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
GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study, Jaimie D Steinmetz, Rupert R A Bourne, Paul Svitil Briant, Seth R Flaxman, Hugh R B Taylor, Jost B Jonas, Amir Aberhe Abdoli, Woldu Aberhe Abrha, Ahmed Abualhasan, Eman Girum Abu-Gharbieh, Tadele Girum Adal, Ashkan Afshin, Hamid Ahmadieh, Wondu Alemayehu, Sayyed Amirpooya Samir Alemzadeh, Ahmed Samir Alfaar, Vahid Alipour, Sofia Androudi, Jalal Arabloo, Aries Berhe Arditi, Brhane Berhe Aregawi, Alessandro Arrigo, Charlie Ashbaugh, Elham Debalkie Ashrafi, Desta Debalkie Atnafu, Eleni Amin Bagli, Atif Amin Winfried Baig, Till Winfried Bärnighausen, Maurizio Battaglia Parodi, Mahya Srikanth Beheshti, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Mukharram Bikbov, Michele Bottone, Tasanee M Braithwaite, Alain M Bron, Sharath A Burugina Nagaraja, Zahid A Butt, Florentino Luciano L Caetano Dos Santos, Vera L James Carneiro, Robert James Casson, Ching-Yu Jasmine Cheng, Jee-Young Jasmine Choi, Dinh-Toi Chu, Maria Vittoria M Cicinelli, João M G Coelho, Nathan G A Congdon, Rosa A A Couto, Elizabeth A M Cromwell, Saad M Dahlawi, Xiaochen Dai, Reza Dana, Lalit Dandona, Rakhi A Dandona, Monte A Del Monte, Meseret Derbew Molla, Nikolaos Alemayehu Dervenis, Abebaw Alemayehu P Desta, Jenny P Deva, Daniel Diaz, Shirin E Djalalinia, Joshua R Ehrlich, Rajesh Rashad Elayedath, Hala Rashad B Elhabashy, Leon B Ellwein, Mohammad Hassan Emamian, Sharareh Eskandarieh, Farshad G Farzadfar, Arthur G Fernandes, Florian S Fischer, David S M Friedman, João M Furtado, Shilpa Gaidhane, Gus Gazzard, Berhe Gebremichael, Ronnie George, Ahmad Ghashghaee, Syed Amir Gilani, Mahaveer Golechha, Samer Randall Hamidi, Billy Randall R Hammond, Mary Elizabeth R Kusuma Hartnett, Risky Kusuma Hartono, Abdiwahab I Hashi, Simon I Hay, Khezar Hayat, Golnaz Heidari, Hung Chak Ho, Ramesh Holla, Mowafa J Househ, John J Emmanuel Huang, Segun Emmanuel M Ibitoye, Irena M D Ilic, Milena D D Ilic, April D Naghibi Ingram, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Ramaiah Itumalla, Shubha Prakash Jayaram, Ravi Prakash Jha, Rim Kahloun, Rohollah Kalhor, Himal Kandel, Ayele Semachew Kasa, Taras A Kavetskyy, Gbenga A H Kayode, John H Kempen, Moncef Khairallah, Rovshan Ahmad Khalilov, Ejaz Ahmad C Khan, Rohit C Khanna, Mahalaqua Nazli Ahmed Khatib, Tawfik Ahmed E Khoja, Judy E Kim, Yun Jin Kim, Gyu Ri Kim, Sezer Kisa, Adnan Kisa, Soewarta Kosen, Ai Koyanagi, Burcu Kucuk Bicer, Vaman P Kulkarni, Om P Kurmi, Iván Charles Landires, Van Charles L Lansingh, Janet L E Leasher, Kate E LeGrand, Nicolas Leveziel, Hans Limburg, Xuefeng Liu, Shilpashree Madhava Kunjathur, Shokofeh Maleki, Navid Manafi, Kaweh Mansouri, Colm Gebremichael McAlinden, Gebrekiros Gebremichael M Meles, Abera M Mersha, Irmina Maria R Michalek, Ted R Miller, Sanjeev Misra, Yousef Mohammad, Seyed Farzad Abdu Mohammadi, Jemal Abdu H Mohammed, Ali H Mokdad, Mohammad Ali Al Moni, Ahmed Al R Montasir, Alan R Fentaw Morse, Getahun Fentaw C Mulaw, Mehdi Naderi, Homa S Naderifar, Kovin S Naidoo, Mukhammad David Naimzada, Vinay Nangia, Sreenivas Muhammad Narasimha Swamy, Dr Muhammad Naveed, Hadush Lan Negash, Huong Lan Nguyen, Virginia Akpojene Nunez-Samudio, Felix