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
Jaimie D Steinmetz, Rupert Bourne, Paul Svitil Briant, Seth Flaxman, Hugh R B Taylor, Jost B. Jonas, Amir Abdoli, Woldu Aberhe Abrha, Ahmed Abualhasan, Eman Girum Abu-Gharbieh, Tadele Girum Girum Adal, Ashkan Afshin, Hamid Ahmadieh, Wondu Alemayehu, Sayyed Amirpooya Alemzadeh, Ahmed Samir Alfaar, Vahid Alipour, Sofia Androudi, Jalal Arabloo, Aries Arditi, Brhane Berhe Aregawi, Alessandro Arrigo, Charlie Ashbaugh, Elham Ashrafi, Desta Debalkie Atnafu, Eleni Bagli, Atif Amin Baig, Till Bärnighausen, Maurízio Battaglia Parodi, Mahya Beheshti, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Mukharram M. Bikbov, Michele Bottone, Tasanee M Braithwaite, Alain M. Bron, Sharath Burugina Nagaraja, Zahid A Butt, Florentino Luciano Caetano dos Santos, Vera Lúcia Alves Carneiro, Robert J. Casson, Ching-Yu Jasmine Cheng, Jee-Young Jasmine Choi, Dinh‐Toi Chu, Maria Vittoria Cicinelli, João M G Coelho, Nathan Congdon, Rosa A A Couto, Elizabeth A. Cromwell, Saad M A Dahlawi, Xiaochen Dai, Reza Dana, Lalit Dandona, Rakhi Dandona, Monte A. Del Monte, Meseret Derbew Molla, Nikolaos Dervenis, Abebaw Alemayehu Desta, Jenny P Deva, Daniel Díaz, Shirin E Djalalinia, Joshua R. Ehrlich, Rajesh Elayedath, Hala Rashad Elhabashy, Leon B. Ellwein, Mohammad Hassan Emamian, Sharareh Eskandarieh, Farshad Farzadfar, Arthur Gustavo Fernandes, Florian Fischer, David S. Friedman, João M. Furtado, Shilpa Gaidhane, Gus Gazzard, Berhe Gebremichael, Ronnie George, Ahmad Ghashghaee, Syed Amir Gilani, Mahaveer Golechha, Samer Randall Hamidi, Billy R. Hammond, M. Elizabeth Hartnett, Risky Kusuma Hartono, Abdiwahab Hashi, Simon I Hay, Khezar Hayat, Golnaz Heidari, Hung Chak Ho, Ramesh Holla, Mowafa J Househ, John J. Huang, Segun Emmanuel Ibitoye, Irena Ilić, Milena Ilić, April Ingram, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam
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.