COVID-19 and the Unfinished Agenda of VISION 2020

Abstract

Purpose: To critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020.

Design: Perspective supplemented with epidemiologic insights from available online databases.

Methods: We extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020.

Results: Over 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population.

Conclusions: Despite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide.

Figure 1

Age-standardized prevalence of combined moderate-to-severe vision impairment (20/70 to 20/400 Snellen distance acuity) and blindness (<20/400 Snellen distance acuity in the better eye), 1990 and 2020. The 2020 figures have been projected from 2015 data. Regions are those captured by the Global Burden of Disease Study.

Figure 2

Estimated total number of individuals affected by combined moderate-to-severe vision impairment and blindness, 1990 and 2020. Note the projected absolute number of affected individuals in 2020 despite an overall trend toward decreased age-standardized prevalence. The 2020 figures have been projected from 2015 data. Regions are those captured by the Global Burden of Disease Study.

Figure 3

Etiology of vision loss by selected region according to 2015 figures from the Global Vision Database. The regions with the highest (South Asia, Western Sub-Saharan Africa, and North Africa and the Middle East) and lowest (North America, Western Europe, and High-Income Asia-Pacific) prevalence of moderate-to-severe vision impairment and blindness are shown. Note the relatively larger proportions of vision loss caused by age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy in high-income regions, and the higher proportions of trachoma and corneal opacity in lower-to middle-income regions.