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

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 ArditiYaniv Barkana, Banu Bozkurt, Alain 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 Elizabeth 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 Battaglia Parodi, Fernando Yaacov Pena, Tunde Peto, Harry Quigley, Murugesan Raju, Pradeep Ramulu, Dana Reza, Alan Robin, Luca Rossetti, Jinan Saaddine, Mya Sandar, Janet Serle, Tueng Shen, Rajesh Shetty, Pamela Sieving, Juan Carlos 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

Research output: Contribution to journalArticle

Abstract

Background Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020. Methods In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014. We identified population-based studies published before July 8, 2014, by searching online databases with no language restrictions (MEDLINE from Jan 1, 1946, and Embase from Jan 1, 1974, and the WHO Library Database). We fitted a series of regression models to estimate the proportion of moderate or severe vision impairment (defined as presenting visual acuity of <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity of <3/60 in the better eye) by cause, age, region, and year. Findings We identified 288 studies of 3 983 541 participants contributing data from 98 countries. Among the global population with moderate or severe vision impairment in 2015 (216·6 million [80% uncertainty interval 98·5 million to 359·1 million]), the leading causes were uncorrected refractive error (116·3 million [49·4 million to 202·1 million]), cataract (52·6 million [18·2 million to 109·6 million]), age-related macular degeneration (8·4 million [0·9 million to 29·5 million]), glaucoma (4·0 million [0·6 million to 13·3 million]), and diabetic retinopathy (2·6 million [0·2 million to 9·9 million]). Among the global population who were blind in 2015 (36·0 million [12·9 million to 65·4 million]), the leading causes were cataract (12·6 million [3·4 million to 28·7 million]), uncorrected refractive error (7·4 million [2·4 million to 14·8 million]), and glaucoma (2·9 million [0·4 million to 9·9 million]). By 2020, among the global population with moderate or severe vision impairment (237·1 million [101·5 million to 399·0 million]), the number of people affected by uncorrected refractive error is anticipated to rise to 127·7 million (51·0 million to 225·3 million), by cataract to 57·1 million (17·9 million to 124·1 million), by age-related macular degeneration to 8·8 million (0·8 million to 32·1 million), by glaucoma to 4·5 million (0·5 million to 15·4 million), and by diabetic retinopathy to 3·2 million (0·2 million to 12·9 million). By 2020, among the global population who are blind (38·5 million [13·2 million to 70·9 million]), the number of patients blind because of cataract is anticipated to rise to 13·4 million (3·3 million to 31·6 million), because of uncorrected refractive error to 8·0 million (2·5 million to 16·3 million), and because of glaucoma to 3·2 million (0·4 million to 11·0 million). Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of vision impairment in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness and vision impairment in this age group, with a low prevalence of cataract (<22% for blindness and 14·1–15·9% for vision impairment) and a high prevalence of age-related macular degeneration (>14% of blindness) as causes in the high-income subregions. Blindness and vision impairment at all ages in 2015 due to diabetic retinopathy (odds ratio 2·52 [1·48–3·73]) and cataract (1·21 [1·17–1·25]) were more common among women than among men, whereas blindness and vision impairment due to glaucoma (0·71 [0·57–0·86]) and corneal opacity (0·54 [0·43–0·66]) were more common among men than among women, with no sex difference related to age-related macular degeneration (0·91 [0·70–1·14]). Interpretation The number of people affected by the common causes of vision loss has increased substantially as the population increases and ages. Preventable vision loss due to cataract (reversible with surgery) and refractive error (reversible with spectacle correction) continue to cause most cases of blindness and moderate or severe vision impairment in adults aged 50 years and older. A large scale-up of eye care provision to cope with the increasing numbers is needed to address avoidable vision loss. Funding Brien Holden Vision Institute.

Original languageEnglish (US)
Pages (from-to)e1221-e1234
JournalThe Lancet Global Health
Volume5
Issue number12
DOIs
StatePublished - Dec 1 2017

ASJC Scopus subject areas

  • Medicine(all)

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    Flaxman, S. R., Bourne, R. R. A., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., Das, A., Jonas, J. B., Keeffe, J., Kempen, J. H., Leasher, J., Limburg, H., Naidoo, K., Pesudovs, K., Silvester, A., Stevens, G. A., Tahhan, N., Wong, T. Y., Taylor, H. R., ... Zheng, Y. (2017). Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health, 5(12), e1221-e1234. https://doi.org/10.1016/S2214-109X(17)30393-5