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in the Western Pacific Region Eye Health

in the Western Pacific Region

Eye Health

Eye Health in the Western Pacific Region

ISBN 978 92 9062 145 4

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Cover: Top: © WHO/Rosa Panggabean; bottom: © The Fred Hollows Foundation New Zealand/Darren James Internal pages: p. xvii: © WHO/Miguel Jeronimo; pp. xviii, 9, 15, 28, 58, 60, 73, 77, 86, 114: © The Fred Hollows Foundation New Zealand/ Darren James; pp. 1, 13, 23: © WHO/NOOR/Sebastian Liste; pp. 4, 5, 35, 36, 40, 64, 88: © WHO/Yoshi Shimizu; p. 8: © WHO/Until Chan; p. 31: © WHO/Valerie Fernandez; p. 39: © The Fred Hollows Foundation New Zealand/Sam Murray; p. 47: © WHO; p. 54: © WHO/Izarra Azuddin; p. 63: © WHO/Faizza Tanggol; pp. 66, 78, 100: © The Fred Hollows Foundation New Zealand; p. 80: © WHO/Ahmad Yusni

Eye Health in the Western Pacific Region iii

Contents

Foreword vii

Acknowledgements ix

Declaration of interests x

Abbreviations xi

Glossary xii

Executive summary xv

Introduction 1

Purpose and scope 6

Methodology and limitations 7

1. Magnitude and causes of vision impairment 8

1.1 Current magnitude 9

1.2 Trends and projections 13

1.3 Causes of vision impairment 15

1.3.1 Uncorrected refractive error 20

1.3.2 Cataract 23

1.3.3 Age-related macular degeneration 24

1.3.4 Glaucoma 25

1.3.5 Diabetic retinopathy 25

1.3.6 Other causes 28

2. Eye health systems in the Western Pacific 31

2.1 Regional overview 32

2.2 Capacity by health system building block 36

2.2.1 Leadership and governance 36

2.2.2 Service delivery 40

2.2.3 Workforce and infrastructure 65

2.2.4 Financing 71

2.2.5 Eye health information 74

Eye Health in the Western Pacific Regioniv

Contents

3. Recommendations, strategies and tools 80

3.1 Recommendations and strategies 81

3.1.1 Global 81

3.1.2 Regional 82

3.2 Tools and resources 84

Conclusion 87

References 89

Annexes 100

Annex 1. Status of population-based surveys and eye health system assessments 101

Annex 2. WHO eye health system maturity ratings 103

Annex 3. Key WHO eye health data tools and sources 105

Annex 4. Integration of eye health across the health system 106

Annex 5. Impact and cost–effectiveness of eye health investment 109

Eye Health in the Western Pacific Region v

Contents

Figures and tables

Figures

Fig. 1. YLD due to vision impairment in the Western Pacific, by age and sex, 2021 2 Fig. 2. People with distance vision impairment in the Western Pacific, by severity and country income level: Number of people (A) and proportion of people (B), 2024

Fig. 3. National age- and sex-adjusted prevalence in people aged 50+: Blindness, by sex (A) and distance vision impairment, by severity of vision impairment (B), 2015–2024

Fig. 4. Estimated number of people with distance vision impairment globally, by severity of vision impairment between 2020 and 2050

Fig. 5. People aged 50+ with blindness and moderate-to-severe vision impairment globally, by leading cause: Number of people (A) and age-standardized prevalence (B), 1990 and 2020

Fig. 6. Proportion of blindness in people aged 50+ in six Western Pacific Member States, by leading cause, 2015–2024

Fig. 7. Proportion of overall blindness in two regions in Malaysia, by leading cause, 2023 18 Fig. 8. Change in crude rate of YLD due to uncorrected refractive error in Western Pacific Member States between 2000 and 2021

Fig. 9. Change in crude rate of YLD due to cataract in Western Pacific Member States between 2000 and 2021

