Prevalence of Blindness and Visual Impairment in Sub-Saharan Africa in 2020: Magnitude and Temporal Trends. Systematic Review and Meta-Analysis

Purpose
To assess burden of blindness and visual impairment (VI) in Sub-Saharan Africa (SSA) as of 2020, the planned end point of the Vision 2020 program.

Methods
A systematic review and meta-analysis assessed burden, in the better eye, of blindness (presenting distance visual acuity, VA < 3/60), moderate and severe vision impairment (MSVI; VA < 6/18 but ≥ 3/60) and mild vision impairment (VA < 6/12 and ≥ 6/18); and also functional presbyopia (<N6 or N8 in the presence of ≥ 6/12 best-corrected distance visual acuity) in SSA.

Results
In 2020, an estimated 5,083,000 people (95%Uncertainty Interval, UI, 4,474,000–5,696,000) in SSA were bilaterally blind; 20442,000 more (95%UI 18,568,000–22,430,000) had MSVI. The age-standardized prevalence of blindness in SSA is the highest for any GBD super-region, nearly double the world average (0.99%, 95%UI, 0.85–1.12; vs 0.52%, 95% UI, 0.46–0.59 respectively). The Western (4.15%) and Eastern (3.79%) SSA sub-regions had the highest age-standardized prevalence of blindness for the 50+ age group amongst SSA sub-regions. Improvement in age-specific prevalence since 2000 was less than the Vision 2020 target (−25%) for all subcategories of VI; improvement in blindness was the only category close to the goal (about 80–100% of goal across SSA sub-regions).

Conclusions
The SSA age-specific prevalence of VI has generally improved since 2000, especially for blindness. However, the number of VI cases has increased with population growth and aging, and Vision 2020 targets were not met. Because most causes of VI require individual-level clinical care, large increases in training and eye care delivery systems development/financing are critical areas of focus.