Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020. METHODS: In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014. We identified population-based studies published before July 8, 2014, by searching online databases with no language restrictions (MEDLINE from Jan 1, 1946, and Embase from Jan 1, 1974, and the WHO Library Database). We fitted a series of regression models to estimate the proportion of moderate or severe vision impairment (defined as presenting visual acuity of <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity of <3/60 in the better eye) by cause, age, region, and year. FINDINGS: We identified 288 studies of 3 983 541 participants contributing data from 98 countries. Among the global population with moderate or severe vision impairment in 2015 (216·6 million [80% uncertainty interval 98·5 million to 359·1 million]), the leading causes were uncorrected refractive error (116·3 million [49·4 million to 202·1 million]), cataract (52·6 million [18·2 million to 109·6 million]), age-related macular degeneration (8·4 million [0·9 million to 29·5 million]), glaucoma (4·0 million [0·6 million to 13·3 million]), and diabetic retinopathy (2·6 million [0·2 million to 9·9 million]). Among the global population who were blind in 2015 (36·0 million [12·9 million to 65·4 million]), the leading causes were cataract (12·6 million [3·4 million to 28·7 million]), uncorrected refractive error (7·4 million [2·4 million to 14·8 million]), and glaucoma (2·9 million [0·4 million to 9·9 million]). By 2020, among the global population with moderate or severe vision impairment (237·1 million [101·5 million to 399·0 million]), the number of people affected by uncorrected refractive error is anticipated to rise to 127·7 million (51·0 million to 225·3 million), by cataract to 57·1 million (17·9 million to 124·1 million), by age-related macular degeneration to 8·8 million (0·8 million to 32·1 million), by glaucoma to 4·5 million (0·5 million to 15·4 million), and by diabetic retinopathy to 3·2 million (0·2 million to 12·9 million). By 2020, among the global population who are blind (38·5 million [13·2 million to 70·9 million]), the number of patients blind because of cataract is anticipated to rise to 13·4 million (3·3 million to 31·6 million), because of uncorrected refractive error to 8·0 million (2·5 million to 16·3 million), and because of glaucoma to 3·2 million (0·4 million to 11·0 million). Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of vision impairment in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness and vision impairment in this age group, with a low prevalence of cataract (<22% for blindness and 14·1-15·9% for vision impairment) and a high prevalence of age-related macular degeneration (>14% of blindness) as causes in the high-income subregions. Blindness and vision impairment at all ages in 2015 due to diabetic retinopathy (odds ratio 2·52 [1·48-3·73]) and cataract (1·21 [1·17-1·25]) were more common among women than among men, whereas blindness and vision impairment due to glaucoma (0·71 [0·57-0·86]) and corneal opacity (0·54 [0·43-0·66]) were more common among men than among women, with no sex difference related to age-related macular degeneration (0·91 [0·70-1·14]). INTERPRETATION: The number of people affected by the common causes of vision loss has increased substantially as the population increases and ages. Preventable vision loss due to cataract (reversible with surgery) and refractive error (reversible with spectacle correction) continue to cause most cases of blindness and moderate or severe vision impairment in adults aged 50 years and older. A large scale-up of eye care provision to cope with the increasing numbers is needed to address avoidable vision loss. FUNDING: Brien Holden Vision Institute.
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The prevalence of diabetic retinopathy in low- and middle-income countries increased by 68% in 10 years.
