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. 2025 Jul;13(7):e1175-e1190.
doi: 10.1016/S2214-109X(25)00143-3.

Global burden of vision impairment due to age-related macular degeneration, 1990-2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Global AMD Collaborators
Collaborators

Global burden of vision impairment due to age-related macular degeneration, 1990-2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Global AMD Collaborators. Lancet Glob Health. 2025 Jul.

Abstract

Background: Age-related macular degeneration (AMD) is a growing public health concern worldwide, as one of the leading causes of vision impairment. We aimed to estimate global, national, and region-specific prevalence and disability-adjusted life-years (DALYs) along with tobacco as a modifiable risk factor to aid public policy addressing AMD.

Methods: Data on AMD were extracted from the Global Burden of Disease, Injuries, and Risk Factor Study 2021 database in 204 countries and territories, 1990-2021. Vision impairment was defined and categorised by severity as follows: moderate to severe vision loss (visual acuity from <6/18 to 3/60) and blindness (visual acuity <3/60 or a visual field <10 degrees around central fixation). The burden of vision impairment attributable to AMD was subsequently estimated. These estimates were further stratified by geographical region, age, year, sex, Healthcare Access and Quality (HAQ) Index, and Socio-demographic Index (SDI) levels. Additionally, the effect of tobacco use, a modifiable risk factor, on the burden of AMD was analysed, and projections of AMD burden were estimated through to 2050. These projections also included scenario modelling to assess the potential effects of tobacco elimination.

Findings: Globally, the number of individuals with vision impairment due to AMD more than doubled, rising from 3·64 million (95% uncertainty inverval [UI] 3·04-4·35) in 1990 to 8·06 million (6·71-9·82) in 2021. Similarly, DALYs increased by 91% over the same period, from 0·30 million (95% UI 0·21-0·42) to 0·58 million (0·40-0·80). By contrast, age-standardised prevalence and DALY rates declined, with prevalence rates decreasing by 5·53% (99·50 per 100 000 of the population [95% UI 83·16-118·04] in 1990 to 94·00 [78·32-114·42] in 2021) and DALY rates dropping by 19·09% (8·38 [5·70-11·53] to 6·78 [4·70-9·32]). These rates showed a consistent decrease in higher SDI quintiles, reflecting the negative correlation between HAQ Index and AMD burden. A general downward trend was observed from 1990 to 2021, with the largest age-standardised reduction occurring in the low-middle SDI quintile. The global contribution of tobacco to age-standardised DALYs decreased by 20%, declining from 12·45% (95% UI 7·73-17·37) in 1990 to 9·96% (6·12-14·06) in 2021. By 2050, the number of individuals affected by AMD is projected to increase from 3·40 million males (95% UI 2·81-4·17) in 2021 to 9·02 million (5·72-14·20) and from 4·66 million females (3·88-5·65) to 12·32 million (8·88-17·08). Eliminating tobacco use could reduce these numbers to 8·17 million males (5·59-11·92) and 11·15 million females (8·58-14·48) in 2050.

Interpretation: While the total prevalence and DALYs due to AMD have steadily increased from 1990 to 2021, age-standardised prevalence and DALY rates have declined, probably reflecting the effect of population ageing and growth. The consistent decrease in age-standardised rates with higher SDI levels highlights the crucial role of health-care resources and public policies in mitigating AMD-related vision impairment. The downward trend observed from 1990 to 2021 might also be partially attributed to the reduced effect of tobacco as a modifiable risk factor, with declines in tobacco use seen globally and across all SDI quintiles. The burden of vision impairment due to AMD is projected to increase to about 21·34 million in 2050. However, effective tobacco regulation has the potential to substantially reduce AMD-related vision impairment, particularly in lower SDI quintiles where health-care resources are limited.

