Global burden of vision impairment due to age-related macular degeneration, 1990-2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Abstract

Background Age-related macular degeneration (AMD) is a growing public health concern worldwide, as one of the leading causes of vision impairment. We aimed to estimate global, national, and region-specific prevalence and disability-adjusted life-years (DALYs) along with tobacco as a modifiable risk factor to aid public policy addressing AMD. Methods Data on AMD were extracted from the Global Burden of Disease, Injuries, and Risk Factor Study 2021 database in 204 countries and territories, 1990-2021. Vision impairment was defined and categorised by severity as follows: moderate to severe vision loss (visual acuity from <6/18 to 3/60) and blindness (visual acuity <3/60 or a visual field <10 degrees around central fixation). The burden of vision impairment attributable to AMD was subsequently estimated. These estimates were further stratified by geographical region, age, year, sex, Healthcare Access and Quality (HAQ) Index, and Socio-demographic Index (SDI) levels. Additionally, the effect of tobacco use, a modifiable risk factor, on the burden of AMD was analysed, and projections of AMD burden were estimated through to 2050. These projections also included scenario modelling to assess the potential effects of tobacco elimination. Findings Globally, the number of individuals with vision impairment due to AMD more than doubled, rising from 3 center dot 64 million (95% uncertainty inverval [UI] 3 center dot 04-4 center dot 35) in 1990 to 8 center dot 06 million (6 center dot 71-9 center dot 82) in 2021. Similarly, DALYs increased by 91% over the same period, from 0 center dot 30 million (95% UI 0 center dot 21-0 center dot 42) to 0 center dot 58 million (0 center dot 40-0 center dot 80). By contrast, age-standardised prevalence and DALY rates declined, with prevalence rates decreasing by 5 center dot 53% (99 center dot 50 per 100 000 of the population [95% UI 83 center dot 16-118 center dot 04] in 1990 to 94 center dot 00 [78 center dot 32-114 center dot 42] in 2021) and DALY rates dropping by 19 center dot 09% (8 center dot 38 [5 center dot 70-11 center dot 53] to 6 center dot 78 [4 center dot 70-9 center dot 32]). These rates showed a consistent decrease in higher SDI quintiles, reflecting the negative correlation between HAQ Index and AMD burden. A general downward trend was observed from 1990 to 2021, with the largest age-standardised reduction occurring in the low-middle SDI quintile. The global contribution of tobacco to age-standardised DALYs decreased by 20%, declining from 12 center dot 45% (95% UI 7 center dot 73-17 center dot 37) in 1990 to 9 center dot 96% (6 center dot 12-14 center dot 06) in 2021. By 2050, the number of individuals affected by AMD is projected to increase from 3 center dot 40 million males (95% UI 2 center dot 81-4 center dot 17) in 2021 to 9 center dot 02 million (5 center dot 72-14 center dot 20) and from 4 center dot 66 million females (3 center dot 88-5 center dot 65) to 12 center dot 32 million (8 center dot 88-17 center dot 08). Eliminating tobacco use could reduce these numbers to 8 center dot 17 million males (5 center dot 59-11 center dot 92) and 11 center dot 15 million females (8 center dot 58-14 center dot 48) in 2050. Interpretation While the total prevalence and DALYs due to AMD have steadily increased from 1990 to 2021, age-standardised prevalence and DALY rates have declined, probably reflecting the effect of population ageing and growth. The consistent decrease in age-standardised rates with higher SDI levels highlights the crucial role of health-care resources and public policies in mitigating AMD-related vision impairment. The downward trend observed from 1990 to 2021 might also be partially attributed to the reduced effect of tobacco as a modifiable risk factor, with declines in tobacco use seen globally and across all SDI quintiles. The burden of vision impairment due to AMD is projected to increase to about 21 center dot 34 million in 2050. However, effective tobacco regulation has the potential to substantially reduce AMD-related vision impairment, particularly in lower SDI quintiles where health-care resources are limited. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd.