularly for children. Vision health must be embedded in child health agendas, educational programs, and social protection schemes [11]. This collection contributes to this goal by offering research grounded in diverse contexts—from molecular science to implementation practice, from quantitative epidemiology to qualitative experiences. Future efforts should also expand research in neglected areas such as school vision programs, pediatric low vision rehabilitation, and psychosocial support.

Conclusion and call to action

Vision is integral to childhood, but pediatric vision disorders often remain in the blind spot of public health. As the Guest Editors of this collection on pediatric vision care, we are honoured to introduce a collection of works that merge scientific advancement, clinical compassion, and forward-looking innovation. This compilation serves not only as a repository of research but also as a clarion call for systemic action. We urge clinicians, researchers, educators, and policymakers to prioritize and strengthen early screening and genetic evaluation for childhood eye disorders, promote equitable access to vision care across all socioeconomic and geographic settings, and endorse interdisciplinary and family-centered models of pediatric eye care. Additionally, strategic investment in digital innovations, including teleophthalmology, is crucial to extend the reach of specialist care into underserved communities. Importantly, efforts must also address the socio-emotional and developmental dimensions of childhood blindness to ensure holistic support for affected children and their families. By embracing and operationalizing these priorities, we can move closer to a world where no child is disadvantaged by preventable or treatable visual impairment. This issue thus stands as both a testament to the progress achieved and a roadmap for the work that lies ahead.

Abbreviations

AI

Artificial Intelligence

NICU

Neonatal Intensive Care Unit

ROP

Retinopathy of Prematurity

SDGs

Sustainable Development Goals

WHO

World Health Organization

Authors’ contributions

The author solely conceived and wrote this editorial.

Funding

No external funding was received for this editorial.

Data availability

Not applicable.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.