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 Arditi & 79 others Yaniv 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 S 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 A Quigley, Murugesan Raju, Pradeep Ramulu, Dana Reza, Alan L. 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 K 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 Methods In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014.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

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Blindness
Meta-Analysis
Databases
Cataract
Population
Corneal Opacity
Refractive Errors
Information Storage and Retrieval
Macular Degeneration
Diabetic Retinopathy
Public Policy
Health Policy
MEDLINE
Sex Characteristics
Glaucoma
Visual Acuity
Libraries
Language
Public Health
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Flaxman, S. R., Bourne, R. R. A., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., ... 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

Global causes of blindness and distance vision impairment 1990–2020 : a systematic review and meta-analysis. / Flaxman, Seth R.; Bourne, Rupert R.A.; Resnikoff, Serge; Ackland, Peter; Braithwaite, Tasanee; Cicinelli, Maria V.; Das, Aditi; Jonas, Jost B.; Keeffe, Jill; Kempen, John H.; Leasher, Janet; Limburg, Hans; Naidoo, Kovin; Pesudovs, Konrad; Silvester, Alex; Stevens, Gretchen A.; Tahhan, Nina; Wong, Tien Y.; Taylor, Hugh R.; Arditi, Aries; Barkana, Yaniv; Bozkurt, Banu; Bron, Alain; Budenz, Donald; Cai, Feng; Casson, Robert; Chakravarthy, Usha; Choi, Jaewan; Congdon, Nathan; Dana, Reza; Dandona, Rakhi; Dandona, Lalit; Dekaris, Iva; Del Monte, Monte; Deva, Jenny; Dreer, Laura; Ellwein, Leon; Frazier, Marcela; Frick, Kevin; Friedman, David S; Furtado, Joao; Gao, Hua; Gazzard, Gus; George, Ronnie; Gichuhi, Stephen; Gonzalez, Victor; Hammond, Billy; Hartnett, Mary Elizabeth; He, Minguang; Hejtmancik, James; Hirai, Flavio; Huang, John; Ingram, April; Javitt, Jonathan; Joslin, Charlotte; Khairallah, Moncef; Khanna, Rohit; Kim, Judy; Lambrou, George; Lansingh, Van Charles; Lanzetta, Paolo; Lim, Jennifer; Mansouri, Kaweh; Mathew, Anu; Morse, Alan; Munoz, Beatriz; Musch, David; Nangia, Vinay; Palaiou, Maria; Parodi, Maurizio Battaglia; Pena, Fernando Yaacov; Peto, Tunde; Quigley, Harry A; Raju, Murugesan; Ramulu, Pradeep; Reza, Dana; Robin, Alan L.; Rossetti, Luca; Saaddine, Jinan; Sandar, Mya; Serle, Janet; Shen, Tueng; Shetty, Rajesh; Sieving, Pamela; Silva, Juan Carlos; Sitorus, Rita S.; Stambolian, Dwight; Tejedor, Jaime; Tielsch, James; Tsilimbaris, Miltiadis; van Meurs, Jan; Varma, Rohit; Virgili, Gianni; Wang, Ya Xing; Wang, Ning Li; West, Sheila K; Wiedemann, Peter; Wormald, Richard; Zheng, Yingfeng.

In: The Lancet Global Health, Vol. 5, No. 12, 01.12.2017, p. e1221-e1234.

