Trends of blindness and visual impairment in individuals aged 70 and older

BACKGROUND: The global ageing population has heightened the importance of eye health, yet comprehensive assessments of blindness and vision impairment (BVI) burden among older adults remain limited. Using Global Burden of Disease 2021 data, we analysed trends and disparities in BVI and major eye diseases across 204 countries and territories from 1990 to 2021 among adults aged ≥70 years. METHODS: Age-standardised prevalence (ASPR), years lived with disability, and average annual percentage change (AAPC) were estimated for BVI and its leading causes, stratified by age, sex, region and Sociodemographic Index (SDI). Temporal trends were assessed using joinpoint regression. RESULTS: Globally, between 1990 and 2021, the number of BVI cases increased 156% (94.5 to 242 million) with an AAPC of 0.11%. Women experienced a faster rise in ASPR than men (AAPC 0.16% vs 0.11%). Age-specific analysis revealed divergent trends: prevalence rose in the 70-84 age group (peak AAPC 1.02% in 70-74 years) but declined in those ≥85 years (AAPC -0.23% in 85-89 years). With increasing SDI, the prevalence rate for BVI and major blinding eye diseases significantly decreased (p<0.001). Regionally, high-income North America showed the largest ASPR reductions (AAPC -0.30%). CONCLUSIONS: Demographic expansion and ageing are the primary drivers of the rise in absolute BVI burden among adults aged ≥70 years since 1990, with persistent inequities across sex and SDI levels. Further country-specific analyses, particularly in settings with limited primary data, will help refine estimates and support future research and service planning.