Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Rupert R.A. Bourne*, Jaimie D. Steinmetz, Mete Saylan, Abera M. Mersha, Abrha Hailay Weldemariam, Temesgen Gebeyehu Wondmeneh, Chandrashekhar T. Sreeramareddy, Marina Pinheiro, Mehdi Yaseri, Chuanhua Yu, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi Jiang Zhang, Stephanie R.M. Zimsen, Naohiro Yonemoto, Gebiyaw Wudie Tsegaye, Giang Thu Vu, Avina Vongpradith, Andre M.N. Renzaho, Muluken Bekele SorrieAmira A. Shaheen, Wondimeneh Shibabaw Shiferaw, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Ganesh Kumar Saya, Vafa Rahimi-Movaghar, Mika Shigematsu, Mohammad Ali Sahraian, Homa Naderifar, Siamak Sabour, Priya Rathi, Brijesh Sathian, Ted R. Miller, Aziz Rezapour, Lal Rawal, Hai Quang Pham, Utsav Parekh, Vivek Podder, Obinna E. Onwujekwe, Maja Pasovic, Nikita Otstavnov, Hadush Negash, Shrikant Pawar, Mukhammad David Naimzada, Ahmed Al Montasir, Felix Akpojene Ogbo, Nathan G. Congdon, David S. Friedman, Tunde Peto, Gianni Virgili, GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study

*Corresponding author for this work

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Abstract

Background
Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error.

Methods
We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older.

Findings
Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]).

Interpretation
Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached.

Original languageEnglish
Pages (from-to)e144-e160
JournalThe Lancet Global Health
Volume9
Issue number2
Early online date01 Dec 2020
DOIs
Publication statusPublished - Feb 2021

ASJC Scopus subject areas

  • General Medicine

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