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  • Prevalence and causes of blindness and vision impairment: magnitude, temporal trends and projections in South and Central Asia

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Global issues
Prevalence and causes of blindness and vision impairment: magnitude, temporal trends and projections in South and Central Asia
  1. Vinay Nangia1,
  2. Jost B Jonas2,
  3. Ronnie George3,
  4. Vijaya Lingam3,
  5. Leon Ellwein4,
  6. Maria Vittoria Cicinelli5,
  7. Aditi Das6,
  8. Seth R Flaxman7,
  9. Jill E Keeffe8,
  10. John H Kempen9,10,
  11. Janet Leasher11,
  12. Hans Limburg12,
  13. Kovin Naidoo13,
  14. Konrad Pesudovs14,
  15. Serge Resnikoff15,
  16. Alexander J Silvester16,
  17. Nina Tahhan15,
  18. Hugh R Taylor17,
  19. Tien Y Wong18,
  20. Rupert R A Bourne19
  21. on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study
    1. 1 Suraj Eye Institute, Nagpur, Maharashtra, India
    2. 2 Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
    3. 3 Department of Glaucoma, Medical Research Foundation, Chennai, Tamil Nadu, India
    4. 4 National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
    5. 5 San Raffaele Scientific Institute, Milan, Italy
    6. 6 Health Education Yorkshire and the Humber, Humber, UK
    7. 7 Department of Mathematics, Data Science Institute, Imperial College, London, UK
    8. 8 Eye Institute, Hyderabad, Telangana, India
    9. 9 Director of Epidemiology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
    10. 10 Discovery Eye Center, MyungSung Christian Medical Center and Medical School, Addis Ababa, Ethiopia
    11. 11 Nova Southeastern University, Fort Lauderdale, Florida, USA
    12. 12 Health Information Services, Grootebroek, The Netherlands
    13. 13 African Vision Research Institute, University of Kwazulu-Natal, South Africa and Brien Holden Vision Institute, Sydney, Victoria, Australia
    14. 14 5 Rose St, Glenelg, Glenelg, South Australia, Australia
    15. 15 Brien Holden Vision Institute, Sydney, Australia & School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
    16. 16 Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
    17. 17 Melbourne School of Population Health, University of Melbourne, Melbourne, Parkville, Australia
    18. 18 Singapore Eye Research Institute, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Asia
    19. 19 Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge, UK
    1. Correspondence to Professor Rupert R A Bourne, Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge, UK; rb{at}rupertbourne.co.uk

    Abstract

    Background To assess prevalence and causes of vision loss in Central and South Asia.

    Methods A systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020.

    Results In Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individuals (28.3% of the global total) had MSVI. From 1990 to 2015, cataract (accounting for 36.58% of all cases with blindness in 2015) was the most common cause of blindness, followed by undercorrected refractive error (36.43%), glaucoma (5.81%), age-related macular degeneration (2.44%), corneal diseases (2.43%), diabetic retinopathy (0.16%) and trachoma (0.04%). For MSVI in South Asia 2015, most common causes were undercorrected refractive error (accounting for 66.39% of all cases with MSVI), followed by cataract (23.62%), age-related macular degeneration (1.31%) and glaucoma (1.09%).

    Conclusions One-third of the global blind resided in South Asia in 2015, although the age-standardised prevalence of blindness and MSVI decreased significantly between 1990 and 2015.

    • global burden of disease study
    • vision loss expert group
    • vision loss
    • blindness
    • vision impairment
    • refractive error
    • cataract
    • glaucoma
    • macular degeneration
    • epidemiology

    https://doi.org/10.1136/bjophthalmol-2018-312292

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      Footnotes

      • VN and JBJ contributed equally.

      • Collaborators Vision Loss Expert Group of the Global Burden of Disease Study.

      • Contributors RRAB, MVC, AD, AS and NT prepared the vision impairment survey data. SRF and RRAB analysed the data. VN and JBJ 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 independently of the final estimates of the Global Burden of Diseases, Injuries and Risk Factors study. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

      • Disclaimer While the work that is reported here was performed by the Vision Loss Expert Group as part of the Global Burden of Disease, Risk Factors and Injuries Study 2015, the results prepared here by the authors in this paper are prepared independently of the final estimates of the Global Burden of Disease 2015.

      • Competing interests JBJ is the patent holder with Biocompatibles UK (Farnham, Surrey, UK) (Title: Treatment of eye diseases using encapsulated cells encoding and secreting neuroprotective factor and / or anti-angiogenic factor; Patent number: 20120263794) and Patent application with 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. SR is the consultant for Brien Holden Vision Institute.

      • Patient consent Not required.

      • Ethics approval Ethics committee II of the Medical Faculty Mannheim of the University of Heidelberg, Germany.

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

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