Funding: Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports support for the present manuscript from King Edward Medical University (Lahore, Pakistan); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from King Edward Medical University and collaborative partners, including Johns Hopkins University (Baltimore, MD, USA), University of California (CA, USA), University of Massachusetts (MA, USA), King Edward Medical College Alumni Association of North America and the UK (KEMCAANA and KEMCA-UK), international scientific conferences, webinars and meetings; support for attending meetings, travel, or both from King Edward Medical University; participation on a Data Safety Monitoring Board or Advisory Board with the National Bioethics Committee Pakistan, King Edward Medical University Ethical Review Board, and Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as a member of the Pakistan Association of Medical Editors, Fellow of Faculty of Public Health Royal Colleges UK (FFPH), Society of Prevention, Advocacy And Research, King Edward Medical University (SPARK), member Pakistan Society of Infectious Diseases, and member of the Technical Expert Advisory Group of the Government to formulate guidelines on the prevention, surveillance and research on infectious diseases; other financial or non-financial interests as Dean of Public Health and Preventive Medicine at King Edward Medical University, Chief Editor Annals of King Edward Medical University since 2014, Director Quality Enhancement Cell King Edward Medical University, at international level, Fellow of Faculty of Public Health UK, Advisory Board Member and Chair Scientific Session, KEMCA-UK, Chairperson International Scientific Conference, KEMCAANA, at national level, member of the Research and Publications Higher Education Commission, HEC (Pakistan), member of the Research and Journals Committee Pakistan Medical and Dental Council (Pakistan), member of the National Bioethics Committee (Pakistan), at Punjab level Member of the Corona Experts Advisory Group, member of the Technical Working Group for Infectious Diseases, member of the Dengue Experts Advisory Group, and Chair, Punjab Residency Program Research Committee; outside the submitted work. S Bhaskar reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) and from The Australian Academy of Science; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid as the visiting director in the department of neurology at the National Cerebral and Cardiovascular Center, Suita (Osaka, Japan), district chair of diversity, equity and inclusion at the Rotary District 9675, chair and manager of the Global Health and Migration Hub Community (Berlin, Germany), an editorial member of PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Aging, Frontiers in Public Health & BMC Medical Research Methodology, a member of the College of Reviewers (Canadian Institutes of Health Research, Government of Canada), a member of the scientific review committee at Cardiff University Biobank (UK), an expert advisor and reviewer with the Cariplo Foundation (Milan, Italy), a Visiting Director at the National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology (Suita, Osaka, Japan); outside the submitted work. R K Garg reports royalties or licences from MedLink Neurology and UpToDate; outside the submitted work. I Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological development, Republic of Serbia (project No 175042, 2011–2023). M Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological development, Republic of Serbia (number 451–03–47/2023–01/200111). K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University (Chandigarh, India); outside the submitted work. M Lee reports support for the present manuscript from the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2023S1A3A2A05095298). B Oancea reports grants or contracts from MRID, Project PNRR-I8 no 842027778, contract no 760096; outside the submitted work. R Passera reports participation on a Data Safety Monitoring Board or Advisory Board as a member of the Data Safety Monitoring Board of the clinical trial “Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKi-treated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patients” - FIL, Fondazione Italiana Linfomi, Alessandria; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as a member of the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris, France, and as a past member 2020–2023 (biostatistician) of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC (Venice, Italy); outside the submitted work. Y L Samodra reports a leadership or fiduciary role as a co-founder of Benang Merah Research Center (Indonesia); outside the submitted work. V Sharma reports support from DFSS (MHA's) research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University (Chandigarh, India); outside the submitted work. J I Shin reports support from the Yonsei Fellowship, funded by Lee Youn Jae. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview healthcare partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs., Adept Field Solutions, Clinical Care options, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications; and the National Institutes of Health]; payment of honoraria for lectures, presentations, speakers bureaus, manuscript writing or education events as a member of the speaker's bureau of Simply Speaking; support for attending meetings as a past steering committee member of OMERACT; participation on a Data Safety Monitoring Board or Advisory Board with the FDA Arthritis Advisory Committee; Leadership or fiduciary role in other board, society, committee or advocacy group, paid as a past steering committee member of the OMERACT (an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies), unpaid as a Co-Chair of the Veterans Affairs Rheumatology Field Advisory Committee, and unpaid as an editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis; stock or stock options in Atai life sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp., and Charlotte's Web Holdings, and previous stock options in Amarin, Viking, and Moderna Pharmaceuticals; outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles as the co-founder of Benang Merah Research Center (Indonesia); outside the submitted work. M Zielinska reports other financial or non-financial interests as an Alexion, AstraZeneca Rare Disease employee; outside the submitted work. All other members declare no competing interests.

Figures

Figure 1
Figure 1
Global distribution of age-related macular degeneration in both sexes, 2021 Age-standardised prevalence (A) and DALY rate (B) per 100 000 of the population, 2021. DALY=disability-adjusted life-year.
Figure 2
Figure 2
Rate per 100 000 of the population of prevalence (A) and DALYs (B) from age-related macular degeneration at the global level by age group and sex, 2021 Shaded regions indicate 95% uncertainty intervals. DALYs=disability-adjusted life-years.
Figure 3
Figure 3
Age-standardised prevalence rate (A) and DALYs (B) per 100 000 of the population from age-related macular degeneration for both sexes by SDI, 2021 Shaded regions indicate 95% uncertainty intervals. DALYs=disability-adjusted life-years. SDI=Socio-demographic Index.
Figure 4
Figure 4
Percentage change in age-standardised DALYs attributed to tobacco as a risk factor from age-related macular degeneration by the SDI groups and regions, 1990–2021 Error bars indicate 95% uncertainty intervals. DALYs=disability-adjusted life-years. SDI=Socio-demographic Index.
Figure 5
Figure 5
Forecasted prevalent cases and rates per 100 000 of the population of age-related macular degeneration by sex, comparing estimates with and without risk factor, all ages, 1990–2050 Number of cases and rates overall (A,B), for males (C,D), and for females (E,F). The shaded regions represent 95% uncertainty intervals, while the dashed line marks the forecast period beginning in 2022. The risk factor for this disease in this study is smoking.
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