Looking Within Rather Than Between Countries to Understand the Risk Factors for Vision Impairment

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Effective refractive error coverage in adults aged 50 years and older - estimates to monitor progress towards the World Health Organisation's 2030 target

Background In 2021, WHO Member States endorsed a global target of a 40-percentage-point increase in effective refractive error coverage (eREC; with a 6/12 visual acuity threshold) by 2030. This study models global and regional estimates of eREC as a baseline for the WHO initiative. Methods The Vision Loss Expert Group analysed data from 565 448 participants of 169 population-based eye surveys conducted since 2000 to calculate eREC (met need/[met need + undermet need + unmet need]). A binary logistic regression model was used to estimate eREC by Global Burden of Disease (GBD) Study super region among adults aged 50 years and older. Findings In 2021, distance eREC was 79·1% (95% CI 72·4–85·0) in the high-income super region; 62·1% (54·7–68·8) in north Africa and Middle East; 49·5% (45·0–54·0) in central Europe, eastern Europe, and central Asia; 40·0% (31·7–48·2) in southeast Asia, east Asia, and Oceania; 34·5% (29·4–40·0) in Latin America and the Caribbean; 9·0% (6·5–12·0) in south Asia; and 5·7% (3·1–9·0) in sub-Saharan Africa. eREC was higher in men and reduced with increasing age. Global distance eREC increased from 2000 to 2021 by 19·0%. Global near vision eREC for 2021 was 20·5% (95% CI 17·8–24·4). Interpretation Over the past 20 years, distance eREC has increased in each super region yet the WHO target will require substantial improvements in quantity and quality of refractive services in particular for near vision impairment

National Eye Institute’s (NEI) coordination efforts and current opportunities for sustainability, adaptation, and climate resilience in global eye health – ARVO 2023 session commentary

Climate change represents an urgent and severe threat to global health [1], directly and indirectly driving detrimental physical and mental health. Climate change impacts all countries, but disproportionately affects low- and middle- income countries, exacerbating worldwide health inequalities...</p

Prevalence and causes of vision loss in Latin America and the Caribbean in 2015: magnitude, temporal trends and projections

OBJECTIVE: To estimate the prevalence and causes of blindness and vision impairment for distance and near in Latin America and the Caribbean (LAC) in 2015, and to forecast trends to 2020. METHODS: A meta-analysis from a global systematic review of cross-sectional, population-representative studies from published and unpublished sources from 1980 to 2014 included in the Global Vision Database. RESULTS: In 2015, across LAC, we estimate age-standardised prevalence to be 0.38% in all ages and 1.56% in those over age 50 for blindness, 2.06% in all ages and 7.86% in those over age 50 for moderate and severe vision impairment (MSVI), 1.89% in all ages and 6.93% in those over age 50 for mild vision impairment, and 39.59% in all ages and 45.27% in those over 50 for near vision impairment. We estimate that in 2015, 123.26 million persons were vision impaired; of those 2.34 million blind, 12.46 million with MSVI, 11.34 million mildly impaired and 97.12 million had near vision impairment. Cataract is the most common cause of blindness. Under- corrected refractive-error is the most common cause of vision impairment. CONCLUSIONS: Increasing granularity in prevalence estimates across all levels of vision loss suggest that one in five persons across LAC had some degree of vision loss in 2015. The absolute numbers of persons with vision impairment are increasing, while the age-standardised prevalence is decreasing. All countries should conduct epidemiologic studies to establish accurate national estimates and trends of vision impairment. Universal eye health services must be included in universal health coverage reforms to address fragmentation and segmentation of health care across the region

Global trends in blindness and vision impairment resulting from corneal opacity 1984–2020

