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      2021                            d  bElsevier BV10aGeneral Medicine10aVision impairment10aBlindness1 aAdelson JD1 aBourne RRA1 aBriant PS1 aFlaxman SR1 aTaylor HRB1 aJonas JB1 aAbdoli AA1 aAbrha WA1 aAbualhasan A1 aAbu-Gharbieh EG1 aAdal TG1 aAfshin A1 aAhmadieh H1 aAlemayehu W1 aAlemzadeh SAS1 aAlfaar AS1 aAlipour V1 aAndroudi S1 aArabloo J1 aArditi AB1 aAregawi BB1 aArrigo A1 aAshbaugh C1 aAshrafi ED1 aAtnafu DD1 aBagli EA1 aBaig AAW1 aBärnighausen TW1 aBattaglia Parodi M1 aBeheshti MS1 aBhagavathula AS1 aBhardwaj N1 aBhardwaj P1 aBhattacharyya K1 aBijani A1 aBikbov M1 aBottone M1 aBraithwaite TM1 aBron AM1 aBurugina Nagaraja SA1 aButt ZA1 aCaetano dos Santos FLL1 aCarneiro VLJ1 aCasson RJ1 aCheng CJ1 aChoi JJ1 aChu D1 aCicinelli MVM1 aCoelho JMG1 aCongdon NGA1 aCouto RAA1 aCromwell EAM1 aDahlawi SM1 aDai X1 aDana R1 aDandona L1 aDandona RA1 aDel Monte MA1 aDerbew Molla M1 aDervenis NA1 aDesta AAP1 aDeva JP1 aDiaz D1 aDjalalinia SE1 aEhrlich JR1 aElayedath RR1 aElhabashy HRB1 aEllwein LB1 aEmamian MH1 aEskandarieh S1 aFarzadfar FG1 aFernandes AG1 aFischer FS1 aFriedman DSM1 aFurtado JM1 aGaidhane S1 aGazzard G1 aGebremichael B1 aGeorge R1 aGhashghaee A1 aGilani SA1 aGolechha M1 aHamidi SR1 aHammond BRR1 aHartnett MERK1 aHartono RK1 aHashi AI1 aHay SI1 aHayat K1 aHeidari G1 aHo HC1 aHolla R1 aHouseh MJ1 aHuang JJE1 aIbitoye SEM1 aIlic IMD1 aIlic MDD1 aIngram ADN1 aIrvani SSN1 aIslam SMS1 aItumalla R1 aJayaram SP1 aJha R1 aKahloun R1 aKalhor R1 aKandel H1 aKasa AS1 aKavetskyy TA1 aKayode GAH1 aKempen JH1 aKhairallah M1 aKhalilov RA1 aKhan EAC1 aKhanna RC1 aKhatib MNA1 aKhoja TAE1 aKim JE1 aKim YJ1 aKim GR1 aKisa S1 aKisa A1 aKosen S1 aKoyanagi A1 aKucuk Bicer B1 aKulkarni VP1 aKurmi OP1 aLandires IC1 aLansingh VCL1 aLeasher JLE1 aLeGrand KE1 aLeveziel N1 aLimburg H1 aLiu X1 aMadhava Kunjathur S1 aMaleki S1 aManafi N1 aMansouri K1 aMcAlinden CG1 aMeles GGM1 aMersha AM1 aMichalek IMR1 aMiller TR1 aMisra S1 aMohammad Y1 aMohammadi SFA1 aMohammed JAH1 aMokdad AH1 aMoni MAA1 aMontasir AAR1 aMorse ARF1 aMulaw GFC1 aNaderi M1 aNaderifar HS1 aNaidoo KS1 aNaimzada MD1 aNangia V1 aNarasimha Swamy SM1 aNaveed DM1 aNegash HL1 aNguyen HL1 aNunez-Samudio VA1 aOgbo FA1 aOgundimu KT1 aOlagunju ATE1 aOnwujekwe OE1 aOtstavnov NO1 aOwolabi MO1 aPakshir K1 aPanda-Jonas S1 aParekh U1 aPark E1 aPasovic M1 aPawar S1 aPesudovs K1 aPeto TQ1 aPham HQ1 aPinheiro M1 aPodder V1 aRahimi-Movaghar V1 aRahman MHUY1 aRamulu PY1 aRathi P1 aRawaf SL1 aRawaf DL1 aRawal L1 aReinig NM1 aRenzaho AM1 aRezapour AL1 aRobin AL1 aRossetti L1 aSabour S1 aSafi S1 aSahebkar A1 aSahraian MAM1 aSamy AM1 aSathian B1 aSaya GK1 aSaylan MA1 aShaheen AAA1 aShaikh MAT1 aShen TT1 aShibuya KS1 aShiferaw WS1 aShigematsu M1 aShin JI1 aSilva JC1 aSilvester AA1 aSingh JA1 aSinghal DS1 aSitorus RS1 aSkiadaresi EY1 aSkryabin VYA1 aSkryabina AA1 aSoheili AB1 aSorrie MBARC1 aSousa RARCT1 aSreeramareddy CT1 aStambolian DG1 aTadesse EG1 aTahhan NI1 aTareque MI1 aTopouzis FX1 aTran BX1 aTsegaye GK1 aTsilimbaris MK1 aVarma R1 aVirgili G1 aVongpradith AT1 aVu GT1 aWang YX1 aWang NH1 aWeldemariam AHK1 aWest SKG1 aWondmeneh TGY1 aWong TY1 aYaseri M1 aYonemoto N1 aYu CS1 aZastrozhin MS1 aZhang ZR1 aZimsen SR1 aResnikoff S1 aVos T00aCauses of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study  uhttps://www.thelancet.com/action/showPdf?pii=S2214-109X%2820%2930489-7  ae144-e1600 v93 aBackground<br>
Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error.<br>
<br>Methods<br>
We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. 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 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older.<br>
<br>Findings<br>
Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]).<br>
<br>Interpretation<br>
Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached.  a2214-109X