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Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis

journal contribution
posted on 2023-09-01, 14:11 authored by Seth R. Flaxman, Rupert R. A. Bourne, Serge Resnikoff, Peter Ackland, Tasanee Braithwaite, Maria V. Cicinelli, Aditi Das, Jost B. Jonas, Jill Keeffe, John H. Kempen, Janet Leasher, Hans Limburg, Kovin Naidoo, Konrad Pesudovs, Alex Silvester, Gretchen A. Stevens, Nina Tahhan, Tien Y. Wong, Hugh R. Taylor, Aries Arditi, Yaniv Barkana, Banu Bozkurt, Alain M. Bron, Donald Budenz, Feng Cai, Robert Casson, Usha Chakravarthy, Jaewan Choi, Nathan Congdon, Reza Dana, Rakhi Dandona, Lalit Dandona, Iva Dekaris, Monte Del Monte, Jenny Deva, Laura Dreer, Leon Ellwein, Marcela Frazier, Kevin Frick, David Friedman, Joao Furtado, Hua Gao, Gus Gazzard, Ronnie George, Stephen Gichuhi, Victor Gonzalez, Billy Hammond, Mary E. Hartnett, Minguang He, James Hejtmancik, Flavio Hirai, John Huang, April Ingram, Jonathan Javitt, Charlotte Joslin, Moncef Khairallah, Rohit Khanna, Judy Kim, George Lambrou, Van Charles Lansingh, Paolo Lanzetta, Jennifer Lim, Kaweh Mansouri, Anu Mathew, Alan Morse, Beatriz Munoz, David Musch, Vinay Nangia, Maria Palaiou, Maurizio B. Parodi, Fernando Y. Pena, Tunde Peto, Harry Quigley, Murugesan Raju, Pradeep Ramulu, Zane Rankin, Dana Reza, Alan Robin, Luca Rossetti, Jinan Saaddine, Mya Sandar, Janet Serle, Tueng Shen, Rajesh Shetty, Pamela C. Sieving, Juan C. Silva, Rita S. Sitorus, Dwight Stambolian, Jaime Tejedor, James Tielsch, Miltiadis Tsilimbaris, Jan van Meurs, Rohit Varma, Gianni Virgili, Ya Xing Wang, Ning-Li Wang, Sheila West, Peter Wiedemann, Richard Wormald, Yingfeng Zheng
Background: Contemporary data on causes of vision impairment and blindness form an important basis for recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modeling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020. Methods: Published and unpublished population-based data on the causes of vision impairment and blindness from 1980 to 2015 were systematically analysed. A series of regression models were fit to estimate the proportion of moderate and severe vision impairment (MSVI; defined as presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60 in the better eye) by cause by age, region, and year. Findings: Among the projected global population with MSVI (216.6 million; 80% uncertainty intervals [UI] 98.5-359.1), in 2015 the leading causes thereof are uncorrected refractive error (116.3 million; UI 49.4-202.1), cataract (52.6 million; UI 18.2-109.6), age-related macular degeneration (AMD; 8.4 million; UI 0.9-29.5), glaucoma (4.0 million; UI 0.6-13.3) and diabetic retinopathy (2.6 million; UI 0.2-9.9). In 2015, the leading global causes of blindness were cataract (12.6 million; UI 3.4-28.7) followed by uncorrected refractive error (7.4 million; UI 2.4-14.8) and glaucoma (2.9 million; UI 0.4-9.9), while by 2020, these numbers affected are anticipated to rise to 13.4 million, 8.0 million and 3.2 million, respectively. Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of MSVI in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness, with a relatively low prevalence of cataract and a relatively high prevalence of AMD as causes for vision loss in the High-income subregions. Blindness due to cataract and diabetic retinopathy was more common among women, while blindness due to glaucoma and corneal opacity was more common among men, with no gender difference related to AMD. Conclusions: The numbers of people affected by the common causes of vision loss have increased substantially as the population increases and ages. Preventable vision loss due to cataract and refractive error (reversible with surgery and spectacle correction respectively), continue to cause the majority of blindness and MSVI in adults aged 50+ years. A massive scale up of eye care provision to cope with the increasing numbers is needed if one is to address avoidable vision loss.



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The Lancet Global Health





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  • Accepted version


  • eng

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ARCHIVED Faculty of Medical Science (until September 2018)

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