Fig. 10. Crude and age-standardized prevalence of diabetes in the Western Pacific between 1990 and 2022 in people aged 18+ and 30+, by sex

Fig. 11. Estimated number of people with diabetes, diabetic retinopathy and vision- threatening diabetic retinopathy in the Western Pacific, 2021 and 2050

Fig. 12. Member States reporting existence of an operational policy, strategy or action plan for eye health, by region, 2023

Fig. 13. New Zealand’s eye health leadership and governance maturity level scores, 2022 38 Fig. 14. Eye health inequities in Papua New Guinea in people aged 50+, by region and sex, 2017

Fig. 15. Proportion of Member States reporting availability of public sector services for detecting, managing and treating eye conditions, by WHO region, 2023

Fig. 16. Global and regional modelled estimates of effective cataract surgical coverage (eCSC6/18) in people aged 50+, by sex, 2025

Fig. 17. Global and regional modelled estimates of effective cataract surgical coverage (eCSC6/18) in people aged 50+ between 2000 and 2030, by sex

Fig. 18. Number and proportion of Member States in the Western Pacific reporting availability of diabetic retinopathy screening in the public health system, 2021 and 2023

Fig. 19. Number and proportion of Member States in the Western Pacific reporting availability of retinal photocoagulation in the public health system between 2015 and 2023

Eye Health in the Western Pacific Regionvi

Contents

Tables

Table 1. Member States of the WHO Western Pacific Region and corresponding World Bank income classification, April 2025

Table 2. Status of elimination of trachoma as a public health problem in the Western Pacific, May 2026

Table 3. Eye health links with climate change 30 Table 4. Summary of eye health system challenges in the Western Pacific Region 34 Table 5. Reported availability of preschool and school eye care programmes by Western Pacific Member States, 2023

Table 6. Age- and sex-adjusted estimates of effective cataract surgical coverage and relative quality gaps in four Western Pacific Member States, 2017–2024

Table 7. Availability of provision of spectacles in the public health system reported by Western Pacific Member States, 2023

Table 8. Availability of low-vision services at primary and tertiary health-care levels, by country income level and geographical grouping, 2017

Table 9. Optometrist-to-population ratios in five Western Pacific Member States, by country income level, 2024

Table 10. Key eye health data gaps in the Western Pacific Region 79 Table 11. Summary of key WHO eye health tools and resources 84 Table A1.1. Status of eye health population-based surveys and eye health system assessments in the Western Pacific, 2025

101

Table A2.1. WHO eye health system maturity ratings 103 Table A4.1. Examples of eye care integration across the health system 106

Fig. 20. Global and regional age-standardized mean eREC in people aged 50+: Overall (A) and by sex (B), 2023

Fig. 21. National modelled crude eREC in people aged 50+ in Western Pacific Member States, by sex, 2023 and 2030

Fig. 22. Prevalent cases of rehabilitation need for vision loss (per 100 population) across the life course in the Western Pacific, 2021

Fig. 23. Map of the eye care workforce in PICs, by cadre, 2025 69 Fig. 24. Status of population-based surveys and eye health system assessments utilizing ECSAT in the Western Pacific, 2016–2025

Fig. A5.1. Relationships between vision impairment and general health 110 Fig. A5.2. Improving eye health and advancing the SDGs 112

Eye Health in the Western Pacific Region vii

Foreword

It is with great honour that the World Health Organization (WHO) Regional Office for the Western Pacific presents this report on eye health, the first of its kind for our Region. This publication is not only a collection of data and recommendations, but a reflection of the lived realities of millions of people for whom the ability to see − or the loss of it − shapes daily life.

The scale of the challenge cannot be overstated. In 2024, approximately 158 million people in the Western Pacific Region were living with distance vision impairment, including more than 10 million who were blind, while the true burden of near vision impairment remains unknown due to the lack of reliable data.

