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Prevalence and causes of vision loss in East Asia in 2015: magnitude, temporal trends and projections
  1. Ching-Yu Cheng1,2,
  2. Ningli Wang3,4,
  3. Tien Y Wong1,2,
  4. Nathan Congdon5,6,
  5. Mingguang He7,
  6. Ya Xing Wang8,
  7. Tasanee Braithwaite9,10,
  8. Robert J Casson11,
  9. Maria Vittoria Cicinelli12,
  10. Aditi Das13,
  11. Seth R Flaxman14,
  12. Jost B Jonas15,
  13. Jill Elizabeth Keeffe16,
  14. John H Kempen17,
  15. Janet Leasher18,
  16. Hans Limburg19,
  17. Kovin Naidoo20,
  18. Konrad Pesudovs21,
  19. Serge Resnikoff22,
  20. Alexander J Silvester23,
  21. Nina Tahhan22,
  22. Hugh R Taylor24,
  23. Rupert R A Bourne9
  24. on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study
    1. 1 Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
    2. 2 Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
    3. 3 Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing, China
    4. 4 Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
    5. 5 Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangdong, China
    6. 6 Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
    7. 7 Ophthalmology Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
    8. 8 Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
    9. 9 School of Medicine, Vision and Eye Research Unit (VERU), Anglia Ruskin University, Chelmsford, UK
    10. 10 Moorfields Eye Hospital NHS Foundation Trust, London, UK
    11. 11 Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
    12. 12 Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
    13. 13 Ophthalmic Public Health, Leeds Teaching Hospital NHS Trust, London, UK
    14. 14 Department of Mathematics and Data Science Institute, Imperial College, London, UK
    15. 15 Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Mannheim, Germany
    16. 16 L V Prasad Eye Institute, Hyderabad, India
    17. 17 Ophthalmology and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    18. 18 HPD/College of Optometry, Nova Southeastern University, Davie, Florida, USA
    19. 19 Health Information Services, Grootebroek, The Netherlands
    20. 20 African Vision Research Institute, Durban, South Africa
    21. 21 Pesudovs, GLENELG, South Australia, Australia
    22. 22 Brien Holden Vision Institute, Sydney, New South Wales, Australia
    23. 23 Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
    24. 24 Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria, Australia
    1. Correspondence to Professor Rupert R A Bourne, School of Medicine, Vision and Eye Research Unit (VERU), Cambridge CB1 1PT, UK; rb{at}


    Background To determine the prevalence and causes of blindness and vision impairment (VI) in East Asia in 2015 and to forecast the trend to 2020.

    Methods Through a systematic literature review and meta-analysis, we estimated prevalence of blindness (presenting visual acuity <3/60 in the better eye), moderate-to-severe vision impairment (MSVI; 3/60≤presenting visual acuity <6/18), mild vision impairment (mild VI: 6/18≤presenting visual acuity <6/12) and uncorrected presbyopia for 1990, 2010, 2015 and 2020. A total of 44 population-based studies were included.

    Results In 2015, age-standardised prevalence of blindness, MSVI, mild VI and uncorrected presbyopia was 0.37% (80% uncertainty interval (UI) 0.12%–0.68%), 3.06% (80% UI 1.35%–5.16%) and 2.65% (80% UI 0.92%–4.91%), 32.91% (80% UI 18.72%–48.47%), respectively, in East Asia. Cataract was the leading cause of blindness (43.6%), followed by uncorrected refractive error (12.9%), glaucoma, age-related macular degeneration, corneal diseases, trachoma and diabetic retinopathy (DR). The leading cause for MSVI was uncorrected refractive error, followed by cataract, age-related macular degeneration, glaucoma, corneal disease, trachoma and DR. The burden of VI due to uncorrected refractive error, cataracts, glaucoma and DR has continued to rise over the decades reported.

    Conclusions Addressing the public healthcare barriers for cataract and uncorrected refractive error can help eliminate almost 57% of all blindness cases in this region. Therefore, public healthcare efforts should be focused on effective screening and effective patient education, with access to high-quality healthcare.

