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May 2018

Prevalence and Causes of Visual Loss Among the Indigenous Peoples of the WorldA Systematic Review

Author Affiliations
  • 1Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
  • 2Department of Surgery, University of Melbourne, Melbourne, Australia
  • 3Department of Ophthalmology, University of Melbourne, Melbourne, Australia
  • 4Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, England
  • 5Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, England
  • 6Department of Ophthalmology, Moorfields Eye Hospital, London, England
  • 7Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  • 8Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
JAMA Ophthalmol. 2018;136(5):567-580. doi:10.1001/jamaophthalmol.2018.0597
Key Points

Question  What is the burden of visual loss and major eye diseases in the indigenous peoples of the world?

Finding  This systematic review of 79 598 participants in 64 unique studies demonstrated that most countries have insufficient data on the burden of visual loss in their indigenous populations. In most cases in which data were available, the prevalence of visual loss and major blinding eye diseases were higher in indigenous than nonindigenous populations.

Meaning  These data suggest that indigenous populations around the world are consistently neglected in eye health research and service delivery programs and therefore may have a greater burden of visual loss.


Importance  Studies have documented a higher disease burden in indigenous compared with nonindigenous populations, but no global data on the epidemiology of visual loss in indigenous peoples are available. A systematic review of literature on visual loss in the world’s indigenous populations could identify major gaps and inform interventions to reduce their burden of visual loss.

Objective  To conduct a systematic review on the prevalence and causes of visual loss among the world’s indigenous populations.

Evidence Review  A search of databases and alternative sources identified literature on the prevalence and causes of visual loss (visual impairment and blindness) and eye diseases in indigenous populations. Studies from January 1, 1990, through August 1, 2017, that included clinical eye examinations of indigenous participants and, where possible, compared findings with those of nonindigenous populations were included. Methodologic quality of studies was evaluated to reveal gaps in the literature.

Findings  Limited data were available worldwide. A total of 85 articles described 64 unique studies from 24 countries that examined 79 598 unique indigenous participants. Nineteen studies reported comparator data on 42 085 nonindigenous individuals. The prevalence of visual loss was reported in 13 countries, with visual impairment ranging from 0.6% in indigenous Australian children to 48.5% in native Tibetans 50 years or older. Uncorrected refractive error was the main cause of visual impairment (21.0%-65.1%) in 5 of 6 studies that measured presenting visual acuity. Cataract was the main cause of visual impairment in all 6 studies measuring best-corrected acuity (25.4%-72.2%). Cataract was the leading cause of blindness in 13 studies (32.0%-79.2%), followed by uncorrected refractive error in 2 studies (33.0% and 35.8%).

Conclusions and Relevance  Most countries with indigenous peoples do not have data on the burden of visual loss in these populations. Although existing studies vary in methodologic quality and reliability, they suggest that most visual loss in indigenous populations is avoidable. Improvements in quality and frequency of research into the eye health of indigenous communities appear to be required, and coordinated eye care programs should be implemented to specifically target the indigenous peoples of the world.