Vision impairment and blindness in individuals aged 60 years and older in Latin America and the Caribbean / Discapacidad visual y ceguera en personas mayores de 60 años en América Latina y el Caribe / Deficiência visual e cegueira em indivíduos com 60 anos ou mais na América Latina e no Caribe

[ABSTRACT]. Objective. To determine the prevalence and causes of vision loss and calculate the effective cataract surgery coverage (eCSC) in adults aged 60 years and older in Latin America and the Caribbean in 2020. Methods. The International Agency for the Prevention of Blindness Vision Atlas and the Rapid Assessment of Avoidable Blindness databases were used as data source. The collected data were used to estimate the prevalence and causes of vision loss in people aged 60 years and older, and to determine the eCSC. Results. The overall prevalence of moderate to severe vision impairment (MSVI) and blindness in Latin America and the Caribbean were 14.14% and 2.94%, respectively. Tropical Latin America was the subregion with the highest prevalence of blindness (3.89%) while Southern Latin America had the lowest (0.96%). For both MSVI and blindness, cataract was the main cause of vision loss. The eCSC rates showed great variation, ranging from 4.0% in Guatemala to 75.2% in Suriname. Conclusions. The prevalence of vision loss in adults aged 60 years and older in Latin America and the Caribbean was higher than previous estimates on younger groups. Cataract was the main cause of blindness, and the eCSC indicates that the outcomes from cataract surgery should be improved. Specific actions associated with improving access, integrating eye assessment with primary care programs, expanding the use of telemedicine, and improving data quality should be taken by public health authorities aiming to address vision loss in this group.

[RESUMEN]. Objetivo. Determinar la prevalencia y las causas de la pérdida de visión y calcular la cobertura efectiva de la cirugía de las cataratas en personas mayores de 60 años en América Latina y el Caribe en el 2020. Métodos. Se utilizaron como fuentes la base de datos del Atlas de la Visión de la Agencia Internacional para la Prevención de la Ceguera y la de Rapid Assessment of Avoidable Blindness [evaluación rápida de la ceguera evitable]. Los datos recopilados se utilizaron para estimar la prevalencia y las causas de la pérdida de visión en personas mayores de 60 años y para determinar la cobertura efectiva de la cirugía de las cataratas. Resultados. La prevalencia general de la discapacidad visual moderada a grave y de la ceguera en América Latina y el Caribe fue del 14,14% y el 2,94%, respectivamente. La subregión de América Latina tropical presentó la mayor prevalencia de ceguera (3,89%), mientras que la de América Latina austral registró la menor (0,96%). Tanto en el caso de la discapacidad visual moderada a grave como en el de la ceguera, la causa principal de pérdida de visión fueron las cataratas. Hubo grandes diferencias en la tasa de cobertura efectiva de la cirugía de las cataratas, con valores que iban del 4,0% en Guatemala al 75,2% en Suriname. Conclusiones. La prevalencia de la pérdida de visión en personas mayores de 60 años en América Latina y el Caribe fue superior a la indicada por las estimaciones anteriores en grupos de menor edad. Las cataratas fueron la principal causa de ceguera, y la cobertura efectiva de la cirugía de las cataratas indica la necesidad de mejorar los resultados de estas intervenciones. Las autoridades de salud pública que pretendan abordar la pérdida de visión en este grupo deben adoptar medidas específicas que se asocien a una mejora del acceso, la integración de las exploraciones oftalmológicas en los programas de atención primaria, la ampliación del uso de la telemedicina y la mejora de la calidad de los datos.

[RESUMO]. Objetivo. Determinar a prevalência e as causas da perda de visão e calcular a cobertura efetiva da cirurgia de catarata em adultos com 60 anos ou mais na América Latina e no Caribe em 2020. Métodos. Foram usadas as bases de dados do Atlas da Visão da Agência Internacional para a Prevenção da Cegueira e da Avaliação Rápida da Cegueira Evitável (RAAB, na sigla em inglês) como fonte de dados. Os dados coletados foram usados para estimar a prevalência e as causas da perda de visão em pessoas com 60 anos ou mais e para determinar a cobertura efetiva da cirurgia de catarata. Resultados. A prevalência global de deficiência visual moderada a grave e cegueira na América Latina e no Caribe foi de 14,14% e 2,94%, respectivamente. A América Latina Tropical foi a sub-região com a maior prevalência de cegueira (3,89%), ao passo que a América Latina Meridional teve a menor prevalência (0,96%). Tanto na deficiência visual moderada a grave quanto na cegueira, a catarata foi a principal causa da perda de visão. As taxas de cobertura efetiva da cirurgia de catarata variaram muito, desde 4,0% na Guatemala até 75,2% no Suriname. Conclusões. A prevalência da perda de visão em adultos com 60 anos ou mais na América Latina e no Caribe foi maior do que as estimativas anteriores em grupos de indivíduos mais jovens. A catarata foi a principal causa de cegueira, e a cobertura efetiva da cirurgia de catarata indica que os desfechos dessa cirurgia precisam ser melhorados. Medidas específicas associadas à melhoria do acesso, à integração da avaliação oftalmológica aos programas de atenção primária, à expansão do uso da telemedicina e à melhoria da qualidade dos dados devem ser adotadas pelas autoridades de saúde pública com o objetivo de enfrentar a perda de visão nesse grupo.

Prevalence and causes of the avoidable blindness and low vision in Mongolia / Монголын Анагаах Ухаан

The Rapid Assessment of Avoidable Blindness (RAAB) has been developed as a simple and rapidsurvey methodology that can provide data on the prevalence and main causes of blindness.AimTo assess the prevalence and main causes of avoidable blindness and visual impairment in peopleaged 50 and above in Mongolia.MethodsThe RAAB uses a standard methodology which is documented in the RAAB Instruction Manual (HansLimburg, International Centre for Eye Health, London School of Hygiene and Tropical Medicine).Assuming an estimated prevalence of blindness in persons aged 50+ of 2.14% and a non-complianceof 5%, with a variation to 25% around the estimate of 2.14% at 95% probability, the required samplesize was calculated at 4,040: 101 clusters of size 40. Visual acuity (VA) was measured with a Snellentumbling E chart, using optotype size 18 (60) on one side and size 60 (200) on the other side. Thelens status of all participants was assessed by both torch and distant direct ophthalmoscopy, by anophthalmologist in a shaded or dark environment. The data were analyzed using RAAB Version 4.02(ICEH, London) for pre-defined reports relating to both crude and age and gender adjusted results.ResultsThe survey included 4,040 people aged 50 years and older, of whom 4,029 were actually examined.The coverage was 99.7%. 7 persons (0.2%) were absent and 4 (0.1%) refused to participate in thestudy. The prevalence of bilateral blindness with available correction in the better eye is 2.2 % (95% CI,1.7 - 2.7%); 2.4% in males and 2.2% in females. The prevalence of bilateral severe visual impairment(SVI) is 2.1% and bilateral moderate visual impairment (MVI) is 10.8%. The prevalence of functionallow vision, requiring low vision services, is 4.5%. In people aged 50+, untreated cataract is the mostcommon cause of bilateral blindness with 38.9%, followed by glaucoma (20.0%), non-trachomatouscorneal opacity (13.3%), and other posterior segment disease (7.8%).Conclusion: Untreated cataract and uncorrected refractive errors are the major causes of avoidableblindness and low vision in Mongolia, respectively. Priority should be given to cataract surgery,followed by the development of optical services and PHC and PEC services, as these are the mostcost-effective interventions. These three interventions will address about three thirds (67.8%) of thecauses of blindness and have most impact.