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(University of Washington), Rupert Bourne(Anglia Ruskin University), Paul Svitil Briant(University of Washington), Seth Flaxman(Imperial College London), Hugh R B Taylor(The University of Melbourne), Jost B. Jonas(Heidelberg University), Amir Abdoli(Jahrom University), Woldu Aberhe Abrha(Aksum University), Ahmed Abualhasan(Cairo University), Eman Girum Abu-Gharbieh(University of Sharjah), Tadele Girum Girum Adal(Wolkite University), Ashkan Afshin(University of Washington), Hamid Ahmadieh(Shahid Beheshti University of Medical Sciences), Wondu Alemayehu(Fred Hollows Foundation), Sayyed Amirpooya Alemzadeh(Iran University of Medical Sciences), Ahmed Samir Alfaar(Leipzig University), Vahid Alipour(Iran University of Medical Sciences), Sofia Androudi(University of Thessaly), Jalal Arabloo(Iran University of Medical Sciences), Aries Arditi, Brhane Berhe Aregawi(Adigrat University), Alessandro Arrigo(Vita-Salute San Raffaele University), Charlie Ashbaugh(University of Washington), Elham Ashrafi(Tehran University of Medical Sciences), Desta Debalkie Atnafu(Bahir Dar University), Eleni Bagli(University Hospital of Ioannina), Atif Amin Baig(Sultan Zainal Abidin University), Till Bärnighausen(Heidelberg University), Maurízio Battaglia Parodi(Vita-Salute San Raffaele University), Mahya Beheshti(Tehran University of Medical Sciences), Akshaya Srikanth Bhagavathula(Charles University), Nikha Bhardwaj, Pankaj Bhardwaj(All India Institute of Medical Sciences), Krittika Bhattacharyya(National Institute of Biomedical Genomics), Ali Bijani(Babol University of Medical Sciences), Mukharram M. Bikbov(Ufa Eye Research Institute), Michele Bottone(Imperial College London), Tasanee M Braithwaite, Alain M. Bron(CHU Dijon Bourgogne), Sharath Burugina Nagaraja(Employees State Insurance Post Graduate Institute of Medical Sciences and Research), Zahid A Butt(University of Waterloo), Florentino Luciano Caetano dos Santos(École Polytechnique Fédérale de Lausanne), Vera Lúcia Alves Carneiro(University of Minho), Robert J. Casson(The University of Adelaide), Ching-Yu Jasmine Cheng(Singapore Eye Research Institute), Jee-Young Jasmine Choi(Seoul National University Hospital), Dinh‐Toi Chu(Hanoi National University of Education), Maria Vittoria Cicinelli(Vita-Salute San Raffaele University), João M G Coelho(Universidade do Porto), Nathan Congdon(Queen's University Belfast), Rosa A A Couto(Universidade do Porto), Elizabeth A. Cromwell(University of Washington), Saad M A Dahlawi(Imam Abdulrahman Bin Faisal University), Xiaochen Dai(University of Washington), Reza Dana(Harvard University Press), Lalit Dandona(University of Washington), Rakhi Dandona(University of Washington), Monte A. Del Monte(University of Michigan), Meseret Derbew Molla(University of Gondar), Nikolaos Dervenis(University of Liverpool), Abebaw Alemayehu Desta(University of Gondar), Jenny P Deva(Universiti Tunku Abdul Rahman), Daniel Díaz(Universidad Nacional Autónoma de México), Shirin E Djalalinia(Ministry of Health and Medical Education), Joshua R. Ehrlich(University of Michigan), Rajesh Elayedath(University of Medical Sciences and Technology), Hala Rashad Elhabashy(Cairo University), Leon B. Ellwein(National Institutes of Health), Mohammad Hassan Emamian(Shahroud University of Medical Sciences), Sharareh Eskandarieh(Tehran University of Medical Sciences), Farshad Farzadfar(Tehran University of Medical Sciences), Arthur Gustavo Fernandes(Universidade Federal de São Paulo), Florian Fischer(University of Applied Sciences Ravensburg-Weingarten), David S. Friedman(Harvard University Press), João M. Furtado(Hospital Universitário da Universidade de São Paulo), Shilpa Gaidhane(Datta Meghe Institute of Higher Education and Research), Gus Gazzard, Berhe Gebremichael(Haramaya University), Ronnie George(Sankara Nethralaya), Ahmad Ghashghaee(Iran University of Medical Sciences), Syed Amir Gilani(University of Lahore), Mahaveer Golechha(Indian Institute of Public Health Gandhinagar), Samer Randall Hamidi(Hamdan Bin Mohammed Smart University), Billy R. Hammond, M. Elizabeth