Prevalence and causes of vision loss in Latin America and the Caribbean: 1990–2010 Janet L Leasher, 1 Van Lansingh, 2 Seth R Flaxman, 3 Jost B Jonas, 4 Jill Keeffe, 5,6 Kovin Naidoo, 7 Konrad Pesudovs, 8 Holly Price, 9 Juan Carlos Silva, 10 Richard A White, 11 Tien Y Wong, 12 Serge Resnikoff, 13 Hugh R Taylor, 14 Rupert R A Bourne, 9 on behalf of the Vision Loss Expert Group of the Global Burden of Disease Study For numbered affiliations see end of article Correspondence to Professor Rupert R A Bourne, Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK; rb@rupertbourne.co.uk JLL and VL share the first authorship SR, HRT and RRAB share the senior authorship Received 15 July 2013 Revised 24 December 2013 Accepted 10 January 2014 To cite: Leasher JL, Lansingh V, Flaxman SR, et al. Br J Ophthalmol Published Online First: [ please include Day Month Year] doi:10.1136/ bjophthalmol-2013-304013 ABSTRACT Objective To present regional estimates of the magnitude and temporal trends in the prevalence and causes of blindness and moderate/severe visual impairment (MSVI) in Latin America and the Caribbean (LAC). Methods A systematic review of cross-sectional population-representative data from published literature and unpublished studies was accessed and extracted to model the estimated prevalence of vision loss by region, country and globally, and the attributable cause fraction by region. Results In the LAC combined region, estimated all-age both-gender age-standardised prevalence of blindness halved from 0.8% (0.6 to 1.1) in 1990 to 0.4% (0.4 to 0.6) in 2010 and MSVI decreased from 4.3% (3.1 to 5.3) to 2.7% (2.2 to 3.4). In the Caribbean, estimated all-age both-gender age-standardised prevalence of blindness decreased from 0.6% (0.4 to 0.8) in 1990 to 0.5% (0.4 to 0.6) in 2010 and MSVI decreased from 3.3% (1.3 to 4.1) in 1990 to 2.9% (1.8 to 3.8). In the LAC regions combined, there was an estimated 2.3 million blind and 14.1 million with MSVI in 2010. In 2010, cataract continues to contribute the largest proportion of blindness, except in Southern Latin America where macular degeneration is most common. In 2010, uncorrected refractive error was the most common cause of MSVI. Conclusions While models suggest a decrease in age- standardised prevalence estimates, better data are needed to evaluate the disparities in the region. The increasing numbers of older people, coupled with the increase in vision loss associated with older age, will require further intervention to continue to reduce prevalence rates and to prevent a rise in absolute numbers of blind. INTRODUCTION Concern about the global burden of blindness and visual impairment led to the WHO global initiative VISION 2020: The Right to Sight, 1 and World Health Assembly Resolutions. 2 3 Regionally, the Pan American Health Organization 4 developed Strategies 5 6 and Resolutions, 7 8 and mobilised both governmental and non-governmental organi- sations to develop blindness prevention pro- grammes nationally and regionally through the International Agency for the Prevention of Blindness and partners. 9 Previous global prevalence meta-analytical esti- mates of blindness and visual impairment for Latin America and the Caribbean (LAC) used a variety of meta-analytical methodologies. 10 11 In 2002, for every million population in LAC, 5000 were esti- mated to be blind and 20 000 visually impaired. At Table 1 Global burden of disease, injury and risk factor study defined country regions in Latin America and the Caribbean Caribbean Latin America, Andean Latin America, Central Latin America, Southern Latin America, Tropical Antigua and Barbuda Haiti Bolivia Colombia Argentina* Brazil* Bahamas Jamaica Ecuador* Costa Rica Chile* Paraguay* Barbados* Puerto Rico Peru* El Salvador Uruguay Belize Saint Lucia Guatemala* Cuba* Saint Vincent & Grenadines Honduras Dominica Suriname Mexico* Dominican Republic* Trinidad and Tobago Nicaragua Grenada Panama Guyana Venezuela* These subregional country designations differ from other regional or geographical designations such as the Pan American Health Organization, the Pan American Association of Ophthalmology or the World Council of Optometry. Other countries not listed here were not included in the analysis. *Countries with included studies in the analysis. Leasher JL, et al. Br J Ophthalmol 2014;0:1–10. doi:10.1136/bjophthalmol-2013-304013 1 Global issues BJO Online First, published on February 11, 2014 as 10.1136/bjophthalmol-2013-304013 Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on February 11, 2014 - Published by bjo.bmj.com Downloaded from