Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study

GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study

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Background: To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990–2020, and forecasts for 2050. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. Only studies with samples representative of the population and with clearly defined visual acuity testing protocols were included. We fitted hierarchical models to estimate 2020 prevalence (with 95% uncertainty intervals [UIs]) of mild vision impairment (presenting visual acuity ≥6/18 and <6/12), moderate and severe vision impairment (<6/18 to 3/60), and blindness (<3/60 or less than 10° visual field around central fixation); and vision impairment from uncorrected presbyopia (presenting near vision <N6 or <N8 at 40 cm where best-corrected distance visual acuity is ≥6/12). We forecast estimates of vision loss up to 2050. Findings: In 2020, an estimated 43·3 million (95% UI 37·6–48·4) people were blind, of whom 23·9 million (55%; 20·8–26·8) were estimated to be female. We estimated 295 million (267–325) people to have moderate and severe vision impairment, of whom 163 million (55%; 147–179) were female; 258 million (233–285) to have mild vision impairment, of whom 142 million (55%; 128–157) were female; and 510 million (371–667) to have visual impairment from uncorrected presbyopia, of whom 280 million (55%; 205–365) were female. Globally, between 1990 and 2020, among adults aged 50 years or older, age-standardised prevalence of blindness decreased by 28·5% (–29·4 to −27·7) and prevalence of mild vision impairment decreased slightly (–0·3%, −0·8 to −0·2), whereas prevalence of moderate and severe vision impairment increased slightly (2·5%, 1·9 to 3·2; insufficient data were available to calculate this statistic for vision impairment from uncorrected presbyopia). In this period, the number of people who were blind increased by 50·6% (47·8 to 53·4) and the number with moderate and severe vision impairment increased by 91·7% (87·6 to 95·8). By 2050, we predict 61·0 million (52·9 to 69·3) people will be blind, 474 million (428 to 518) will have moderate and severe vision impairment, 360 million (322 to 400) will have mild vision impairment, and 866 million (629 to 1150) will have uncorrected presbyopia. Interpretation: Age-adjusted prevalence of blindness has reduced over the past three decades, yet due to population growth, progress is not keeping pace with needs. We face enormous challenges in avoiding vision impairment as the global population grows and ages. Funding: Brien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.

Original languageEnglish
Pages (from-to)e130-e143
JournalThe Lancet Global Health
Issue number2
Early online date01 Dec 2020
Publication statusPublished - Feb 2021

Bibliographical note

Funding Information:
P S Briant reports personal fees from WHO outside of the submitted work. G Gazzard reports grants from National Institute for Health Research (NIHR) Health Technology Assessment (HTA); personal fees, non-financial support, speaker fees, honoraria, consulting fees, and in-kind compensation from Alcon, Allergan, Bausch & Lomb, Belkin, Ellex, Equinox Genentech, Glaukos, Haag-Streit, Ivantis, Lumenis, McKinsey, Santen, Sight Science, and Thea; personal fees, non-financial support, and membership on an advisory panel, committee, or board of directors from Allergan, Belkin, Equinox Genentech, Glaukos, Ivantis, McKinsey, Santen, Sight Science, and Thea; and participation in a clinical trial from Hydrus & Preserflo trials outside of the submitted work. J H Kempen reports personal fees from Gilead; grants from National Eye Institute/National Institutes of Health, Sight for Souls, and Christoffel Blindenmission outside of the submitted work. K S Naidoo reports employment in the Social Impact Division of Essilor, which is an optical company. P Y Ramulu reports grants from National Institute of Health; personal fees from Ivantis, Aerie Pharmaceutics, and W L Gore; and other support from Thea outside of the submitted work. S Resnikoff reports personal fees from BHVI outside of the submitted work. J B Serle reports advisory board and lecture support from Aerie; consulting support from Allergan and Bausch & Lomb; and advisory board support from Qlaris outside of the submitted work. F Topouzis reports grants from Pfizer, Thea, Rheon, Alcon, Bayer, and Bausch & Lomb and grants and personal fees from Novartis and Omikron outside of the submitted work. M K Tsilimbaris reports grants, personal fees, and non-financial support from Novartis Hellas and Bayer Hellas; grants from Alcon Hellas; and grants and non-financial support from Mavrogenis outside of the submitted work. All other authors declare no competing interests.

Funding Information:
T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. R R A Bourne received institutional support from Anglia Ruskin University (Cambridge, UK). G Gazzard is employed by University College London and supported by grants from the NIHR (HTA 09/104/40), Moorfields Eye Charity, British Council to Prevent Blindness, Fight for Sight, and the International Glaucoma Association. E R Hartnett's work in this article is supported by NEI R01EY017011 and R01EY015130 and a departmental grant from Research to Prevent Blindness awarded to Moran Eye Center, University of Utah (Salt Lake City, UT, USA), and a core grant EY018400. Y J Kim's work in this study was supported from the Research Management Centre, Xiamen University Malaysia (grant number: XMUMRF/2018-C6/ITCM/0004). A M Samy has a fellowship from the Egyptian Fulbright Mission Program. The views expressed in this Article are those of the authors and not necessarily those of any funding body or Department of Health.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Copyright 2021 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • General Medicine


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