Research output: Contribution to journalArticle

Flaxman, SR, Bourne, RRA, Resnikoff, S, Ackland, P, Braithwaite, T, Cicinelli, MV, Das, A, Jonas, JB, Keeffe, J, Kempen, JH, Leasher, J, Limburg, H, Naidoo, K, Pesudovs, K, Silvester, A, Stevens, GA, Tahhan, N, Wong, TY, Taylor, HR, Arditi, A, Barkana, Y, Bozkurt, B, Bron, A, Budenz, D, Cai, F, Casson, R, Chakravarthy, U, Choi, J, Congdon, N, Dana, R, Dandona, R, Dandona, L, Dekaris, I, Del Monte, M, Deva, J, Dreer, L, Ellwein, L, Frazier, M, Frick, K, Friedman, DS, Furtado, J, Gao, H, Gazzard, G, George, R, Gichuhi, S, Gonzalez, V, Hammond, B, Hartnett, ME, He, M, Hejtmancik, J, Hirai, F, Huang, J, Ingram, A, Javitt, J, Joslin, C, Khairallah, M, Khanna, R, Kim, J, Lambrou, G, Lansingh, VC, Lanzetta, P, Lim, J, Mansouri, K, Mathew, A, Morse, A, Munoz, B, Musch, D, Nangia, V, Palaiou, M, Parodi, MB, Pena, FY, Peto, T, Quigley, HA, Raju, M, Ramulu, P, Reza, D, Robin, AL, Rossetti, L, Saaddine, J, Sandar, M, Serle, J, Shen, T, Shetty, R, Sieving, P, Silva, JC, Sitorus, RS, Stambolian, D, Tejedor, J, Tielsch, J, Tsilimbaris, M, van Meurs, J, Varma, R, Virgili, G, Wang, YX, Wang, NL, West, SK, Wiedemann, P, Wormald, R & Zheng, Y 2017, 'Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis', The Lancet Global Health, vol. 5, no. 12, pp. e1221-e1234. https://doi.org/10.1016/S2214-109X(17)30393-5
Flaxman, Seth R. ; Bourne, Rupert R.A. ; Resnikoff, Serge ; Ackland, Peter ; Braithwaite, Tasanee ; Cicinelli, Maria V. ; Das, Aditi ; Jonas, Jost B. ; Keeffe, Jill ; Kempen, John H. ; Leasher, Janet ; Limburg, Hans ; Naidoo, Kovin ; Pesudovs, Konrad ; Silvester, Alex ; Stevens, Gretchen A. ; Tahhan, Nina ; Wong, Tien Y. ; Taylor, Hugh R. ; Arditi, Aries ; Barkana, Yaniv ; Bozkurt, Banu ; Bron, Alain ; Budenz, Donald ; Cai, Feng ; Casson, Robert ; Chakravarthy, Usha ; Choi, Jaewan ; Congdon, Nathan ; Dana, Reza ; Dandona, Rakhi ; Dandona, Lalit ; Dekaris, Iva ; Del Monte, Monte ; Deva, Jenny ; Dreer, Laura ; Ellwein, Leon ; Frazier, Marcela ; Frick, Kevin ; Friedman, David S ; Furtado, Joao ; Gao, Hua ; Gazzard, Gus ; George, Ronnie ; Gichuhi, Stephen ; Gonzalez, Victor ; Hammond, Billy ; Hartnett, Mary Elizabeth ; He, Minguang ; Hejtmancik, James ; Hirai, Flavio ; Huang, John ; Ingram, April ; Javitt, Jonathan ; Joslin, Charlotte ; Khairallah, Moncef ; Khanna, Rohit ; Kim, Judy ; Lambrou, George ; Lansingh, Van Charles ; Lanzetta, Paolo ; Lim, Jennifer ; Mansouri, Kaweh ; Mathew, Anu ; Morse, Alan ; Munoz, Beatriz ; Musch, David ; Nangia, Vinay ; Palaiou, Maria ; Parodi, Maurizio Battaglia ; Pena, Fernando Yaacov ; Peto, Tunde ; Quigley, Harry A ; Raju, Murugesan ; Ramulu, Pradeep ; Reza, Dana ; Robin, Alan L. ; Rossetti, Luca ; Saaddine, Jinan ; Sandar, Mya ; Serle, Janet ; Shen, Tueng ; Shetty, Rajesh ; Sieving, Pamela ; Silva, Juan Carlos ; Sitorus, Rita S. ; Stambolian, Dwight ; Tejedor, Jaime ; Tielsch, James ; Tsilimbaris, Miltiadis ; van Meurs, Jan ; Varma, Rohit ; Virgili, Gianni ; Wang, Ya Xing ; Wang, Ning Li ; West, Sheila K ; Wiedemann, Peter ; Wormald, Richard ; Zheng, Yingfeng. / Global causes of blindness and distance vision impairment 1990–2020 : a systematic review and meta-analysis. In: The Lancet Global Health. 2017 ; Vol. 5, No. 12. pp. e1221-e1234.
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title = "Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis",
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.",
author = "Flaxman, {Seth R.} and Bourne, {Rupert R.A.} and Serge Resnikoff and Peter Ackland and Tasanee Braithwaite and Cicinelli, {Maria V.} and Aditi Das and Jonas, {Jost B.} and Jill Keeffe and Kempen, {John H.} and Janet Leasher and Hans Limburg and Kovin Naidoo and Konrad Pesudovs and Alex Silvester and Stevens, {Gretchen A.} and Nina Tahhan and Wong, {Tien Y.} and Taylor, {Hugh R.} and Aries Arditi and Yaniv Barkana and Banu Bozkurt and Alain Bron and Donald Budenz and Feng Cai and Robert Casson and Usha Chakravarthy and Jaewan Choi and Nathan Congdon and Reza Dana and Rakhi Dandona and Lalit Dandona and Iva Dekaris and {Del Monte}, Monte and Jenny Deva and Laura Dreer and Leon Ellwein and Marcela Frazier and Kevin Frick and Friedman, {David S} and Joao Furtado and Hua Gao and Gus Gazzard and Ronnie George and Stephen Gichuhi and Victor Gonzalez and Billy Hammond and Hartnett, {Mary Elizabeth} and Minguang He and James Hejtmancik and Flavio Hirai and John Huang and April Ingram and Jonathan Javitt and Charlotte Joslin and Moncef Khairallah and Rohit Khanna and Judy Kim and George Lambrou and Lansingh, {Van Charles} and Paolo Lanzetta and Jennifer Lim and Kaweh Mansouri and Anu Mathew and Alan Morse and Beatriz Munoz and David Musch and Vinay Nangia and Maria Palaiou and Parodi, {Maurizio Battaglia} and Pena, {Fernando Yaacov} and Tunde Peto and Quigley, {Harry A} and Murugesan Raju and Pradeep Ramulu and Dana Reza and Robin, {Alan L.} and Luca Rossetti and Jinan Saaddine and Mya Sandar and Janet Serle and Tueng Shen and Rajesh Shetty and Pamela Sieving and Silva, {Juan Carlos} and Sitorus, {Rita S.} and Dwight Stambolian and Jaime Tejedor and James Tielsch and Miltiadis Tsilimbaris and {van Meurs}, Jan and Rohit Varma and Gianni Virgili and Wang, {Ya Xing} and Wang, {Ning Li} and West, {Sheila K} and Peter Wiedemann and Richard Wormald and Yingfeng Zheng",
year = "2017",
month = "12",
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language = "English (US)",
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journal = "The Lancet Global Health",
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}