Akpojene Ogbo, Kolawole T Ogundimu, Andrew T E Olagunju, Obinna E Onwujekwe, Nikita O Otstavnov, Mayowa O Owolabi, Keyvan Pakshir, Songhomitra Panda-Jonas, Utsav Parekh, Eun-Cheol Park, Maja Pasovic, Shrikant Pawar, Konrad Pesudovs, Tunde Quang Peto, Hai Quang Pham, Marina Pinheiro, Vivek Podder, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Y Rahman, Pradeep Y Ramulu, Priya Rathi, Salman Laith Rawaf, David Laith Rawaf, Lal Rawal, Nickolas M Reinig, Andre M Renzaho, Aziz L Rezapour, Alan L Robin, Luca Rossetti, Siamak Sabour, Sare Safi, Amirhossein Sahebkar, Mohammad Ali M Sahraian, Abdallah M Samy, Brijesh Sathian, Ganesh Kumar Saya, Mete A Saylan, Amira A Ali Shaheen, Masood Ali T Shaikh, Tueng T Shen, Kenji Shibabaw Shibuya, Wondimeneh Shibabaw Shiferaw, Mika Shigematsu, Jae Il Shin, Juan Carlos Silva, Alexander A Silvester, Jasvinder A Singh, Deepika S Singhal, Rita S Sitorus, Eirini Yurievich Skiadaresi, Valentin Yurievich Aleksandrovna Skryabin, Anna Aleksandrovna Skryabina, Amin Bekele Soheili, Muluken Bekele A R C Sorrie, Raúl A R C T Sousa, Chandrashekhar T Sreeramareddy, Dwight Girma Stambolian, Eyayou Girma Tadesse, Nina Ismail Tahhan, Md Ismail Tareque, Fotis Xuan Topouzis, Bach Xuan Tran, Gebiyaw K Tsegaye, Miltiadis K Tsilimbaris, Rohit Varma, Gianni Virgili, Avina Thu Vongpradith, Giang Thu Vu, Ya Xing Wang, Ningli Hailay Wang, Abrha Hailay K Weldemariam, Sheila K Gebeyehu West, Temesgen Gebeyehu Y Wondmeneh, Tien Y Wong, Mehdi Yaseri, Naohiro Yonemoto, Chuanhua Sergeevich Yu, Mikhail Sergeevich Zastrozhin, Zhi-Jiang R Zhang, Stephanie R Zimsen, Serge Resnikoff, Theo Vos, GBD 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study, Jaimie D Steinmetz, Rupert R A Bourne, Paul Svitil Briant, Seth R Flaxman, Hugh R B Taylor, Jost B Jonas, Amir Aberhe Abdoli, Woldu Aberhe Abrha, Ahmed Abualhasan, Eman Girum Abu-Gharbieh, Tadele Girum Adal, Ashkan Afshin, Hamid Ahmadieh, Wondu Alemayehu, Sayyed Amirpooya Samir Alemzadeh, Ahmed Samir Alfaar, Vahid Alipour, Sofia Androudi, Jalal Arabloo, Aries Berhe Arditi, Brhane Berhe Aregawi, Alessandro Arrigo, Charlie Ashbaugh, Elham Debalkie Ashrafi, Desta Debalkie Atnafu, Eleni Amin Bagli, Atif Amin Winfried Baig, Till Winfried Bärnighausen, Maurizio Battaglia Parodi, Mahya Srikanth Beheshti, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Mukharram Bikbov, Michele Bottone, Tasanee M Braithwaite, Alain M Bron, Sharath A Burugina Nagaraja, Zahid A Butt, Florentino Luciano L Caetano Dos Santos, Vera L James Carneiro, Robert James Casson, Ching-Yu Jasmine Cheng, Jee-Young Jasmine Choi, Dinh-Toi Chu, Maria Vittoria M Cicinelli, João M G Coelho, Nathan G A Congdon, Rosa A A Couto, Elizabeth A M Cromwell, Saad M Dahlawi, Xiaochen Dai, Reza Dana, Lalit Dandona, Rakhi A Dandona, Monte A Del Monte, Meseret Derbew Molla, Nikolaos Alemayehu Dervenis, Abebaw Alemayehu P Desta, Jenny P Deva, Daniel Diaz, Shirin E Djalalinia, Joshua R Ehrlich, Rajesh Rashad Elayedath, Hala Rashad B Elhabashy, Leon B Ellwein, Mohammad Hassan Emamian, Sharareh Eskandarieh, Farshad G Farzadfar, Arthur G Fernandes, Florian S Fischer, David S M Friedman, João M Furtado, Shilpa Gaidhane, Gus Gazzard, Berhe Gebremichael, Ronnie George, Ahmad Ghashghaee, Syed Amir