review · Eye
Uncorrected refractive error remains a major, treatable source of global visual impairment. A meta-analysis of population-based surveys spanning 1980 to 2018 shows that by 2020, 3.7 million individuals were blind and 157 million experienced moderate-to-severe vision impairment from uncorrected refractive error. These figures reflect an increase of 21.8 percent in blindness and 72.0 percent in moderate-to-severe visual impairment since 2000, despite drops in age-standardised prevalence over the same timeframe. Additionally, 419 million individuals aged 50 and older experienced near vision impairment from uncorrected presbyopia in 2020, marking a 75.3 percent rise over two decades. The burden remains unevenly distributed, with higher rates among women and the greatest impact recorded in South Asia. Population ageing continues to expand this public health challenge, indicating a pressing requirement for new service delivery approaches.
Uncorrected refractive error is a treatable condition, yet global demographic shifts and population ageing mean absolute numbers of visually impaired individuals are steadily expanding. Demonstrating where this burden falls by age, sex, and geography assists global health planners in prioritising eye care resources and addressing stark disparities in access to basic corrective vision interventions.
The findings highlight a clear demand for novel refractive service delivery models to reach underserved groups, particularly older adults and women. Potential applications include scalable diagnostic tools, affordable corrective eyewear, and decentralised service delivery frameworks for eye health providers. While the epidemiological models operate at the population level and are removed from commercial product testing, they define a rapidly growing global market for accessible vision correction technologies.
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BACKGROUND: Uncorrected refractive error (URE) is a readily treatable cause of visual impairment (VI). This study provides updated estimates of global and regional vision loss due to URE, presenting temporal change for VISION 2020 METHODS: Data from population-based eye disease surveys from 1980-2018 were collected. Hierarchical models estimated prevalence (95% uncertainty intervals [UI]) of blindness (presenting visual acuity (VA) < 3/60) and moderate-to-severe vision impairment (MSVI; 3/60 ≤ presenting VA < 6/18) caused by URE, stratified by age, sex, region, and year. Near VI prevalence from uncorrected presbyopia was defined as presenting near VA < N6/N8 at 40 cm when best-corrected distance (VA ≥ 6/12). RESULTS: In 2020, 3.7 million people (95%UI 3.10-4.29) were blind and 157 million (140-176) had MSVI due to URE, a 21.8% increase in blindness and 72.0% increase in MSVI since 2000. Age-standardised prevalence of URE blindness and MSVI decreased by 30.5% (30.7-30.3) and 2.4% (2.6-2.2) respectively during this time. In 2020, South Asia GBD super-region had the highest 50+ years age-standardised URE blindness (0.33% (0.26-0.40%)) and MSVI (10.3% (8.82-12.10%)) rates. The age-standardized ratio of women to men for URE blindness was 1.05:1.00 in 2020 and 1.03:1.00 in 2000. An estimated 419 million (295-562) people 50+ had near VI from uncorrected presbyopia, a +75.3% (74.6-76.0) increase from 2000 CONCLUSIONS: The number of cases of VI from URE substantively grew, even as age-standardised prevalence fell, since 2000, with a continued disproportionate burden by region and sex. Global population ageing will increase this burden, highlighting urgent need for novel approaches to refractive service delivery.
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DOI: 10.1038/s41433-024-03106-0
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