Burden of Global Vision Loss due to Glaucoma: Temporal and Regional Changes 2000-2020

Abstract

Purpose : To update estimates of the global vision loss burden due to glaucoma, presenting temporal change since the beginning of VISION 2020 and distribution by sex and region.

Methods : Data gathered from population-based surveys of eye disease from January, 1980, to October, 2018 were collated. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60) caused by glaucoma, by age, sex, region, and year.

Results : In 2020, 3.60 million (95% UI 2.80-4.41) people aged 50+ years were blind due to glaucoma, and a further 4.13 million (3.24-5.17) had MSVI, a 41.0% increase in cases of blindness and 91.9% increase in cases of MSVI since 2000. Over the same period, age-standardised prevalence of glaucoma blindness decreased by 23.3% but for MSVI it increased by 5.9%. The age-standardised ratio of women to men for glaucoma blindness was 0.71:1.00 in 2020 and 0.67:1.00 in 2000. For MSVI, this ratio was 0.87:1.00 in 2020 and 0.84:1.00 in 2000. Sub-Saharan Africa was the super-region with the highest 50+ age-standardised glaucoma blindness and MSVI rates in 2020 (blind: 0.66%; 0.52-0.81, MSVI: 0.46%; 0.36-0.57), followed by North African and Middle East (blind: 0.57%; 0.44-0.71, MSVI: 0.38%; 0.29-0.48) and Latin America and the Caribbean (blind: 0.26%; 0.20-0.32, MSVI: 0.39%; 0.30-0.48).

Conclusions : Raw prevalence of vision impairment from glaucoma has grown due to population aging since 2000. The decline in age-adjusted glaucoma blindness (compared to MSVI) suggests successful targeting of the most severe cases or earlier detection. Further reduction in the burden of VI from glaucoma can be realised by improved access and affordability of topical medications and laser, and a focus on high quality glaucoma surgery and postoperative care. Screening must be cost-effective and sustainable and this may be possible in some populations, but in most areas of the World there is a reliance on opportunistic case detection. Heightening awareness of glaucoma among family members of cases and in primary care and within existing eyecare programs such as cataract and diabetic retinopathy screening may slow the rise in numbers of people with irreversible vision loss due to glaucoma.

This is a 2021 ARVO Annual Meeting abstract.