Gilani, Mahaveer Golechha, Samer Randall Hamidi, Billy Randall R Hammond, Mary Elizabeth R Kusuma Hartnett, Risky Kusuma Hartono, Abdiwahab I Hashi, Simon I Hay, Khezar Hayat, Golnaz Heidari, Hung Chak Ho, Ramesh Holla, Mowafa J Househ, John J Emmanuel Huang, Segun Emmanuel M Ibitoye, Irena M D Ilic, Milena D D Ilic, April D Naghibi Ingram, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Ramaiah Itumalla, Shubha Prakash Jayaram, Ravi Prakash Jha, Rim Kahloun, Rohollah Kalhor, Himal Kandel, Ayele Semachew Kasa, Taras A Kavetskyy, Gbenga A H Kayode, John H Kempen, Moncef Khairallah, Rovshan Ahmad Khalilov, Ejaz Ahmad C Khan, Rohit C Khanna, Mahalaqua Nazli Ahmed Khatib, Tawfik Ahmed E Khoja, Judy E Kim, Yun Jin Kim, Gyu Ri Kim, Sezer Kisa, Adnan Kisa, Soewarta Kosen, Ai Koyanagi, Burcu Kucuk Bicer, Vaman P Kulkarni, Om P Kurmi, Iván Charles Landires, Van Charles L Lansingh, Janet L E Leasher, Kate E LeGrand, Nicolas Leveziel, Hans Limburg, Xuefeng Liu, Shilpashree Madhava Kunjathur, Shokofeh Maleki, Navid Manafi, Kaweh Mansouri, Colm Gebremichael McAlinden, Gebrekiros Gebremichael M Meles, Abera M Mersha, Irmina Maria R Michalek, Ted R Miller, Sanjeev Misra, Yousef Mohammad, Seyed Farzad Abdu Mohammadi, Jemal Abdu H Mohammed, Ali H Mokdad, Mohammad Ali Al Moni, Ahmed Al R Montasir, Alan R Fentaw Morse, Getahun Fentaw C Mulaw, Mehdi Naderi, Homa S Naderifar, Kovin S Naidoo, Mukhammad David Naimzada, Vinay Nangia, Sreenivas Muhammad Narasimha Swamy, Dr Muhammad Naveed, Hadush Lan Negash, Huong Lan Nguyen, Virginia Akpojene Nunez-Samudio, Felix Akpojene Ogbo, Kolawole T Ogundimu, Andrew T E Olagunju, Obinna E Onwujekwe, Nikita O Otstavnov, Mayowa O Owolabi, Keyvan Pakshir, Songhomitra Panda-Jonas, Utsav Parekh, Eun-Cheol Park, Maja Pasovic, Shrikant Pawar, Konrad Pesudovs, Tunde Quang Peto, Hai Quang Pham, Marina Pinheiro, Vivek Podder, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Y Rahman, Pradeep Y Ramulu, Priya Rathi, Salman Laith Rawaf, David Laith Rawaf, Lal Rawal, Nickolas M Reinig, Andre M Renzaho, Aziz L Rezapour, Alan L Robin, Luca Rossetti, Siamak Sabour, Sare Safi, Amirhossein Sahebkar, Mohammad Ali M Sahraian, Abdallah M Samy, Brijesh Sathian, Ganesh Kumar Saya, Mete A Saylan, Amira A Ali Shaheen, Masood Ali T Shaikh, Tueng T Shen, Kenji Shibabaw Shibuya, Wondimeneh Shibabaw Shiferaw, Mika Shigematsu, Jae Il Shin, Juan Carlos Silva, Alexander A Silvester, Jasvinder A Singh, Deepika S Singhal, Rita S Sitorus, Eirini Yurievich Skiadaresi, Valentin Yurievich Aleksandrovna Skryabin, Anna Aleksandrovna Skryabina, Amin Bekele Soheili, Muluken Bekele A R C Sorrie, Raúl A R C T Sousa, Chandrashekhar T Sreeramareddy, Dwight Girma Stambolian, Eyayou Girma Tadesse, Nina Ismail Tahhan, Md Ismail Tareque, Fotis Xuan Topouzis, Bach Xuan Tran, Gebiyaw K Tsegaye, Miltiadis K Tsilimbaris, Rohit Varma, Gianni Virgili, Avina Thu Vongpradith, Giang Thu Vu, Ya Xing Wang, Ningli Hailay Wang, Abrha Hailay K Weldemariam, Sheila K Gebeyehu West, Temesgen Gebeyehu Y Wondmeneh, Tien Y Wong, Mehdi Yaseri, Naohiro Yonemoto, Chuanhua Sergeevich Yu, Mikhail Sergeevich Zastrozhin, Zhi-Jiang R Zhang, Stephanie R Zimsen, Serge Resnikoff, Theo Vos
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.