Topic: We provide global estimates of the prevalence of corneal blindness and vision impairment in adults 40 years of age and older and examine the burden by age, sex, and geographic region from 1984 through 2020. Clinical Relevance: Corneal opacities (COs) are among the top 5 causes of blindness worldwide, yet the global prevalence, regional differences, and risk factors are unclear. Methods: Abstracted data from the published literature and surveys were obtained from the Global Burden of Disease Vision Loss Expert Group. We supplemented this by an independent systematic literature search of several databases. Studies that provided CO vision impairment data based on population-based surveys for those 40 years of age or older were included, for a total of 244. For each of the 4 outcomes of blindness and moderate to severe vision impairment (MSVI) caused by trachomatous and nontrachomatous CO (NTCO), time trends and differences in prevalence by region, age, and sex were evaluated using a Poisson log-linear model with a generalized estimating equation method. Age-standardized estimates of global prevalence of blindness and MSVI were calculated using the 2015 United Nations standard populations. Results: The global prevalence of blindness resulting from NTCO in those 40 years and older was 0.081% (95% confidence interval [CI], 0.049%–0.315%); that of MSVI was 0.130% (95% CI, 0.087%–0.372%). A significant increase with age was found (prevalence rate ratio, 2.15; 95% CI, 1.99–2.32). Latin America and Europe showed the lowest rates, with 2- to 8-fold higher rates of blindness or MSVI in other regions. The global prevalence of blindness resulting from trachomatous CO in those 50 years and older was 0.0094% (95% CI, 0%-0.0693%); that from MSVI was 0.012% (95% CI, 0%–0.0761%). Blindness resulting from trachomatous CO and MSVI increased with age and female sex, and rates were significantly higher in the African regions. A decrease in trachomatous blindness rates over time was found (prevalence rate ratio, 0.91; 95% CI, 0.86–0.96). Discussion: An estimated 5.5 million people worldwide are bilaterally blind or have MSVI resulting from CO, with an additional 6.2 million unilaterally blind. Blindness resulting from trachomatous CO is declining over time, likely because of the massive scaleup of the global trachoma elimination program and overall socioeconomic development. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p

Self‐reported visual difficulties in Europe and related factors: a European population‐based cross‐sectional survey

Purpose: There is a relative paucity of self‐reported vision problems data in European countries. Methods: In this context, we investigated self‐reported vision problems through European Health Interview Survey 2, a cross‐sectional European population survey based on a standardized questionnaire including 147 medical, demographic and socioeconomic variables applied to non‐institutionalized individuals aged 15 years or more in 28 European countries, in addition to Iceland and Norway. Results: The survey included 311 386 individuals (54.18% women), with overall crude prevalence of self‐reported vision problems of 2.07% [95% CI; 2.01–2.14]. Among them, 1.70 % [1.61–1.78] of men, 2.41% [2.31–2.51] of women and 4.71% [4.53–4.89] of individuals aged 60 or more reported to have a lot of vision problems or to be not able to see. The frequency of self‐reported vision problems was the highest in Eastern European countries with values of 2.43% [2.30–2.56]. In multivariate analyses, limiting long‐standing illness, depression, daily smoking, lack of physical activity, lower educational level and social isolation were associated with self‐reported vision problems with ORs of 2.66 [2.42–2.92], 2.16 [2.01–2.32], 1.11 [1.01–1.23], 1.31 [1.21–1.42], 1.29 [1.19–1.40] and 1.45 [1.26–1.67], respectively, while higher income was associated with less self‐reported vision problems with OR of 0.80 [0.73–0.86]. Conclusions: This study demonstrated inequalities in terms of prevalence of self‐reported vision problems in Europe, with higher prevalence in Eastern European countries and among women and older individuals

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.

<p>PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.</p

Number of people (mean, 95% uncertainty interval) blind (presenting visual acuity <3/60) or visually impaired (MSVI) (presenting visual acuity <6/18, ≥3/60) due to glaucoma and the age-standardized prevalences (mean, 95% uncertainty interval) in different world regions in 1990.

<p>Number of people (mean, 95% uncertainty interval) blind (presenting visual acuity <3/60) or visually impaired (MSVI) (presenting visual acuity <6/18, ≥3/60) due to glaucoma and the age-standardized prevalences (mean, 95% uncertainty interval) in different world regions in 1990.</p

Flow path for TRA.

Flow path for TRA.</p

TRA result for TF and TT in suspected trachoma endemic areas in 14 provinces.

TRA result for TF and TT in suspected trachoma endemic areas in 14 provinces.</p