Hartnett(University of Utah), Risky Kusuma Hartono, Abdiwahab Hashi(Jigjiga University), Simon I Hay(University of Washington), Khezar Hayat(University of Veterinary and Animal Sciences), Golnaz Heidari, Hung Chak Ho(Chinese University of Hong Kong), Ramesh Holla(Manipal Academy of Higher Education), Mowafa J Househ(Hamad bin Khalifa University), John J. Huang(Yale University), Segun Emmanuel Ibitoye(University of Ibadan), Irena Ilić(University of Belgrade), Milena Ilić(University of Kragujevac), April Ingram, Seyed Sina Naghibi Irvani(Shahid Beheshti University of Medical Sciences), Sheikh Mohammed Shariful Islam(Deakin University), Ramaiah Itumalla(University of Ha'il), Shubha Prakash Jayaram(Mysore Medical College), Ravi Prakash Jha(Banaras Hindu University), Rim Kahloun(University of Monastir), Rohollah Kalhor(Qazvin University of Medical Sciences), Himal Kandel(The University of Sydney), Ayele Semachew Kasa(Bahir Dar University), Taras A Kavetskyy(John Paul II Catholic University of Lublin), Gbenga A Kayode(Institute of Human Virology), John H. Kempen(Kyungbok University), Moncef Khairallah(Hospital Fatuma Bourguiba Monastir), Rovshan Ahmad Khalilov(Baku State University), Ejaz Ahmad Khan(Health Services Academy), Rohit Khanna(L V Prasad Eye Institute), Mahalaqua Nazli Khatib(Datta Meghe Institute of Higher Education and Research), Tawfik Ahmed E Khoja, Judy E. Kim(Medical College of Wisconsin), Yun Jin Kim(Xiamen University Malaysia), Gyu Ri Kim(Yonsei University), Sezer Kısa(Metropolitan University), Adnan Kısa, Soewarta Kosen, Ai Koyanagi, Burcu Küçük Biçer, Vaman Kulkarni, Om Kurmi, Iván Landires, Van Charles Lansingh, Janet L Leasher, Kate E LeGrand(University of Washington), Nicolas Leveziel, Hans Limburg, Xuefeng Liu, Shilpashree Madhava Kunjathur, Shokofeh Maleki, Navid Manafi, Kaweh Mansouri, Colm McAlinden, Gebrekiros Gebremichael M Meles, Abera Mersha, Irmina Maria Michałek, Ted R. Miller, Sanjeev Misra, Yousef Mohammad, Seyed-Farzad Mohammadi, Jemal Mohammed, Ali H. Mokdad(University of Washington), Mohammad Ali Moni, Ahmed Al Montasir, Alan R. Morse, Getahun Fentaw Mulaw, Mehdi Naderi, Homa Naderifar, Kovin Naidoo, Mukhammad David Naimzada, Vinay Nangia, Sreenivas Muhammad Narasimha Swamy, Muhammad Asif Naveed, Hadush Lan Negash, Huong Lan Thi Nguyen, Virginia Núñez-Samudio, Felix Akpojene Ogbo, Kolawole T Ogundimu, Andrew T Olagunju, Obinna Onwujekwe, Nikita O Otstavnov, Mayowa Owolabi, Keyvan Pakshir, Songhomitra Panda‐Jonas, Utsav Parekh, Eun‐Cheol Park, Maja Pasovic(University of Washington), Shrikant Pawar, Konrad Pesudovs, Tunde Quang Peto, Hai Quang Pham, Marina Pinheiro, Vivek Podder, Vafa Rahimi‐Movaghar, Mohammad Hifz Ur Rahman, Pradeep Y. Ramulu, Priya Rathi, Salman Rawaf(Imperial College London), David Laith Rawaf(Imperial College London), Lal Rawal, Nickolas Reinig(University of Washington), André M. N. Renzaho, Aziz Rezapour, Alan L. Robin, Luca Rossetti, Siamak Sabour, Sare Safi, Amirhossein Sahebkar, Mohammad Ali Sahraian, Abdallah M Samy, Brijesh Sathian, Ganesh Kumar Saya, Mete A Saylan, Amira Shaheen, Masood Ali 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 Singhal, Rita S. Sitorus, Eirini Skiadaresi, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Amin Soheili, Muluken Bekele Sorrie, Raúl A. R. C. Sousa, Chandrashekhar T Sreeramareddy, Dwight Girma Stambolian, Eyayou Girma Tadesse, Nina Tahhan, Md. Ismail Tareque, Fotis Xuan Topouzis, Bach Xuan Tran, Gebiyaw Wudie Tsegaye, Miltiadis K. Tsilimbaris, Rohit Varma, Gianni Virgili, Avina Vongpradith(University of Washington), Giang Thu Vu, Ya Xing Wang, Ningli Wang, Abrha Hailay K Weldemariam, Sheila K. West, Temesgen Gebeyehu Wondmeneh, Tien Yin Wong, Mehdi Yaseri, Naohiro Yonemoto, Chuanhua Yu, Mikhail Sergeevich Zastrozhin, Zhi-Jiang Zhang, Stephanie R M Zimsen(University of Washington), Serge Resnikoff(UNSW Sydney), Theo Vos(University of Washington)
The Lancet Global Health
December 1, 2020
10.1016/s2214-109x(20)30489-7
Cited by 2,991Open Access
Full Text

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.

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