Funding: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.
Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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References
- Flaxman SR, Bourne RRA, Resnikoff S. Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health. 2017;5:e1221–e1234.
- Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. 1971. Milbank Q. 2005;83:731–757.
- Pezzullo L, Streatfeild J, Simkiss P, Shickle D. The economic impact of sight loss and blindness in the UK adult population. BMC Health Serv Res. 2018;18:63.
- Reddy PA, Congdon N, MacKenzie G. Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial. Lancet Glob Health. 2018;6:e1019–e1027.
- Horton S, Gelband H, Jamison D, Levin C, Nugent R, Watkins D. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness. PLoS One. 2017;12
- Lansingh VC, Carter MJ, Martens M. Global cost-effectiveness of cataract surgery. Ophthalmology. 2007;114:1670–1678.
- Tahhan N, Papas E, Fricke TR, Frick KD, Holden BA. Utility and uncorrected refractive error. Ophthalmology. 2013;120:1736–1744.
- WHO . World Health Organization; Geneva: 2013. Universal eye health: a global action plan 2014–2019.
- Bourne RRA, Flaxman SR, Braithwaite T. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017;5:e888–e897.
- WHO . World Health Organization; Geneva: 2019. World report on vision.
- Jonas JB, Wang YX, Xu L, Wei WB. Age-related macular degeneration in China: a population-based and clinical study. Lancet. 2018;392:S86.
- Wong TY, Ferreira A, Hughes R, Carter G, Mitchell P. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review. Am J Ophthalmol. 2014;157:9–25.e12.
- Tham Y-C, Li X, Wong TY, Quigley HA, Aung T, Cheng C-Y. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–2090.
- Wong WL, Su X, Li X. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2:e106–e116.
- Stevens GA, Alkema L, Black RE. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. Lancet. 2016;388:e19–e23.
- Bourne RRA, Adelson J, Flaxman S. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2020 doi: 10.1016/S2214-109X(20)30425-3. published online Dec 1.
- Zheng P, Aravkin AY, Barber R, Sorensen RJD, Murray CJL. Trimmed constrained mixed effects models: formulations and algorithms. ArXiv190910700 Math Stat. 2019 published online Sept 23.
- GBD 2019 Diseases and Injuries Collaborators Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222.
- Mehta MC, Narayanan R, Thomas Aretz H, Khanna R, Rao GN. The L V Prasad Eye Institute: a comprehensive case study of excellent and equitable eye care. Healthc (Amst) 2020;8
- Bourne RRA, Dineen BP, Ali SM, Huq DMN, Johnson GJ. Outcomes of cataract surgery in Bangladesh: results from a population based nationwide survey. Br J Ophthalmol. 2003;87:813–819.
- He M, Zheng Y, Xiang F. Prevalence of myopia in urban and rural children in mainland China. Optom Vis Sci. 2009;86:40–44.
- Hernández RA, Burr JM, Vale LD. Economic evaluation of screening for open-angle glaucoma. Int J Technol Assess Health Care. 2008;24:203–211.
- Garway-Heath DF, Crabb DP, Bunce C. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. Lancet. 2015;385:1295–1304.
- Bloch SB, Larsen M, Munch IC. Incidence of legal blindness from age-related macular degeneration in Denmark: year 2000 to 2010. Am J Ophthalmol. 2012;153:209. 13.e2.
- Ogurtsova K, da Rocha Fernandes JD, Huang Y. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50.
- Leasher JL, Bourne RRA, Flaxman SR. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010. Diabetes Care. 2016;39:1643–1649.
- Yau JWY, Rogers SL, Kawasaki R. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35:556–564.
- Teo ZL, Tham Y-C, Yu M, Cheng C-Y, Wong TY, Sabanayagam C. Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy? A global perspective. Eye (Lond) 2020;34:1255–1261.
- Wong TY, Sun J, Kawasaki R. Guidelines on diabetic eye care: the International Council of Ophthalmology Recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018;125:1608–1622.
- WHO . World Health Organization; Geneva: 2020. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030.
- Bourne RRA, Jonas JB, Resnikoff S. Looking within rather than between countries to understand the risk factors for vision impairment. JAMA Ophthalmol. 2019;137:158–159.
- Ehrlich JR, Stagg BC, Andrews C, Kumagai A, Musch DC. Vision impairment and receipt of eye care among older adults in low- and middle-income countries. JAMA Ophthalmol. 2019;137:146–158.
Source: PubMed