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Vision loss is the third-largest global impairment after anaemia and hearing loss in terms of the number of people affected worldwide. Almost 300m people experience moderate to severe vision impairment and an additional 43m are classified as blind. By 2050 these numbers are expected to increase to 474m and 61m respectively. In Western Europe, cataracts, age-related macular degeneration (AMD), glaucoma and diabetic retinopathy (DR) are the main eye diseases (they account for more than half of all cases of blindness), particularly among those aged 50 or older. More specifically, AMD and diabetic macular edema (DME), a complication of DR, are the leading causes of vision loss in developed countries. This calls for a targeted approach.
Economist Impact examines the global burden of vision loss across key conditions, the causes and consequences of inadequate care now and in the future, and the most promising solutions. Key findings include:
Executive summary
AMD and DR are two of the leading causes of visual impairment worldwide and prevalence is set to grow in the future, taking an unequal toll (on people living with the diseases, and their families and loved ones) based on socio-economic factors. Women are more affected than men, and the poorest in society are more likely to suffer adverse outcomes due to lack of access to timely, high-quality care. By 2040, population ageing could lead to 288m people being affected by AMD (compared with 170m in 2014); likewise, incidence of DR will increase, taking a heavy toll on individuals, their families and loved ones, and wider society.
Health systems are presently not able to meet the demand for eye care, and demand is expected to increase exponentially, particularly as new therapeutic modalities arise. The majority of vision loss can be prevented or treated, yet access to appropriate support is constrained. Factors include a shortage of eyecare specialists; regional inequality in service provision, with rural areas in particular lagging; poorly integrated health systems for diagnosis and referral; high financial cost of care for people affected; treatment intensity of available therapies; lack of public awareness about eye health; and long waiting lists. If these factors are not addressed the chasm between need for and access to care will grow.
AMD and DR are the two leading causes of visual impairment worldwide and prevalence is set to grow in the future, taking an unequal toll (on people living with the diseases, and their families and loved ones) based on socio-economic factors. Women are more affected than men, and the poorest in society are more likely to suffer adverse outcomes due to lack of access to timely, high-quality care. By 2040, population ageing could lead to 288m people being affected by AMD (compared with 170m in 2014); likewise, incidence of DR will increase, taking a heavy toll on individuals, their families and loved ones, and wider society.
Health systems are presently not able to meet the demand for eye care, and demand is expected to increase exponentially, particularly as new therapeutic modalities arise. The majority of vision loss can be prevented or treated, yet access to appropriate support is constrained. Factors include a shortage of eyecare specialists; regional inequality in service provision, with rural areas in particular lagging; poorly integrated health systems for diagnosis and referral; high financial cost of care for people affected; treatment intensity of available therapies; lack of public awareness about eye health; and long waiting lists. If these factors are not addressed the chasm between need for and access to care will grow.
Treatment burden for many people is significant and can lead to suboptimal outcomes if patients are unwilling or unable to adhere to multiple clinic visits and injections. This presents an opportunity to partner with industry to devise innovations that reduce treatment burden. For people who have to endure ongoing treatment through multiple courses of injections into the eye over several years, frequent visits can prove costly and burdensome, particularly for those from rural areas or a lower socioeconomic background, raising barriers to completion of treatment. This burden extends to family members who need to accompany patients to their appointments and care for them. Patients who drop out of chronic treatment will see their disease progress to vision loss, for which care can be more costly, further placing strain on providers. Reasons for dropping out include treatment fatigue, which reduces compliance, but the end result is advanced disease and increased risk of comorbidities.
Reducing the number of specialist clinic visits due to less frequent injections may relieve capacity constraints within ophthalmology services and free up time for the growing demand of eye care. This may also be achieved through bolstering primary care and the number of non-clinician healthcare assistants who can provide treatments, freeing up time for ophthalmologists to handle more complex conditions.International guidelines recommend the use of intravitreal anti-VEGF intraocular
injections as a first-line therapy for neovascular non-age-related macular degeneration and DME. Vision gains seen early on in treatment are frequently not maintained, as treatments require multiple, frequent injections and monitoring visits that may become a burden for many. Alternative treatments, which reduce the number of visits through longer-lasting therapies, are being explored.
Action is needed to tackle preventable sight loss in keeping with the UN General Assembly resolution on vision. There are disparities in access to care that are dependent on socioeconomic backgrounds: those who can afford to pay out of pocket can jump the queue to access care in a timely fashion while those who cannot are forced to wait for increasingly longer periods of time owing to demand for services. Access also varies based on geographic location, with ophthalmology services clustered in urban regions, forcing those living in rural areas to travel greater distances or forego treatments. In the resolution unanimously adopted by UN member countries in 2021, a target to achieve eyecare for all was set for 2030.
Reducing the number of specialist clinic visits due to less frequent injections may relieve capacity constraints within ophthalmology services and free up time for the growing demand of eye care. This may also be achieved through bolstering primary care and the number of non-clinician healthcare assistants who can provide treatments, freeing up time for ophthalmologists to handle more complex conditions.International guidelines recommend the use of intravitreal anti-VEGF intraocular injections as a first-line therapy for neovascular non-age-related macular degeneration and DME. Vision gains seen early on in treatment are frequently not maintained, as treatments require multiple, frequent injections and monitoring visits that may become a burden for many. Alternative treatments, which reduce the number of visits through longer-lasting therapies, are being explored.