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

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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. 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.

Original languageEnglish
Pages (from-to)e144-e160
Number of pages17
JournalThe Lancet Global Health
Volume9
Issue number2
Early online date1 Dec 2020
DOIs
Publication statusPublished - Feb 2021
Externally publishedYes

Bibliographical note

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Funder

A M Bron reports personal fees from Aerie, Allergan, Bausch & Lomb, Santen, and Théa, outside the submitted work. D S Friedman reports personal fees from W L Gore, Bausch & Lomb, Life Biosciences, and Théa, outside the submitted work. G Gazzard reports grants from National Institute for Health Research (NIHR) Health Technology Assessment (HTA); personal fees, non-financial support and speaker fees, honoraria, and consulting fees from Alcon, Allergan, Bausch & Lomb, Belkin, Ellex, Equinox Genentech, Glaukos, Haag-Streit, Ivantis, Lumenis, McKinsey, Santen, Sight Science, and Théa; personal fees, non-financial support and membership on an advisory panel, committee and board of directors from Allergan, Belkin, Equinox Genentech, Glaukos, Ivantis, McKinsey, Santen, Sight Science, and Théa; and participation in clinical trial from Hydrus & Preserflo trials, outside the submitted work. M E R Hartnett reports grants from the National Eye Institute and grants from the National Institutes of Health (NIH), outside the submitted work. S M S Islam reports grants from the National Health and Medical Research Council and from the National Heart Foundation of Australia, outside the submitted work. J H Kempen Kempen reports equity ownership with Betaliq and personal fees from Gilead, outside the submitted work. K S Naidoo is employed by Essilor—an optical company. P Y Ramulu reports grants from the NIH and personal fees from Aerie Pharmaceuticals, W L Gore, Théa, and Ivantis, outside the submitted work. J A Singh reports having received personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, NIH, the American College of Rheumatology, and Simply Speaking; owning stock from Amarin, Viking, Moderna, Vaxart pharmaceuticals, and Charlotte's Web Holdings; and having received non-financial support from FDA Arthritis Advisory Committee, from Steering committee of OMERACT (an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies), from Veterans Affairs Rheumatology Field Advisory Committee, and from the Editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. F Topouzis reports grants from Pfizer, Théa, Novartis, Rheon, Omikron, Pharmaten, Bayer, and Bausch & Lomb; and personal fees from Novartis and Omikron; outside the submitted work. M K Tsilimbaris reports grants from Novartis Hellas, Bayer Hellas, Mavrogenis, Allergan Hellas, and Johnson & Johnson; personal fees from Novartis Hellas, Bayer Hellas, and Allergan Hellas; and non-financial support from Novartis Hellas, Alcon Hellas, Bayer Hellas, Mavrogenis, and Allergan Hellas.

Funding Information:
This manuscript was produced as part of the GBD Collaborator Network and in accordance with the GBD protocol. 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 (London, UK) and supported by grants from the NIHR (HTA 09/104/40), Moorfields Eye Charity, British Council to Prevent Blindness, and Fight for Sight and the International Glaucoma Association. M E R Hartnett's work is supported by grants from NIH R01 EY015130, NIH R01 EY017011, and NIH EY014800 Unrestricted Grant from Research to Prevent Blindness (NY, USA) to the Department of Ophthalmology & Visual Sciences, University of Utah (Salt Lake City, UT, USA). S M S Islam received funding from National Health and Medical Research Council (NHMRC) and National Heart Foundation. J H Kempen received support from the Massachusetts Eye and Ear Global Surgery Program; Sight for Souls. Y J Kim received support by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá. A M Samy received support from a fellowship from the Egyptian Fulbright Mission Program. D Stambolia received research support from the National Eye Institute of the NIH under Award Number R01EY031209.


ASJC Scopus subject areas

  • Medicine(all)

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