Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe in 2015: magnitude, temporal trends and projections

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Abstract

Background

Within a surveillance of the prevalence and causes of vision impairment in high-income regions and Central/Eastern Europe, we update figures through 2015 and forecast expected values in 2020.

Methods

Based on a systematic review of medical literature, prevalence of blindness, moderate and severe vision impairment (MSVI), mild vision impairment and presbyopia was estimated for 1990, 2010, 2015, and 2020.

Results

Age-standardised prevalence of blindness and MSVI for all ages decreased from 1990 to 2015 from 0.26% (0.10–0.46) to 0.15% (0.06–0.26) and from 1.74% (0.76–2.94) to 1.27% (0.55–2.17), respectively. In 2015, the number of individuals affected by blindness, MSVI and mild vision impairment ranged from 70 000, 630 000 and 610 000, respectively, in Australasia to 980 000, 7.46 million and 7.25 million, respectively, in North America and 1.16 million, 9.61 million and 9.47 million, respectively, in Western Europe. In 2015, cataract was the most common cause for blindness, followed by age-related macular degeneration (AMD), glaucoma, uncorrected refractive error, diabetic retinopathy and cornea-related disorders, with declining burden from cataract and AMD over time. Uncorrected refractive error was the leading cause of MSVI.

Conclusions

While continuing to advance control of cataract and AMD as the leading causes of blindness remains a high priority, overcoming barriers to uptake of refractive error services would address approximately half of the MSVI burden. New data on burden of presbyopia identify this entity as an important public health problem in this population. Additional research on better treatments, better implementation with existing tools and ongoing surveillance of the problem is needed.

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Most cited references 11

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Ranibizumab and bevacizumab for neovascular age-related macular degeneration.

Daniel Martin, Maureen Maguire, Gui-shuang Ying … (2011)

Clinical trials have established the efficacy of ranibizumab for the treatment of neovascular age-related macular degeneration (AMD). In addition, bevacizumab is used off-label to treat AMD, despite the absence of similar supporting data. In a multicenter, single-blind, noninferiority trial, we randomly assigned 1208 patients with neovascular AMD to receive intravitreal injections of ranibizumab or bevacizumab on either a monthly schedule or as needed with monthly evaluation. The primary outcome was the mean change in visual acuity at 1 year, with a noninferiority limit of 5 letters on the eye chart. Bevacizumab administered monthly was equivalent to ranibizumab administered monthly, with 8.0 and 8.5 letters gained, respectively. Bevacizumab administered as needed was equivalent to ranibizumab as needed, with 5.9 and 6.8 letters gained, respectively. Ranibizumab as needed was equivalent to monthly ranibizumab, although the comparison between bevacizumab as needed and monthly bevacizumab was inconclusive. The mean decrease in central retinal thickness was greater in the ranibizumab-monthly group (196 μm) than in the other groups (152 to 168 μm, P=0.03 by analysis of variance). Rates of death, myocardial infarction, and stroke were similar for patients receiving either bevacizumab or ranibizumab (P>0.20). The proportion of patients with serious systemic adverse events (primarily hospitalizations) was higher with bevacizumab than with ranibizumab (24.1% vs. 19.0%; risk ratio, 1.29; 95% confidence interval, 1.01 to 1.66), with excess events broadly distributed in disease categories not identified in previous studies as areas of concern. At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab given as needed with monthly evaluation had effects on vision that were equivalent to those of ranibizumab administered monthly. Differences in rates of serious adverse events require further study. (Funded by the National Eye Institute; ClinicalTrials.gov number, NCT00593450.).

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Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990-2010.

Richard White, Kovin Naidoo, … (2014)

To assess prevalence and causes of blindness and vision impairment in high-income regions and in Central/Eastern Europe in 1990 and 2010. Based on a systematic review of medical literature, prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity <3/60) was estimated for 1990 and 2010. Age-standardised prevalence of blindness and MSVI decreased from 0.2% to 0.1% (3.314 million to 2.736 million people) and from 1.6% to 1.0% (25.362 million to 22.176 million), respectively. Women were generally more affected than men. Cataract was the most frequent cause of blindness in all subregions in 1990, but macular degeneration and uncorrected refractive error became the most frequent causes of blindness in 2010 in all high-income countries, except for Eastern/Central Europe, where cataract remained the leading cause. Glaucoma and diabetic retinopathy were fourth and fifth most common causes for blindness for all regions at both times. Uncorrected refractive error, followed by cataract, macular degeneration, glaucoma and diabetic retinopathy, was the most common cause for MSVI in 1990 and 2010. In highly developed countries, prevalence of blindness and MSVI has been reduced by 50% and 38%, respectively, and the number of blind people and people with MSVI decreased by 17.4% and 12.6%, respectively, even with the increasing number of older people in the population. In high-income countries, macular degeneration has become the most important cause of blindness, but uncorrected refractive errors continue to be the leading cause of MSVI.

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Changing views on open-angle glaucoma: definitions and prevalences--The Rotterdam Study.

