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Abstract Estimates of the prevalence of visual impairment caused by uncorrected refractive errors in 2004 have been determined at
regional and global levels for people aged 5 years and over from recent published and unpublished surveys. The estimates were based
on the prevalence of visual acuity of less than 6/18 in the better eye with the currently available refractive correction that could be
improved to equal to or better than 6/18 by refraction or pinhole.
A total of 153 million people (range of uncertainty: 123 million to 184 million) are estimated to be visually impaired from
uncorrected refractive errors, of whom eight million are blind. This cause of visual impairment has been overlooked in previous
estimates that were based on best-corrected vision. Combined with the 161 million people visually impaired estimated in 2002
according to best-corrected vision, 314 million people are visually impaired from all causes: uncorrected refractive errors become the
main cause of low vision and the second cause of blindness.
Uncorrected refractive errors can hamper performance at school, reduce employability and productivity, and generally impair quality
of life. Yet the correction of refractive errors with appropriate spectacles is among the most cost-effective interventions in eye health care.
The results presented in this paper help to unearth a formerly hidden problem of public health dimensions and promote policy
development and implementation, programmatic decision-making and corrective interventions, as well as stimulate research.
Bulletin of the World Health Organization 2008;86:6370.
Une traduction en franais de ce rsum figure la fin de larticle. Al final del artculo se facilita una traduccin al espaol. .
Introduction
Refractive errors (myopia, hyperopia
and astigmatism; presbyopia is not included in this study given the present
paucity of data, but it is recognized that
uncorrected, it could lead to an impaired
quality of life) affect a large proportion
of the population worldwide, irrespective of age, sex and ethnic group. Such
refractive errors can be easily diagnosed,
measured and corrected with spectacles
or other refractive corrections to attain
normal vision. If, however, they are
not corrected or the correction is inadequate, refractive errors become a major
cause of low vision and even blindness
(for a selection of studies, see http://ftp.
who.int/nmh/references/RE-estimatesreferences.pdf ).
Visual impairment from uncorrected refractive errors can have immediate and long-term consequences in
children and adults, such as lost educational and employment opportunities,
lost economic gain for individuals, families and societies, and impaired quality
of life. Various factors are responsible for
refractive errors remaining uncorrected:
Methods
Definitions
Presenting vision is defined by the visual
acuity in the better eye using currently
available refractive correction, if any.
Chronic Disease Prevention and Management, WHO, 20 avenue Appia, 1211 Geneva 27, Switzerland.
Correspondence to Serge Resnikoff (e-mail: resnikoffs@who.int).
doi:10.2471/BLT.07.041210
(Submitted: 11 February 2007 Revised version received: 28 May 2007 Accepted: 11 June 2007 Published online: 16 November 2007 )
a
63
Number of
surveys
Afr-D
Afr-E
Amr-A
Amr-B
2
1
3
5
Amr-D
Emr-B
Eur-A
Eur-B2
Sear-B
Sear-D
Wpr-A
Wpr-B1
Wpr-B2
2
5
2
2
6
13
4
7
16
Countries
Mali, Mauritania
South Africa
United States of America
Argentina, Brazil, Chile, Paraguay, Venezuela
(Bolivarian Republic of)
Guatemala, Peru
Iran (Islamic Republic of), Lebanon, Oman, Qatar
Ireland, Italy
Armenia, Turkmenistan
Malaysia, Philippines, Singapore
Bangladesh, India, Nepal, Pakistan
Australia
China
Cambodia, Myanmar, Viet Nam
Afr, WHO African Region; Amr, WHO Region of the Americas; Emr, WHO Eastern Mediterranean Region;
Eur, WHO European Region; Sear, WHO South-East Asia Region; Wpr, WHO Western Pacific Region.
In subregions Emr-D, Eur-B1, Eur-C and Wpr-B3, no population-based surveys met the selection criteria.