TY - JOUR

T1 - Global causes of blindness and distance vision impairment 1990–2020

T2 - a systematic review and meta-analysis

AU - Flaxman, Seth R.

AU - Bourne, Rupert R.A.

AU - Resnikoff, Serge

AU - Ackland, Peter

AU - Braithwaite, Tasanee

AU - Cicinelli, Maria V.

AU - Das, Aditi

AU - Jonas, Jost B.

AU - Keeffe, Jill

AU - Kempen, John H.

AU - Leasher, Janet

AU - Limburg, Hans

AU - Naidoo, Kovin

AU - Pesudovs, Konrad

AU - Silvester, Alex

AU - Stevens, Gretchen A.

AU - Tahhan, Nina

AU - Wong, Tien Y.

AU - Taylor, Hugh R.

AU - Arditi, Aries

AU - Barkana, Yaniv

AU - Bozkurt, Banu

AU - Bron, Alain

AU - Budenz, Donald

AU - Cai, Feng

AU - Casson, Robert

AU - Chakravarthy, Usha

AU - Choi, Jaewan

AU - Congdon, Nathan

AU - Dana, Reza

AU - Dandona, Rakhi

AU - Dandona, Lalit

AU - Dekaris, Iva

AU - Del Monte, Monte

AU - Deva, Jenny

AU - Dreer, Laura

AU - Ellwein, Leon

AU - Frazier, Marcela

AU - Frick, Kevin

AU - Friedman, David S

AU - Furtado, Joao

AU - Gao, Hua

AU - Gazzard, Gus

AU - George, Ronnie

AU - Gichuhi, Stephen

AU - Gonzalez, Victor

AU - Hammond, Billy

AU - Hartnett, Mary Elizabeth

AU - He, Minguang

AU - Hejtmancik, James

AU - Hirai, Flavio

AU - Huang, John

AU - Ingram, April

AU - Javitt, Jonathan

AU - Joslin, Charlotte

AU - Khairallah, Moncef

AU - Khanna, Rohit

AU - Kim, Judy

AU - Lambrou, George

AU - Lansingh, Van Charles

AU - Lanzetta, Paolo

AU - Lim, Jennifer

AU - Mansouri, Kaweh

AU - Mathew, Anu

AU - Morse, Alan

AU - Munoz, Beatriz

AU - Musch, David

AU - Nangia, Vinay

AU - Palaiou, Maria

AU - Parodi, Maurizio Battaglia

AU - Pena, Fernando Yaacov

AU - Peto, Tunde

AU - Quigley, Harry A

AU - Raju, Murugesan

AU - Ramulu, Pradeep

AU - Reza, Dana

AU - Robin, Alan L.

AU - Rossetti, Luca

AU - Saaddine, Jinan

AU - Sandar, Mya

AU - Serle, Janet

AU - Shen, Tueng

AU - Shetty, Rajesh

AU - Sieving, Pamela

AU - Silva, Juan Carlos

AU - Sitorus, Rita S.

AU - Stambolian, Dwight

AU - Tejedor, Jaime

AU - Tielsch, James

AU - Tsilimbaris, Miltiadis

AU - van Meurs, Jan

AU - Varma, Rohit

AU - Virgili, Gianni

AU - Wang, Ya Xing

AU - Wang, Ning Li

AU - West, Sheila K

AU - Wiedemann, Peter

AU - Wormald, Richard

AU - Zheng, Yingfeng

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

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U2 - 10.1016/S2214-109X(17)30393-5

DO - 10.1016/S2214-109X(17)30393-5

M3 - Article

VL - 5

SP - e1221-e1234

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 12

ER -