There are an estimated 45 million blind people in the world of whom only 3% are children.1 This dramatic difference in numbers of blind adults compared with children accounts in part for the relatively minor importance that has been attributed to the problem surrounding childhood blindness. Certainly, the well organised advocacy groups for the elderly in many developed countries are not matched by comparable ones for children. The result of this can be seen in the difference in resources made available for health services and research for adult blindness versus childhood blindness. One hopes that, now that the World Health Organization (WHO) and International Agency for Prevention of Blindness have developed a global initiative to eliminate avoidable blindness and have included childhood blindness as one of its five key areas, this will change.2 In this issue of theBJO (p 1149) Kocur and co-workers report on the causes of severe visual impairment (visual acuity in the better eye less than 6/60) and blindness (visual acuity in the better eye less than 3/60) in the Czech Republic. This is an excellent study and the authors raise issues that go well beyond the borders of the Czech Republic. We wish to highlight only two of these issues.

First, and foremost, is the issue that the authors emphasise themselves—the continuing havoc resulting from retinopathy of prematurity (ROP). In this study ROP was the leading cause of blindness—41.9% had ROP. Although this figure appears to …