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A n estimated 45 million people around the world are blind. 1 Most of them have lost their sight to diseases that are treatable or preventable. Eighty percent of them live in the lesser-developed world in countries where chronic economic deprivation is exacerbated by the added challenge of failing vision. Without intervention, the number of individuals with blindness might reach 76 million by 2020 because of a number of factors, primarily the rapid aging of populations in most countries. 2 Since eye disease is seen largely in older people, the projected doubling of the world's population older than 50 years to 2 billion by 2020 has profound effects on the number of those with blindness and low vision.

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Purpose To estimate the prevalence, potential determinants, and proportion of met need for near vision impairment (NVI) correctable with refraction approximately 2 years after initial examination of a multi-country cohort. Design Population-based, prospective cohort study. Participants People aged ≥35 years examined at baseline in semi-rural (Shunyi) and urban (Guangzhou) sites in China; rural sites in Nepal (Kaski), India (Madurai), and Niger (Dosso); a semi-urban site (Durban) in South Africa; and an urban site (Los Angeles) in the United States. Methods Near visual acuity (NVA) with and without current near correction was measured at 40 cm using a logarithm of the minimum angle of resolution near vision tumbling E chart. Participants with uncorrected binocular NVA ≤20/40 were tested with plus sphere lenses to obtain best-corrected binocular NVA. Main Outcome Measures Prevalence of total NVI (defined as uncorrected NVA ≤20/40) and NVI correctable and uncorrectable to >20/40, and current spectacle wearing among those with bilateral NVA ≤20/63 improving to >20/40 with near correction (met need). Results Among 13 671 baseline participants, 10 533 (77.2%) attended the follow-up examination. The prevalence of correctable NVI increased with age from 35 to 50–60 years and then decreased at all sites. Multiple logistic regression modeling suggested that correctable NVI was not associated with gender at any site, whereas more educated persons aged >54 years were associated with a higher prevalence of correctable NVI in Nepal and India. Although near vision spectacles were provided free at baseline, wear among those who could benefit was <40% at all but 2 centers (Guangzhou and Los Angeles). Conclusions Prevalence of correctable NVI is greatest among persons of working age, and rates of correction are low in many settings, suggesting that strategies targeting the workplace may be needed.

The unprecedented partnership for onchocerciasis control that followed Merck's decision to donate Mectizan has inspired the formation of a global initiative for the elimination of all avoidable blindness by the year 2020. 'Vision 2020, the Right to Sight', jointly co-ordinated by the World Health Organization's Programme for the Prevention of Blindness and Deafness and the International Agency for the Prevention of Blindness, was launched in 1999. This initiative's three pillars are disease control, human resource development, and infrastructure development. Vision 2020's achievements to date include the growth of the partnership, to include more than 60 member organizations, the revitalization of prevention activities, the completion of Vision-2020 plans in 40% of all countries and a reduction not only of blindness caused by onchocerciasis but also of blindness caused by trachoma. Cataract remains the leading cause of avoidable blindness.