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

Steinmetz, Jaimie D., Bourne, Rupert R. A., Briant, Paul Svitil, Flaxman, Seth R., Taylor, Hugh R. B., Jonas, Jost B., Abdoli, Amir Aberhe, Abrha, Woldu Aberhe, Abualhasan, Ahmed, Abu-Gharbieh, Eman Girum, Adal, Tadele Girum, Afshin, Ashkan, Ahmadieh, Hamid, Alemayehu, Wondu, Alemzadeh, Sayyed Amirpooya Samir, Alfaar, Ahmed Samir, Alipour, Vahid, Androudi, Sofia, Arabloo, Jalal, Arditi, Aries Berhe, Aregawi, Brhane Berhe, Arrigo, Alessandro, Ashbaugh, Charlie, Ashrafi, Elham Debalkie, Atnafu, Desta Debalkie, Bagli, Eleni Amin, Baig, Atif Amin Winfried, Bärnighausen, Till Winfried, Battaglia Parodi, Maurizio, Beheshti, Mahya Srikanth, Bhagavathula, Akshaya Srikanth, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhattacharyya, Krittika, Bijani, Ali, Bikbov, Mukharram, Bottone, Michele ORCID: https://orcid.org/0009-0008-2515-4184, Braithwaite, Tasanee M., Bron, Alain M., Burugina Nagaraja, Sharath A., Butt, Zahid A., Caetano dos Santos, Florentino Luciano L., Carneiro, Vera L. James, Casson, Robert James, Cheng, Ching-Yu Jasmine, Choi, Jee-Young Jasmine, Chu, Dinh-Toi, Cicinelli, Maria Vittoria M., Coelho, João M. G., Congdon, Nathan G. A., Couto, Rosa A. A., Cromwell, Elizabeth A. M., Dahlawi, Saad M., Dai, Xiaochen, Dana, Reza, Dandona, Lalit, Dandona, Rakhi A., Del Monte, Monte A., Derbew Molla, Meseret, Dervenis, Nikolaos Alemayehu, Desta, Abebaw Alemayehu P., Deva, Jenny P., Diaz, Daniel, Djalalinia, Shirin E., Ehrlich, Joshua R., Elayedath, Rajesh Rashad, Elhabashy, Hala Rashad B., Ellwein, Leon B., Emamian, Mohammad Hassan, Eskandarieh, Sharareh, Farzadfar, Farshad G., Fernandes, Arthur G., Fischer, Florian S., Friedman, David S. M., Furtado, João M., Gaidhane, Shilpa, Gazzard, Gus, Gebremichael, Berhe, George, Ronnie, Ghashghaee, Ahmad, Gilani, Syed Amir, Golechha, Mahaveer, Hamidi, Samer Randall, Hammond, Billy Randall R., Hartnett, Mary Elizabeth R. Kusuma, Hartono, Risky Kusuma, Hashi, Abdiwahab I., Hay, Simon I., Hayat, Khezar, Heidari, Golnaz, Ho, Hung Chak, Holla, Ramesh, Househ, Mowafa J., Huang, John J. Emmanuel, Ibitoye, Segun Emmanuel M., Ilic, Irena M. D., Ilic, Milena D. D., Ingram, April D. Naghibi, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Itumalla, Ramaiah, Jayaram, Shubha Prakash, Jha, Ravi Prakash, Kahloun, Rim, Kalhor, Rohollah, Kandel, Himal, Kasa, Ayele Semachew, Kavetskyy, Taras A., Kayode, Gbenga A. H., Kempen, John H., Khairallah, Moncef, Khalilov, Rovshan Ahmad, Khan, Ejaz Ahmad C., Khanna, Rohit C., Khatib, Mahalaqua Nazli Ahmed, Khoja, Tawfik Ahmed E., Kim, Judy E., Kim, Yun Jin, Kim, Gyu Ri, Kisa, Sezer, Kisa, Adnan, Kosen, Soewarta, Koyanagi, Ai, Kucuk Bicer, Burcu, Kulkarni, Vaman P., Kurmi, Om P., Landires, Iván Charles, Lansingh, Van Charles