These figures reflect more than statistics: they represent a parent unable to watch their child grow; an older person who can no longer move through the world with confidence; and a young student whose future narrows with every line they cannot read. Vision impairment disproportionately affects those who already face disadvantage, further widening health and socioeconomic inequities.

The urgency of the challenge is growing. The Western Pacific includes some of the world’s most rapidly ageing populations, and the number of older people in the Region is projected to double by 2050. At the same time, noncommunicable diseases are increasing, bringing with them a rising burden of diabetic retinopathy and other chronic eye conditions that require long-term care. Myopia is also increasing rapidly, particularly among children and young people in parts of East and Southeast Asia. Together, these trends are reshaping the profile of vision impairment in the Region. Yet because most vision impairment is preventable or treatable, there is also a significant opportunity to reduce this burden through sustained investment and effective action.

There is real cause for encouragement and pride in what has already been achieved. Countries across the Region have made important progress in reducing avoidable blindness, developing the eye care workforce, strengthening eye care policies and plans, adopting digital innovation and integrating eye care into broader health systems. Strong regional partnerships have helped train more than 370 eye care professionals across Pacific island countries and areas over the past two decades. These achievements show what is possible with commitment and collaboration.

Eye Health in the Western Pacific Regionviii

Foreword

Despite this progress, significant gaps remain. Too many people lack access to essential services, including cataract surgery and appropriate refractive correction. Eye care is often fragmented, insufficiently integrated into primary health care, and difficult to access for people in remote areas and island communities. In the Region, high out-of-pocket costs still keep essential eye care out of reach for too many families − this further underscores the need to strengthen financial protection and equitable access to care.

Meeting these challenges will require sustained commitment and coordinated action. Strengthening integration within and beyond the health system, investing in workforce and service delivery, improving financial protection, and building strong partnerships across governments, civil society, the private sector and communities will all be essential.

Our regional vision, Weaving Health for Families, Communities and Societies in the Western Pacific Region (2025–2029), calls for bringing these efforts together into a stronger, more resilient whole. Eye health is an essential part of that vision. It underpins health, well-being and development, and investment in eye care delivers substantial social and economic returns. Advancing integrated people-centred eye care is therefore central to universal health coverage and to ensuring that no one is left behind.

I commend this report to ministries of health, partners and stakeholders across the Region. Through collective action, we can expand equitable access to quality-assured eye care so that all people have the opportunity to live healthy, productive and fulfilling lives, and where vision cannot be restored, to access rehabilitation, assistive products and inclusive services that support full participation in society.

Dr Saia Ma’u Piukala WHO Regional Director for the Western Pacific

Eye Health in the Western Pacific Region ix

Acknowledgements

This report was prepared by the World Health Organization (WHO) Regional Office for the Western Pacific, initiated and overseen by Dr Kidong Park, Director of the Division of Programme Management. Oversight was also provided by Dr Huong Tran, Director of the Division of Health Promotion, Disease Prevention and Control (DPC); and Dr Hiromasa Okayasu, Director of the Division of Data, Strategy and Innovation (DSI).

Technical oversight, guidance and direction in the development of this report was provided by Mr Dilip Hensman, Coordinator, Health Information and Digital Health unit, DSI; and Dr Enrique Domingo, Coordinator, Noncommunicable Diseases unit, DPC.

The writing team consisted of Ms Danielle Petrie-Deely (Health Information and Digital Health unit, DSI), Professor Teresita R. Castillo (Chairperson, Department of Ophthalmology and Visual Sciences, University of the Philippines, Manila) and Dr Mario Bustos-Rubilar (Noncommunicable Diseases unit, DPC).

Technical contributions were provided by Mr Shanlong Ding, Mr Robert Arciaga and Dr Ana Méndez-López (Health Information and Digital Health unit, DSI). Data-related technical contributions were also provided by Dr Stuart Keel, Dr Vera Carneiro and Dr Xiaotong Han from the Vision and Eye Care Programme in the Department of Noncommunicable Diseases at WHO headquarters.