For further discussion of selection criteria, see Resnikoff et al.,2 and Pascolini
et al., 2004.9
Table 2. Number of people visually impaired from uncorrected refractive errors and corresponding prevalence, by age group and
WHO subregion or country, 2004
WHO subregion a
or country
No. in millions
(prevalence %)
No. in millions
(prevalence %)
No. in millions
(prevalence %)
No. in millions
(prevalence %)
Population
in millions
No. in millions
(prevalence %)
Afr-D, Afr-E
0.534 (0.24)
0.683 (0.24)
0.647 (1.13)
4.529 (5.94)
640.4
6.393 (1.00)
Amr-A
0.501 (1.00)
1.098 (1.00)
0.810 (1.60)
3.417 (3.60)
305.4
5.826 (1.91)
Amr-B
0.709 (0.70)
1.331 (0.70)
0.998 (1.81)
3.204 (4.07)
432.4
6.242 (1.44)
Amr-D
0.137 (0.70)
0.209 (0.70)
0.127 (1.81)
0.486 (4.86)
66.4
0.959 (1.44)
Emr-B, Emr-D
0.405 (0.55)
0.688 (0.55)
0.356 (1.20)
1.708 (4.76)
264.3
3.157 (1.19)
Eur-A
0.516 (1.00)
1.379 (1.00)
0.991 (1.60)
5.289 (3.60)
398.3
8.175 (2.05)
0.721 (1.00)
1.740 (1.00)
1.065 (1.60)
3.335 (2.80)
431.7
6.861 (1.59)
Sear-B, Wpr-B1,
Wpr-B2, Wpr-B3
(China excluded)
1.098 (0.79)
1.806 (0.74)
1.244 (1.70)
4.511 (4.67)
554.0
8.659 (1.56)
Sear-D
(India excluded)
0.606 (0.63)
0.986 (0.73)
0.909 (2.39)
9.295 (19.45)
317.5
11.796 (3.71)
Wpr-A
0.034 (0.20)
0.097 (0.20)
0.039 (0.20)
1.177 (1.99)
144.4
1.347 (0.93)
China
5.940 (2.66)
14.414 (2.66)
7.209 (3.95)
26.903 (9.61)
1229.0
54.466 (4.43)
India
World
a
1.610 (0.63)
2.695 (0.63)
4.042 (3.39)
30.970 (18.70)
966.9
39.317 (4.07)
12.811 (0.97)
27.126 (1.11)
18.437 (2.43)
94.824 (7.83)
5750.7
153.198 (2.67)
Estimation of prevalence of
blindness from uncorrected
refractive errors
Uncorrected refractive errors in adults
aged 50 years and older have been
shown to lead to blindness in some
regions: the corresponding prevalence
of blindness was determined from the
difference between prevalence of presenting and best-corrected visual acuity
of less than 3/60.
Blindness from uncorrected refractive errors was also reported in some
surveys for the age group 4049 years.
Since there were insufficient data worldwide, it was assumed that the global
number of people blind from this cause
in this age group was 5.13 times lower
100]
Extrapolations
Since data were not available for every
country, extrapolations were made to
estimate the global prevalence of visual
Table 3. Blindness from uncorrected refractive errors in adults aged 50 years and
older, by WHO subregion or country, 2004
WHO subregion a
or country
Population
type
Afr-D, Afr-E
Amr-A
1.250 (1.64)
NRB
Results
Amr-B
0.233 (0.3)
0.075 (0.75)
Emr-B, Emr-D
Rural
Urban
0.142 (0.95)
0.084 (0.4)
Amr-D
Eur-A
NRB
NRB
0.319 (0.26)
0.834 (1.74)
Wpr-A
Wpr-B1
(China excluded)
0.032 (0.2)
China
Rural
Urban
0.528 (0.33)
0.240 (0.2)
India
3.147 (1.9)
World
6.884 (0.57)
NRB
Discussion
Limitations: uncertainties of the
data and extrapolations
The sampling and examination methods
in the RESC studies were designed to
produce results that could be directly
compared between countries: for presenting visual acuity of less than 6/18,
the uncertainties given were between
20% and 25%. These uncertainties in
turn affect the estimates for the age
group 1639 years, which are based
on the results for the age group 515
years. The uncertainties reported in the
RACSS studies are between 15% and
25% for the prevalence of visual acuity
of less than 6/18; other studies reported
Table 4. Estimated average coverage of refractive services for age group 515 years,
by WHO subregion or country, 2004
WHO subregion a
or country
Population type
30
Amr-B, Amr-D
Rural
Urban
30
45
Emr-B, Emr-D
Rural
Urban
45
80
Eur-A
Rural
Urban
Most developed urban
30
55
80
Wpr-A
China
Rural
Urban
Rural, 1317 years
45
85
70
India
Rural
Urban
30
55
Amr-A
Blind
Low vision
Visual impairment
a
8.226
144.972
153.198
36.857
124.264
161.121
from all
causes
45.083
269.236
314.319
These estimates were based on best-corrected visual acuity and the population in 2002: the global
population change from 2002 to 2004 is estimated to be around 3%.