“LMICs face unique challenges, as the prevalence of DR has increased by 68% in 10 years and many diabetes cases are undiagnosed.”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [3]
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- Authors
- Flaxman, S. R., Bourne, R. R. A., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., Das, A., Jonas, J. B., Keeffe, J., Kempen, J. H., Leasher, J., Limburg, H., Naidoo, K., Pesudovs, K., Silvester, A., Stevens, G. A., Tahhan, N., Wong, T. Y., Taylor, H. R., Bourne, R., Ackland, P., Arditi, A., Barkana, Y., Bozkurt, B., Braithwaite, T., Bron, A., Budenz, D., Cai, F., Casson, R., Chakravarthy, U., Choi, J., Cicinelli, M. V., Congdon, N., Dana, R., Dandona, R., Dandona, L., Das, A., Dekaris, I., Del Monte, M., deva, J., Dreer, L., Ellwein, L., Frazier, M., Frick, K., Friedman, D., Furtado, J., Gao, H., Gazzard, G., George, R., Gichuhi, S., Gonzalez, V., Hammond, B., Hartnett, M. E., He, M., Hejtmancik, J., Hirai, F., Huang, J., Ingram, A., Javitt, J., Jonas, J., Joslin, C., Keeffe, J., Kempen, J., Khairallah, M., Khanna, R., Kim, J., Lambrou, G., Lansingh, V. C., Lanzetta, P., Leasher, J., Lim, J., LIMBURG, H., Mansouri, K., Mathew, A., Morse, A., Munoz, B., Musch, D., Naidoo, K., Nangia, V., Palaiou, M., Parodi, M. B., Pena, F. Y., Pesudovs, K., Peto, T., Quigley, H., Raju, M., Ramulu, P., Rankin, Z., Resnikoff, S., Reza, D., Robin, A., Rossetti, L., Saaddine, J., Sandar, M., Serle, J., Shen, T., Shetty, R., Sieving, P., Silva, J. C., Silvester, A., Sitorus, R. S., Stambolian, D., Stevens, G., Taylor, H., Tejedor, J., Tielsch, J., Tsilimbaris, M., van Meurs, J., Varma, R., Virgili, G., Wang, Y. X., Wang, N.-L., West, S., Wiedemann, P., Wong, T., Wormald, R., & Zheng, Y.
- Affiliations
- Imperial College London (GB)
- Brien Holden Vision Institute (AU)
- Université de Bourgogne (FR)
- World Health Organization (CH)
- Massachusetts Eye and Ear Infirmary (US)
- IRCCS Ospedale San Raffaele (IT)
- Nova Southeastern University (US)
- International Agency for the Prevention of Blindness (GB)
- ORCID
- Flaxman, Seth R
- Tahhan, Nina
- Arditi, Aries
- Bozkurt, Banu
- Bron, Alain
- Budenz, Donald
- Casson, Robert
- Chakravarthy, Usha
- Choi, Jaewan
- Congdon, Nathan
- Dana, Reza
- Dandona, Rakhi
- Dekaris, Iva
- Dreer, Laura
- Frick, Kevin
- Friedman, David
- Gao, Hua
- Gazzard, Gus
- George, Ronnie
- Gichuhi, Stephen
- Hartnett, Mary Elizabeth
- Hejtmancik, James
- Hirai, Flavio
- Ingram, April
- Joslin, Charlotte
- Khanna, Rohit
- Kim, Judy
- Lansingh, Van Charles
- Lanzetta, Paolo
- Lim, Jennifer
- Mansouri, Kaweh
- Morse, Alan
- Musch, David
- Quigley, Harry
- Robin, Alan
- Rossetti, Luca
- Saaddine, Jinan
- Serle, Janet
- Shen, Tueng
- Sieving, Pamela
- Silva, Juan Carlos
- Sitorus, Rita S.
- Tejedor, Jaime
- Tielsch, James
- Tsilimbaris, Miltiadis
- Varma, Rohit
- Virgili, Gianni
- Wang, Ya Xing
- West, Sheila
- Wiedemann, Peter
- Wormald, Richard
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 5
- Issue
- 12
- Pages
- e1221-e1234
- ISSN
- 2214-109X (ISSN-L)
- OpenAlex
- W2761604622
- Cited by
- 3,477
- References
- 1
- Citations by year
- 2026: 336 · 2025: 432 · 2024: 451 · 2023: 461 · 2022: 451 · 2021: 541 · 2020: 465 · 2019: 228 · 2018: 96 · 2017: 8 · 2016: 1 · 2014: 1
- FWCI
- 28.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by)
- NSUWorks (Nova Southeastern University) (submittedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion, cc-by)
- Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Flinders Academic Commons (Flinders University) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- Funders
- World Health Organization
- Brien Holden Vision Institute
- National Institutes of Health (UL1TR001425)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
- Health Sciences › Medicine › Ophthalmology › Glaucoma and retinal disorders
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Keywords
- blindness, visual impairment, uncorrected refractive error, cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, visual impairment prevalence, disability burden, blindness prevention, blindness rehabilitation
- MeSH terms
- Aging, Blindness, Cataract, Diabetic Retinopathy, Glaucoma, Humans, Macular Degeneration, Visual Acuity, Global Health, Prevalence
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