Special thanks to the Global Eye Health unit at the Singapore National Eye Centre, a WHO Collaborating Centre for the Prevention of Blindness and Vision Impairment, for reviewing the document.

The Fred Hollows Foundation New Zealand is gratefully acknowledged for its technical and in-kind contribution to the development of this report.

Eye Health in the Western Pacific Regionx

All external experts and contributors involved in the development of this report completed the World Health Organization Declaration of Interests process. No conflicts of interest – financial, professional or personal – were identified that were judged to influence the independence, objectivity or integrity of this work. Given the report uses secondary data, no ethics approvals were required.

Declaration of interests

Eye Health in the Western Pacific Region xi

Abbreviations

CSOM cataract surgical outcome monitoring

ECIM Eye Care Indicator Menu

ECSAT Eye Care Situation Analysis Tool

eCSC effective cataract surgical coverage

EENC Early Essential Newborn Care

eREC effective refractive error coverage

GBD Global Burden of Disease

GPW 14 WHO Fourteenth General Programme of Work, 2025–2028

HIS health information systems

IAPB International Agency for the Prevention of Blindness

ICD-11 International Classification of Diseases 11th Revision

ICOPE Integrated Care for Older People

IPEC integrated people-centred eye care

NCD noncommunicable disease

NGO nongovernmental organization

PHC primary health care

PICs Pacific island countries and areas

RAAB Rapid Assessment of Avoidable Blindness

SDG Sustainable Development Goal

STEPS STEPwise approach to NCD risk surveillance

UHC universal health coverage

VLEG Vision Loss Expert Group

VLEG–GBD Vision Loss Expert Group–Global Burden of Disease

WHO World Health Organization

YLD years lived with disability

Eye Health in the Western Pacific Regionxii

Glossary

Age-related macular degeneration: Progressive disease affecting the central area of the retina (macula) responsible for detailed vision, leading to dark patches, shadows or distortion of the central vision. Usually affects people over 60, but can occur earlier.

Assistive technology: An umbrella term for assistive products and their related systems and services that help maintain or improve an individual’s functioning related to vision, cognition, communication, hearing, mobility and self-care, thus enabling their health, well-being, inclusion and participation. Vision-related assistive products include spectacles, magnifiers, braille equipment, talking or touching watches and white canes.

Cataract: Cloudiness in the lens of the eye, leading to increasingly blurred vision. The risk of developing cataract increases with age.

Diabetic retinopathy: A complication of diabetes mellitus characterized by damage to blood vessels in the retina that become leaky or blocked. Vision loss most commonly occurs due to swelling in the central part of the retina, which can lead to vision impairment. Abnormal blood vessels can also grow from the retina, which can bleed or cause scarring of the retina and blindness.

Disability: In the context of eye health, disability refers to the impairments, limitations and restrictions that a person with an eye condition faces in their interactions with their environment – physical, social or attitudinal. As outlined in the 2019 WHO World report on vision:

In the International Classification of Functioning, Disability and Health (ICF), disability encompasses impairments, the difficulties a person may have in carrying out activities such as self-care, and the problems they experience in involvement in everyday life situations, such as going to school or work.1 According to the ICF, the disability experienced is determined not only by the eye condition, but also by the physical, social and attitudinal environment in which the person lives, and the possibility of accessing quality eye care, assistive products (such as spectacles), and rehabilitation services. (p. 14)

Effective cataract surgical coverage (eCSC): A health system performance indicator that measures the proportion of people who have received cataract surgery and have a resultant good-quality outcome relative to the number of people in need of cataract surgery.2,3

1 This is consistent with the understanding of disability in the United Nations Convention on the Rights of Persons with Disabilities. 2 Although the global reporting framework will monitor progress using the 6/12 threshold, WHO proposes that countries report eCSC at the cataract surgical thresholds most applicable to their context. 3 See the WHO Report on the 2030 Targets on Effective Coverage of Eye Care and McCormick et al. (2026) for more information about this indicator, including the method of calculation.

