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Prevalence and causes of vision loss in sub-Saharan Africa in 2015: magnitude, temporal trends and projections
  1. Kovin Naidoo1,2,
  2. John H Kempen3,4,
  3. Stephen Gichuhi5,
  4. Tasanee Braithwaite6,7,
  5. Robert J Casson8,9,
  6. Maria Vittoria Cicinelli10,
  7. Aditi Das11,
  8. Seth R Flaxman12,
  9. Jost B Jonas13,
  10. Jill Elizabeth Keeffe14,
  11. Janet Leasher15,
  12. Hans Limburg16,
  13. Konrad Pesudovs6,17,
  14. Serge Resnikoff17,
  15. Alexander J Silvester18,
  16. Nina Tahhan2,17,
  17. Hugh R Taylor19,
  18. Tien Y Wong20,
  19. Rupert R A Bourne6
  20. on behalf of Vision Loss Expert Group of the Global Burden of Disease Study
    1. 1African Vision Research Institute, University of Kwazulu-Natal, Durban, KZN, South Africa
    2. 2School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
    3. 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
    4. 4MCM Eye Unit, MyungSung Christian Medical Center and Medical School, Addis Ababa, Ethiopia
    5. 5Ophthalmology, University of Nairobi, Nairobi, Kenya
    6. 6Vision and Eye Research Unit (VERI), Anglia Ruskin University, Chelmsford, UK
    7. 7Department of Neuro-Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
    8. 8Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
    9. 9South Australia Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
    10. 10Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, MI, Italy
    11. 11Department of Ophthalmology, Health Education Yorkshire and the Humber, Leeds, UK
    12. 12Department of Mathematics and Data Science Institute, Imperial College London, London, London, UK
    13. 13Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Department of Ophthalmology, Mannheim, Germany
    14. 14Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
    15. 15HPD/College of Optometry, Nova Southeastern University, Davie, Florida, USA
    16. 16Health Information Services, Grootebroek, Netherlands
    17. 17Brien Holden Vision Institute, Sydney, New South Wales, Australia
    18. 18Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
    19. 19Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria, Australia
    20. 20Glaucoma, Singapore National Eye Centre & Singapore Eye Research Institute, Singapore
    1. Correspondence to Professor Rupert R A Bourne, Postgraduate Medical Institute, Vision and Eye Research Unit (VERU), Cambridge, UK; rb{at}rupertbourne.co.uk

    Abstract

    Background This study aimed to assess the prevalence and causes of vision loss in sub-Saharan Africa (SSA) in 2015, compared with prior years, and to estimate expected values for 2020.

    Methods A systematic review and meta-analysis assessed the prevalence of blindness (presenting distance visual acuity <3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting distance visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting distance visual acuity <6/12 and ≥6/18), and also near vision impairment (<N6 or N8 in the presence of ≥6/12 best-corrected distance visual acuity) in SSA for 1990, 2010, 2015 and 2020.

    In SSA, age-standardised prevalence of blindness, MSVI and MVI in 2015 were 1.03% (80% uncertainty interval (UI) 0.39–1.81), 3.64% (80% UI 1.71–5.94) and 2.94% (80% UI 1.05–5.34), respectively, for male and 1.08% (80% UI 0.40–1.93), 3.84% (80% UI 1.72–6.37) and 3.06% (80% UI 1.07–5.61) for females, constituting a significant decrease since 2010 for both genders. There were an estimated 4.28 million blind individuals and 17.36 million individuals with MSVI; 101.08 million individuals were estimated to have near vision loss due to presbyopia. Cataract was the most common cause of blindness (40.1%), whereas undercorrected refractive error (URE) (48.5%) was the most common cause of MSVI. Sub-Saharan West Africa had the highest proportion of blindness compared with the other SSA subregions.

    Conclusions Cataract and URE, two of the major causes of blindness and vision impairment, are reversible with treatment and thus promising targets to alleviate vision impairment in SSA.

    • public health
    • epidemiology
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    Footnotes

    • Collaborators On behalf of Vision Loss Expert Group of the Global Burden of Disease Study: 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, UK); 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, MD (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 (Glaucoma Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, 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); Seth Flaxman (Department of Mathematics and Data Science Institute, Imperial College London).

    • Contributors RRAB, MVC, AD, AS, NT and TB prepared the vision impairment survey data. SRF and RRAB analysed the data. KN and JHK 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. JHK is supported by an institutional Research to Prevent Blindness Grant and Sight for Souls. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests KN: employed by Essilor International. JBJ: 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. JHK: consultant for Gilead (DSMC Chair), Santen, Clearside. 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 are available on request. Summary data are available from the IAPB Vision Atlas. More disaggregated data can be requested by contacting the coordinator of the Vision Loss Expert Group, Professor Rupert Bourne, at rb@rupertbourne.co.uk.

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