L., Leasher, Janet L. E., LeGrand, Kate E., Leveziel, Nicolas, Limburg, Hans, Liu, Xuefeng, Madhava Kunjathur, Shilpashree, Maleki, Shokofeh, Manafi, Navid, Mansouri, Kaweh, McAlinden, Colm Gebremichael, Meles, Gebrekiros Gebremichael M., Mersha, Abera M., Michalek, Irmina Maria R., Miller, Ted R., Misra, Sanjeev, Mohammad, Yousef, Mohammadi, Seyed Farzad Abdu, Mohammed, Jemal Abdu H., Mokdad, Ali H., Moni, Mohammad Ali Al, Montasir, Ahmed Al R., Morse, Alan R. Fentaw, Mulaw, Getahun Fentaw C., Naderi, Mehdi, Naderifar, Homa S., Naidoo, Kovin S., Naimzada, Mukhammad David, Nangia, Vinay, Narasimha Swamy, Sreenivas Muhammad, Naveed, Dr Muhammad, Negash, Hadush Lan, Nguyen, Huong Lan, Nunez-Samudio, Virginia Akpojene, Ogbo, Felix Akpojene, Ogundimu, Kolawole T., Olagunju, Andrew T. E., Onwujekwe, Obinna E., Otstavnov, Nikita O., Owolabi, Mayowa O., Pakshir, Keyvan, Panda-Jonas, Songhomitra, Parekh, Utsav, Park, Eun-Cheol, Pasovic, Maja, Pawar, Shrikant, Pesudovs, Konrad, Peto, Tunde Quang, Pham, Hai Quang, Pinheiro, Marina, Podder, Vivek, Rahimi-Movaghar, Vafa, Rahman, Mohammad Hifz Ur Y., Ramulu, Pradeep Y., Rathi, Priya, Rawaf, Salman Laith, Rawaf, David Laith, Rawal, Lal, Reinig, Nickolas M., Renzaho, Andre M., Rezapour, Aziz L., Robin, Alan L., Rossetti, Luca, Sabour, Siamak, Safi, Sare, Sahebkar, Amirhossein, Sahraian, Mohammad Ali M., Samy, Abdallah M., Sathian, Brijesh, Saya, Ganesh Kumar, Saylan, Mete A., Shaheen, Amira A. Ali, Shaikh, Masood Ali T., Shen, Tueng T., Shibuya, Kenji Shibabaw, Shiferaw, Wondimeneh Shibabaw, Shigematsu, Mika, Shin, Jae Il, Silva, Juan Carlos, Silvester, Alexander A., Singh, Jasvinder A., Singhal, Deepika S., Sitorus, Rita S., Skiadaresi, Eirini Yurievich, Skryabin, Valentin Yurievich Aleksandrovna, Skryabina, Anna Aleksandrovna, Soheili, Amin Bekele, Sorrie, Muluken Bekele A. R. C., Sousa, Raúl A. R. C. T., Sreeramareddy, Chandrashekhar T., Stambolian, Dwight Girma, Tadesse, Eyayou Girma, Tahhan, Nina Ismail, Tareque, Md Ismail, Topouzis, Fotis Xuan, Tran, Bach Xuan, Tsegaye, Gebiyaw K., Tsilimbaris, Miltiadis K., Varma, Rohit, Virgili, Gianni, Vongpradith, Avina Thu, Vu, Giang Thu, Wang, Ya Xing, Wang, Ningli Hailay, Weldemariam, Abrha Hailay K., West, Sheila K. Gebeyehu, Wondmeneh, Temesgen Gebeyehu Y., Wong, Tien Y., Yaseri, Mehdi, Yonemoto, Naohiro, Yu, Chuanhua Sergeevich, Zastrozhin, Mikhail Sergeevich, Zhang, Zhi-Jiang R., Zimsen, Stephanie R., Resnikoff, Serge and Vos, Theo (2021) 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. The Lancet Global Health, 9 (2) . e144-e160. ISSN 2214-109X [Article] (doi:10.1016/S2214-109X(20)30489-7)

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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.

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