A conversation with leading epidemiologists about the status of vision loss in the seven super-regions of the world.
In this article we speak with Vision Loss Expert (VLEG) members Dr Rim Kahloun and Dr Moncef Khairallah about the status of vision loss in the North Africa and the Middle East Region.
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What are the 3 key take away messages for policy makers about vision loss in your region?
Dr Rim Kahloun (RK): first, the number of people affected with blindness is increasing although there is reduction in global age-standardized prevalence of blindness in NAME region. So, vision impairment remains an urgent and increasingly important public health priority.
Second, in 2020, cataract and undercorrected refractive error remain the major causes of vision impairment in adults aged 50 years and older.
Third, glaucoma, diabetic retinopathy, and age-related macular degeneration are a public health problem in several countries in the NAME region, making these diseases important additional targets for prevention and treatment.
What are the 3 key take away messages you would like to the eye health sector to know about vision loss in your region?
Dr Moncef Khairallah (MK): the first take away message is that strengthened efforts are needed to reduce blindness from cataract and undercorrected refractive error, which still both the leading causes of vision impairment in NAME region. Secondly, particular attention is required for screening of diabetic retinopathy which was the only cause to increase in age-standardized blindness prevalence over three decades. In addition, global awareness of and local approaches to improve gender equity in eye care service use in NAME are needed.
In your region, how have the patterns of vision loss changed over time? Are you able to present any theories about why these changes have occurred?
RK: Between 1990 and 2020, there was a decrease in age-standardized prevalence by 41.5% for blindness, by 6.1% for moderate and severe vision impairment, by 10.1% for mild vision impairment, and by 14.0% for near vision impairment in NAME region.
The age-standardized prevalence due to all causes of blindness has decreased between 1990 and 2020 with the exception of diabetic retinopathy that increased by 0.9%. In addition, the age-standardized prevalence of moderate and severe vision impairment has decreased in the period from 1990-2010 for all causes except cataract that increased by 0.6%.
This decline may reflect the effect of the Vision 2020 the Right to Sight initiative of WHO and the International Agency for the Prevention of Blindness. That is a global partnership for the elimination of avoidable blindness that involves a collaboration of governmental and international nongovernmental organizations, professional associations, and eye-care institutions.
Does the data tell you anything about how services have been responding to need?
MK: Although the age-standardized prevalence of blindness decreased, the number of people with visual impairment continued to rise over time. This suggests that despite major improvements in terms of reduction of prevalence of blindness in NAME region, eye care services did not meet the growing need due to ageing and growth of the population.
What surprised you about the data?
RK: While proportion of blindness from glaucoma declined as expected, glaucoma became the second most common cause of blindness in 2020; also cataract became the leading cause of moderate and severe vision impairment instead of undercorrected refractive error in both cases. Thus, despite major improvements in terms of reduction of prevalence, strengthened efforts in terms of promotion, availability and accessibility to high-volume and high-quality cataract surgery in the NAME countries are still needed to further decrease the prevalence of blindness and moderate and severe vision impairment caused by cataract in the NAME region.
Have any ‘good news’ stories emerged from the data in your region?
MK: Despite political and economic instability in several countries in the NAME region in the last two decades, an objective and significant progress in terms of implementing prevention of blindness and moderate and severe vision impairment activities should be noted. For example, Jordan, Tunisia, and Saudi Arabia are replacing inflexible hospital- based programs with comprehensive community-based screening initiatives. Data also suggests the efficiency of several school eye health programs focused on detection and management of refractive error that were established in several countries from the NAME region, including Oman, Saudi Arabia, Pakistan and Tunisia.
What concerns you most about vision loss trends in your region?
RK: Diabetic retinopathy was the only cause of blindness that showed a global increase in age standardized prevalence of blindness between 1990 and 2020 in NAME region. This may be the result of the ageing of the population combined with an increasing prevalence of diabetes mellitus in most countries of NAME. In this respect, diabetic retinopathy is a bigger public health problem in several countries in the region than in the rest of the world.
Are there any additional data elements (causes, populations) that you would like to see included in future studies?
MK: With regard to the NAME region, many countries remained without data or only had subnational data. In addition, it would be interesting if additional causes of visual impairment will be included like corneal diseases, myopia maculopathy, ocular injuries, and retinopathy of prematurity …
There is also a particular lack of data on near vision impairment from NAME region.
Image on top: Getting his eye bandaged after surgery/Fauzia Aziz