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Prevalence and causes of vision loss in North Africa and Middle East in 2015: magnitude, temporal trends and projections
  1. Rim Kahloun1,
  2. Moncef Khairallah2,
  3. Serge Resnikoff3,4,
  4. Maria Vittoria Cicinelli5,
  5. Seth R Flaxman6,
  6. Aditi Das7,
  7. Jost B Jonas8,
  8. Jill E Keeffe9,
  9. John H Kempen10,11,
  10. Janet Leasher12,
  11. Hans Limburg13,
  12. Kovin Naidoo3,14,
  13. Konrad Pesudovs15,
  14. Alexander J Silvester16,
  15. Nina Tahhan3,4,
  16. Hugh R Taylor17,
  17. Tien Yin Wong18,
  18. Rupert R A Bourne19
  19. on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study
  1. 1 Les Ophtalmologistes Associés de Monastir, Monastir, Tunisia
  2. 2 Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
  3. 3 Brien Holden Vision Institute, Sydney, New South Wales, Australia
  4. 4 School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
  5. 5 San Raffaele Scientific Institute, Milan, Italy
  6. 6 Department of Mathematics and Data Science Institute, Imperial College London, London, UK
  7. 7 Health Education Yorkshire and the Humber, London, UK
  8. 8 Department of Ophthalmology, Universitätsmedizin, Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
  9. 9 L V Prasad Eye Institute, Hyderabad, India
  10. 10 Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  11. 11 MyungSung Christian Medical Center and Medical School, Discovery Eye Center, Addis Ababa, Ethiopia
  12. 12 Nova Southeastern University, Fort Lauderdale, Florida, USA
  13. 13 Health Information Services, Grootebroek, The Netherlands
  14. 14 African Vision Research Institute, University of Kwazulu-Natal, Durban, South Africa
  15. 15 5 Rose St, Glenelg, South Australia, Australia
  16. 16 St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  17. 17 Melbourne School of Population Health, University of Melbourne, Parkville, Melbourne, Australia
  18. 18 Singapore Eye Research Institute, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
  19. 19 Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge, UK
  1. Correspondence to Professor Moncef Khairallah, Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia; moncef.khairallah{at}


Background To assess the prevalence and causes of vision impairment in North Africa and the Middle East (NAME) from 1990 to 2015 and to forecast projections for 2020.

Methods Based on a systematic review of medical literature, the prevalence of blindness (presenting visual acuity (PVA) <3/60 in the better eye), moderate and severe vision impairment (MSVI; PVA <6/18 but ≥3/60) and mild vision impairment (PVA <6/12 but ≥6/18) was estimated for 2015 and 2020.

Results The age-standardised prevalence of blindness and MSVI for all ages and genders decreased from 1990 to 2015, from 1.72 (0.53–3.13) to 0.95% (0.32%–1.71%), and from 6.66 (3.09–10.69) to 4.62% (2.21%–7.33%), respectively, with slightly higher figures for women than men. Cataract was the most common cause of blindness in 1990 and 2015, followed by uncorrected refractive error. Uncorrected refractive error was the leading cause of MSVI in the NAME region in 1990 and 2015, followed by cataract. A reduction in the proportions of blindness and MSVI due to cataract, corneal opacity and trachoma is predicted by 2020. Conversely, an increase in the proportion of blindness attributable to uncorrected refractive error, glaucoma, age-related macular degeneration and diabetic retinopathy is expected.

Conclusions In 2015 cataract and uncorrected refractive error were the major causes of vision loss in the NAME region. Proportions of vision impairment from cataract, corneal opacity and trachoma are expected to decrease by 2020, and those from uncorrected refractive error, glaucoma, diabetic retinopathy and age-related macular degeneration are predicted to increase by 2020.

  • North Africa and the Middle East
  • blindness
  • vision impairment
  • cataract
  • uncorrected refractive error
  • epidemiology

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  • RK and MK contributed equally.

  • Collaborators A list of the members of the Vision Loss Expert Group of the Global Burden of Disease Study can be found by accessing this site:

  • Contributors RRAB, SR, MVC, AD, AJS and NT prepared the vision impairment survey data. RK, MK, SR and RRAB analysed the data. RK and MK wrote the first draft of the report. All authors contributed to the study design, analysis and writing of the report. RRAB oversaw the research.

  • Funding This study was funded by the Brien Holden Vision Institute. The results in this paper are prepared independent of the final estimates of the Global Burden of Diseases, Injuries, and Risk Factors Study.

  • Competing interests JBJ: consultant for Mundipharma (Cambridge, UK); patent holder with Biocompatibles UK (Farnham, Surrey, UK) (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and/or antiangiogenic factor; patent number: 20120263794) and patent application with the University of Heidelberg (Heidelberg, Germany) (Title: Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; Europäische Patentanmeldung 15 000 771.4). JHK: consultant for Gilead and Santen. SR: consultant for Brien Holden Vision Institute.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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