Conclusions
These findings warrant the urgent
implementation of the following fundamental policies.
Screening of children for refractive
errors should be conducted at community level and integrated into
school health programmes, accompanied by education and awareness
campaigns to ensure that the corrections are used and cultural barriers to compliance are addressed and
removed.
As the cost of refractive corrections
is still high compared with the personal and family resources in many
regions, corrections must be accessible and affordable for people of all
ages.
Eye-care personnel should be trained
in refraction techniques. Training
and information programmes should
also be designed for teachers and
school health-care workers.
Cataract
39.1
3.2
3.9
Uncorrected
refractive error
Glaucoma
Age-related
macular degeneration
4.2
Corneal opacities
Diabetic retinopathy
7.1
Childhood blindness
Trachoma
Onchocerciasis
10.1
18.2
Other
Rsum
Prvalence mondiale des dficiences visuelles dues des dfauts de rfraction non corrigs en 2004
Des estimations mondiales et rgionales pour lanne 2004 de
la prvalence des dficiences visuelles dues des dfauts de
rfraction non corrigs chez les plus de 5 ans ont t tablies
partir denqutes rcentes publies et non publies. Ces estimations
ont t obtenues daprs la prvalence dune acuit visuelle
infrieure 6/18 pour le meilleur des deux yeux avec la correction
rfractive actuellement disponible, susceptible dtre ramene
une valeur suprieure ou gale 6/18 par une correction rfractive
ou un trou stnopique.
On estime 153 millions (plage dincertitude : 123 184
millions) le nombre total de personnes souffrant dune dficience
visuelle due un dfaut de rfraction non corrig, dont huit millions
daveugles. La cause de la dficience visuelle a t laisse de ct
dans les estimations antrieures reposant sur la meilleure vision
corrige. Si lon combine ce chiffre lestimation de 2002 du
nombre dindividus dficients visuels tablie daprs la meilleure
68
Resumen
Magnitud mundial de las discapacidades visuales por defectos de refraccin no corregidos en 2004
Se ha estimado la prevalencia de las discapacidades visuales
causadas por los defectos de refraccin no corregidos en 2004 a
nivel regional y mundial en la poblacin de 5 o ms aos a partir
de encuestas recientes publicadas o inditas. Las estimaciones
se basaron en la prevalencia de una agudeza visual inferior a
6/18 en el mejor ojo con la correccin refractiva del momento,
pero mejorable hasta 6/18 o ms con medidas de correccin de
la refraccin o con un agujero estenopeico.
Se estima que un total de 153 millones de personas
(intervalo de incertidumbre: 123 - 184 millones) sufren
discapacidad visual como consecuencia de defectos de refraccin
no corregidos, incluidos ocho millones que padecen ceguera.
Esta causa de discapacidad visual no se ha tenido debidamente
en cuenta en estimaciones anteriores basadas en la mejor visin
corregida. Si se suman a ello los 161 millones de personas con
discapacidad visual estimados en 2002 de acuerdo con el criterio
314
:
.
.
.
.
2004
.
18/6
18/6
.
( 153
) 184 123
. 8
.
2002 161
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Bulletin of the World Health Organization | January 2008, 86 (1)
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