Rates of blindness have fallen by 50% in high-income countries, and the primary cause has changed from cataract to macular degeneration, according to a systematic review published online March 24 in the British Journal of Ophthalmology. Moreover, the prevalence of uncorrected refractive error has decreased by 38% and remains the leading cause of moderate and severe vision impairment (MSVI).
Rupert R.A. Bourne, MD, from the Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, United Kingdom, and colleagues evaluated epidemiological studies published between 1980 and 2012 and included a total of 243 cross-sectional, population-based investigations in their review.
Most of the studies were community-based, as opposed to national. They included communities in Asia Pacific, Australasia, North America, Western Europe, and Central and Eastern Europe.
The investigators used the studies to estimate the prevalence and most common cause of blindness and MSVI in 190 countries. Globally, they found that prevalence of blindness and MSVI fell by 37% and 27%, respectively.
They also found that the incidence of blindness in high-income countries dropped from 3.314 million people (0.2% of the population) to 2.736 million people (0.1% of the population). Similarly, the incidence of MSVI dropped from 25.362 million (1.6% of the population) to 22.176 million (1.0% of the population). Women were more likely to be blind or have MSVI than men.
The authors report that the prevalence of age-related blindness and MSVI in older people was markedly lower in high-income regions than in global populations.
In addition, in 2010, in high-income regions, macular degeneration replaced cataract as the most frequent cause of blindness. Cataract remained the most common cause in 2010 in Eastern and Central Europe, however. The third most common cause of blindness, even in highly developed countries, was uncorrected refractive error; glaucoma and diabetic retinopathy, respectively, were the fourth and fifth leading causes of blindness in 1990 and 2010.
In their discussion, the investigators call for increased access to anti–vascular endothelial growth factor therapies that can be used to treat macular degeneration. The investigators also note that the impending epidemic of diabetes will soon take its toll on vision, with as many as 100 million people being expected to develop diabetic retinopathy.
This study was partially funded by the Bill & Melinda Gates Foundation, Fight for Sight, Fred Hollows Foundation and the Brien Holden Vision Institute. The authors have disclosed no relevant financial relationships.
Br J Ophthalmol. Published online March 24, 2014. Abstract
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Cite this: Blindness Down 50% in High-Income Countries, Causes Shifting - Medscape - Mar 25, 2014.