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

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    • C-YC, NW and TYW are joint first authors.

    • C-YC, NW and TYW contributed equally.

    • Collaborators Rupert Bourne (Anglia Ruskin University, Cambridge, UK); Peter Ackland (International Agency for Prevention of Blindness, London, UK); Aries Arditi (Visibility Metrics LLC, New York, USA); Yaniv Barkana (Assaf Harofe Medical Center, Zerifin, Israel); Banu Bozkurt (Department of Ophthalmology, Meram Medical Faculty, Selcuk University, Konya, Turkey); Tasanee Braithwaite (Moorfields Eye Hospital, London); Alain Bron (Service d'Ophtalmologie CHU Dijon, France); Donald Budenz (University of Miami, Miami, USA); Feng Cai (Green-Valley Group, Freedom, California, USA); Robert Casson (University of Adelaide, Adelaide, Australia); Usha Chakravarthy (The Queen's University of Belfast, Belfast, Northern Ireland); Jaewan Choi (Hangil Eye Hospital, Incheon, South Korea); Maria Vittoria Cicinelli (San Raffaele Scientific Institute, Milan, Italy); Nathan Congdon (The Queen's University of Belfast, Belfast, Northern Ireland); Reza Dana (Massachussets Eye & Ear Infirmary, Harvard Medical School, Boston, USA); Rakhi Dandona (George Institute for International Health, Sydney, Australia); Lalit Dandona (Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA); Aditi Das (St James’s University Hospital, Leeds, UK); Iva Dekaris (Eye Clinic Svjetlost, Zagreb, Croatia); Monte Del Monte (University of Michigan, Ann Arbor, USA); Jenny Deva (Universiti Tunku Abdul Rahman, Dept of Surgery (Ophthalmology)); Mohamed Dirani (Singapore Eye Research Institute, Singapore); Laura Dreer (University of Alabama, Birmingham, USA); Leon Ellwein (National Eye Institute, Bethesda, USA); Marcela Frazier (University of Alabama at Birmingham); Kevin Frick (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA); David Friedman (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA); Joao Furtado (University of São Paulo, São Paulo, Brazil); Hua Gao (Henry Ford Medical Center, Dept of Ophthalmology); Andrew Gazzard (Institute of Ophthalmology, London); Ronnie George (Medical Research Foundation, Chennai, India); Stephen Gichuhi (University of Nairobi, Nairobi, Kenya); Victor Gonzalez (Valley Retina Institute, Texas, USA); Billy Hammond (University of Georgia, Athens, USA); Mary Elizabeth Hartnett (University of Utah, Salt Lake City, USA); Minguang He (University of Melbourne, Melbourne, USA); James Hejtmancik (National Eye Institute, Bethesda, USA); Flavio Hirai (Federal University of Sao Paulo, Brazil); John Huang (Yale University School of Medicine, Connecticut, USA); April Ingram (Alberta Children's Hospital, Calgary, Canada); Jonathan Javitt (Johns Hopkins University School of Medicine, Baltimore, USA); Jost Jonas (Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany); Charlotte Joslin (University of Illinois, Chicago, USA); Jill Keeffe (L V Prasad Eye Institute, Hyderabad, India); John Kempen (University of Pennsylvania Perelman School of Medicine, Philadelphia, USA); Moncef Khairallah (University Hospital Monastir,Tunisia); Rohit Khanna (L V Prasad Eye Institute, Hyderabad, India); Judy Kim (Medical College of Wisconsin, Milwaukee, USA); George Lambrou (Novartis, Basel, Switzerland); Van Charles Lansingh (HelpMeSee, Inc. New York, USA); Paolo Lanzetta (Department of Ophthalmology, University of Udine. Udine, Italy); Janet Leasher (Nova Southeastern University, Florida, USA); Jennifer Lim (University of Illinois, Urbana, USA); Hans Limburg (Health Information Services, Grootebroek, Netherlands); Kaweh Mansouri (Clinique De Montchoisi, Lausanne, Switzerland); Anu Mathew (Royal Children's Hospital, Melbourne, Australia); Alan Morse (Jewish Guild Healthcare, New