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In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014.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.

中文翻译：

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1990-2020年失明和远视力受损的全球原因：系统回顾和荟萃分析

背景

有关视力障碍和失明原因的当代数据构成了公共卫生政策中建议的重要基础。借助最新发布的数据源对全球视觉数据库进行的刷新，可以对1990年至2015年的视力丧失数据进行建模，进一步按原因进行分类，并预测到2020年。

方法

在这项系统的回顾和荟萃分析中，我们分析了1980年至2014年间已发表和未发表的基于人群的数据，以分析视力障碍和失明的原因。语言限制（1946年1月1日起为MEDLINE，1974年1月1日起为Embase，以及WHO图书馆数据库）。我们拟合了一系列回归模型，以估计中度或重度视力障碍（定义为呈现出<6/18的视力，但在更好的眼睛中≥3/ 60）和失明（呈现出<3/60的视力）的比例。更好的眼睛）（按原因，年龄，地区和年份）。

发现

我们确定了288个研究，涉及3,983,541名参与者，这些数据来自98个国家/地区。2015年全球中度或重度视力障碍人群（216.6百万[80％不确定区间98.5百万至359.1百万]）中，主要原因是未矫正的屈光不正（116.3百万[49·4]百万至202·100万]，白内障（52·600万[18·200万至109·600万]），年龄相关性黄斑变性（8·400万[0·900万至29·500万]） ，青光眼（4 000万[0·600万至13·300万]）和糖尿病性视网膜病变（2 600万[0·200万至9·900万]）。在2015年失明的全球人口中（3600·0百万[12·900万至65·400万]），主要原因是白内障（1200·600万[3·400万至28·700万]），未校正的屈光不正（7·400万[2·400万至14·800万]），和青光眼（2·9百万[0·4百万至9·9百万]）。到2020年，在中度或重度视力障碍（237.1百万[101.5百万至399.0百万]的全球人口中），未矫正屈光不正影响的人数预计将增加到127·700万人（ 51·000万至225·300万，白内障为57·100万（17·900万至124·100万），年龄相关性黄斑变性为8·800万（0·800万至32·1）百万分之三），青光眼至4·500万（0·500万至15·400万）和糖尿病性视网膜病变至3·200万（0·200万至12·900万）。到2020年，在全球失明人口中（38·500万[13·200万至70·900万]），因白内障而失明的患者人数预计将增加到13·400万（3·300万）至31·600万），由于未校正的屈光不正至8·0百万（2·500万至16·300万），以及由于青光眼至3·200万（0·400万至11·0百万）。2015年，白内障和未矫正的屈光不正加重了50岁及以上成年人的55％的失明和77％的视力障碍。该年龄段的世界范围内，失明和视力障碍的原因差异很大，白内障（失明<22％，视力障碍为14·1–15·9％）和年龄相关性黄斑变性的高患病率（> 14％的失明）是高收入地区的原因。在2015年，由于糖尿病性视网膜病变（几率2·52 [1·48-3·73]）和白内障（1·21 [1·17-1·25]]导致的所有年龄段的失明和视力障碍更为普​​遍比男人中间

解释

随着人口的增加和年龄的增长，受视力丧失的常见原因影响的人数已大大增加。由白内障（手术可逆）和屈光不正（眼镜矫正可逆）导致的可预防的视力丧失继续导致大多数年龄在50岁以上的成年人失明和中度或重度视力障碍。为了解决可避免的视力丧失，需要大规模扩大眼保健服务以应对数量不断增加的情况。

资金

布里恩·霍尔顿视觉研究所。