Andrea C. Klaver, P Borger, Andréa Souza … (2000)

To create a quantitative basis for diagnostic criteria for open-angle glaucoma (OAG), to propose an epidemiologic definition for OAG based on these, and to determine the prevalence of OAG in a general white population. Of the 7983 subjects 55 years of age or older participating in the population-based Rotterdam Study, 6756 subjects participated in the ophthalmic part of this study (6281 subjects living independently and 475 in nursing homes). The criteria for the diagnosis of OAG were based on ophthalmoscopic and semiautomated Imagenet estimations of the optic disc such as vertical cup-to-disc ratio (VCDR), minimal width of neural rim, or asymmetry in VCDR between both eyes, and visual field testing with kinetic Goldmann perimetry. All criteria for the diagnosis of OAG were assessed in a masked way independently of each other. Mean VCDR on ophthalmoscopy was 0.3 and with Imagenet 0.49, and the 97.5th percentile for both was 0.7. The prevalence of glaucomatous visual field defects was 1.5%. Overall prevalence of definite OAG in the independently living subjects was 0.8% (95% confidence interval [CI] 0.6, 1.0; 50 cases). Prevalence of OAG in men was double that in women (odds ratio 2.1; 95% CI 1.2, 3.6). Different commonly used criteria for diagnosis of OAG resulted in prevalence figures ranging from 0.1% to 1.2%. The overall prevalence of OAG in the present study was comparable to most population-based studies. However, prevalence figures differed by a factor of 12 when their criteria for OAG were applied to this population. A definition for definite OAG is proposed: a glaucomatous optic neuropathy in eyes with open angles in the absence of history or signs of secondary glaucoma characterized by glaucomatous changes based on the 97.5 percentile for this population together with glaucomatous visual field loss. In the absence of the latter or of a visual field test, it is proposed to speak of probable OAG based on the 99.5th or possible OAG based on the 97.5th percentiles of glaucomatous disc changes for a population under study.

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Author and article information

Journal

Journal ID (nlm-ta): Br J Ophthalmol

Journal ID (iso-abbrev): Br J Ophthalmol

Journal ID (hwp): bjophthalmol

Journal ID (publisher-id): bjo

Title: The British Journal of Ophthalmology

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0007-1161

ISSN (Electronic): 1468-2079

Publication date (Print): May 2018

Publication date (Electronic): 15 March 2018

Volume: 102

Issue: 5

Pages: 575-585

Affiliations

[1 ] departmentVision & Eye Research Unit , Anglia Ruskin University , Cambridge, UK

[2 ] departmentDepartment of Ophthalmology , Universitätsmedizin , Mannheim, Germany

[3 ] departmentMedical Faculty Mannheim , Heidelberg University , Mannheim, Germany

[4 ] departmentINRA , UMR1324 Centre des Sciences du Goût et de l’Alimentation , Dijon, France

[5 ] departmentCNRS , UMR6265 Centre des Sciences du Goût et de l’Alimentation , Dijon, France

[6 ] departmentCentre des Sciences du Goût et de l’Alimentation , Université Bourgogne Franche-Comté , Dijon, France

[7 ] departmentOphthalmology Department , Dijon University Hospital , Dijon, France

[8 ] San Raffaele Scientific Institute , Milan, Italy

[9 ] Health Education Yorkshire and the Humber , Leeds, UK

[10 ] departmentDepartment of Mathematics and Data Science Institute , Imperial College London , London, UK

[11 ] departmentDepartment of Statistics , University of Oxford , Oxford, UK

[12 ] departmentDana Center for Preventive Ophthalmology , Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA

[13 ] LV Prasad Eye Institute , Hyderabad, India

[14 ] departmentDepartment of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston, Massachusetts, USA

[15 ] Discovery Eye Center , Addis Ababa, Ethiopia

[16 ] Myungsung Christian Medical Center and Medical School , Addis Ababa, Ethiopia

[17 ] Nova Southeastern University , Davie, Florida, USA

[18 ] Health Information Services , Grootebroek, The Netherlands

[19 ] departmentAfrican Vision Research Institute , University of Kwazulu-Natal, Brien Holden Vision Institute , Durban, South Africa

[20 ] NHMRC Centre for Clinical Eye Research, Flinders University , Adelaide, South Australia, Australia

[21 ] departmentSchool of Medicine, Dentistry and Biomedical Sciences , Queen’s University Belfast , Belfast, UK

[22 ] Centers for Disease Control and Prevention , Atlanta, Georgia, USA

[23 ] departmentSt Pauls Eye Unit , Royal Liverpool University Hospital , Liverpool, UK

[24 ] Brien Holden Vision Institute , Sydney, New South Wales, Australia

[25 ] departmentSchool of Optometry and Vision Science , University of New South Wales , Sydney, New South Wales, Australia

[26 ] departmentMelbourne School of Population Health , University of Melbourne , Melbourne, Victoria, Australia

[27 ] departmentDepartment of Ophthalmology , Keck School of Medicine of USC , Los Angeles, California, USA

[28 ] departmentSingapore Eye Research Institute , Duke-NUS Graduate Medical School, National University of Singapore , Singapore

Author notes

[Correspondence to ] Professor Rupert R A Bourne, Vision and Eye Research Unit, School of Medicine, Anglia Ruskin University, Cambridge CB1 1PT, UK; rb@ 123456rupertbourne.co.uk

Author information

Rupert R A Bourne http://orcid.org/0000-0002-8169-1645

Jost B Jonas http://orcid.org/0000-0003-2972-5227

Alain M Bron http://orcid.org/0000-0002-7265-931X

Janet Leasher http://orcid.org/0000-0002-8779-5162

Serge Resnikoff http://orcid.org/0000-0002-5866-4446

Article

Publisher ID: bjophthalmol-2017-311258

DOI: 10.1136/bjophthalmol-2017-311258

PMC ID: 5909755

PubMed ID: 29545417

SO-VID: 08a6cdd0-7a78-421c-9224-78a7c95af700

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/