York, USA); Beatriz Munoz (Wilmer Eye Institute John Hopkins University, Baltimore, USA); David Musch (University of Michigan, Ann Arbor, USA); Kovin Naidoo (University of KwaZulu-Natal, Durban, South Africa); Vinay Nangia (Suraj Eye Institute, Nagpur, India); Maria Palaiou (Massachusetts Eye and Ear Institute, Boston, USA); Maurizio Battaglia Parodi (University Vita Salute, Ospedale San Raffaele, Milan, Italy); Fernando Yaacov Pena (Fundacion Vision, Asuncion, Paraguay); Konrad Pesudovs (Adelaide, Australia); Tunde Peto (The Queen's University of Belfast, Belfast, Northern Ireland); Harry Quigley (Wilmer Eye Institute John Hopkins University, Baltimore, USA); Murugesan Raju (University of Missouri, Columbia, USA); Pradeep Ramulu (Wilmer Eye Institute John Hopkins University, Baltimore, USA); Serge Resnikoff (Brien Holden Vision Institute, Sydney, Australia); Dana Reza (Schepens Eye Research Inst./Mass Eye and Ear, Harvard Medical School, Boston, USA); Alan Robin (Johns Hopkins University, Baltimore, USA); Luca Rossetti (University of Milan, Milan, Italy); Jinan Saaddine (National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA); Mya Sandar (Singapore Eye Research Institute, Singapore); Janet Serle (Mt Sinai School of Medicine, New York, USA); Tueng Shen (University of Washington, Seattle, USA); Rajesh Shetty (Mayo Clinic, Minnesota, USA); Pamela Sieving (National Institutes of Health, Bethesda, USA); Juan Carlos Silva (Pan-American Health Organization, Columbia); Alex Silvester (St Paul's Eye Unit, Royal Liverpool University Hospital.Liverpool, UK); Rita S Sitorus (Department of Ophthalmology, Faculty of Medicine University of Indonesia, Depok, Indonesia); Dwight Stambolian (University of Pennsylvania, Philadelphia, USA); Gretchen Stevens (World Health Organization, Geneva, Switzerland); Hugh Taylor (Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia); Jaime Tejedor (Hospital Raman y Cajal, Madrid, Spain); James Tielsch (Johns Hopkins Bloomberg School of Public Health, Baltimore, USA); Fotis Topouzis (University of Thessaloniki, Greece); Miltiadis Tsilimbaris (University of Crete Medical School. Crete); Jan van Meurs (The Rotterdam Eye Hospital and Erasmus University, Rotterdam, Netherlands); Rohit Varma (Department of Ophthalmology for Keck School of Medicine, University of Southern California, USA); Gianni Virgili (Department of Ophthalmology, University of Florence, Italy); Jimmy Volmink (Faculty of Health Sciences, Stellenbosch University, South Africa); Ya Xing Wang (Capital Medical University, Beijing, China); Ning-Li Wang (Eye Centre of Beijing Tongren Hospital, Beijing, China); Sheila West (Johns Hopkins Hospital, Baltimore, USA); Peter Wiedemann (Leipzig University, Leipzig, Germany); Tien Wong (University of Melbourne, Melbourne, Australia); Richard Wormald (Moorfields Eye Hospital, London); Yingfeng Zheng (Singapore Eye Research Institute, Singapore).

    • Contributors RRAB, MVC, AD, AJS, NT and TB prepared the vision impairment survey data. SRF and RRAB analysed the data. C-YC and TYW wrote the first draft 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. NC is supported by the Ulverscroft Foundation (UK), JK is supported by an institutional Research to Prevent Blindness Grant and Sight for Souls.

    • Competing interests JBJ: Consultant for Mundipharma Co. (Cambridge, UK); Patent holder with Biocompatibles UK Ltd. (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). JHK: consultant for Gilead (DSMC Chair), Santen (protocol design). SR: consultant for Brien Holden Vision Institute.

    • Patient consent for publication Not required.

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

    • Data availability statement Data may be obtained from a third party and are not publicly available.