https://iris.who.int/handle/10665/363158 https://doi.org/10.1016/S2214-109X(25)00435-8

Eye Health in the Western Pacific Region xiii

Glossary

Effective refractive error coverage (eREC): A health system performance indicator that measures the proportion of people who have received refractive error services (that is, spectacles, contact lenses or refractive surgery) and have a resultant good-quality outcome relative to the number of people in need of refractive error services.4

Glaucoma: Progressive damage to the optic nerve. Initially, loss of vision occurs in the periphery and can progress to severe vision impairment.

Low vision and vision rehabilitation services:5 Low vision and vision rehabilitation services are for people who have residual vision that can be used and enhanced by aids, optimizing their everyday functioning. Services may include provision of habilitation, rehabilitation, assistive technology, and assistance and support services. Vision rehabilitation refers to a continuum of activities from assessment of visual functions through to provision of appropriate assistive devices and technologies, plus social inclusion, all geared towards optimizing visual functioning and a sense of well-being.

Optical services: The provision of correction spectacles or contact lenses.

Refractive error: A common vision problem that occurs across the lifespan due to an abnormal shape or length of the eyeball, or from lens abnormality, which prevents correct focusing of light on the retina, leading to blurred vision. Uncorrected refractive error is the leading cause of vision impairment in both adults and children. There are several types of refractive error:

• Myopia (short-sightedness or near-sightedness): Difficulty in seeing distant objects clearly. • Hyperopia (long-sightedness or far-sightedness): Difficulty in seeing close objects clearly. • Astigmatism: Distorted vision resulting from irregular curvature of the cornea or lens of

the eye, resulting in difficulty in seeing distant and close objects clearly. • Presbyopia: Difficulty in seeing objects at near distance that is associated with

increasing age (that is, after 40 years of age) and occurs almost universally.

Refractive services: Assessment of the corrective needs of a person with uncorrected refractive error.

Vision impairment: Vision impairment is a broad term for reduced vision that affects daily life, even with spectacles or contact lenses. It is usually categorized by presenting visual acuity (with spectacles if worn) in the better eye. The International Classification of Diseases 11th Revision (ICD-11) classifies vision impairment into two groups: distance vision impairment and near vision impairment. Visual acuity is a simple, non-invasive measure of the visual system’s ability to discriminate two high-contrast points in space. Distance visual acuity is the most common clinical measurement of visual function.

• Distance vision impairment: Assessed using a vision chart at a fixed distance, commonly six metres (or 20 feet). The smallest line read on the chart is written as a fraction, where the numerator refers to the distance at which the chart is viewed, and the denominator is the distance at which a so-called healthy eye can read that line of the vision chart.

4 See the WHO Report on the 2030 Targets on Effective Coverage of Eye Care and Bourne et al. (2025) for more information about this indicator, including the method of calculation. 5 The term “low vision” as used here refers to functional low vision and must not be confused with the WHO definitions of moderate and severe vision impairment.

https://icd.who.int/en/ https://icd.who.int/en/ https://iris.who.int/handle/10665/363158 https://doi.org/10.1016/S2214-109X(25)00194-9

Eye Health in the Western Pacific Regionxiv

Glossary

Category Visual acuity in the better eye

Worse than: Equal to or better than:

Mild vision impairment 6/12 6/18

Moderate vision impairment 6/18 6/60

Severe vision impairment 6/60 3/60

Blindness 3/60

Near vision impairment N6 or M 0.8 at 40 cm

Note: Severe vision impairment and blindness are also categorized according to the degree of constriction of the central visual field in the better eye to less than 20 degrees or 10 degrees, respectively.

Source: World Health Organization (1).

• Near vision impairment: In population surveys, near vision impairment is commonly classified as a presenting near visual acuity of less than N6 or M 0.8 at 40 centimetres, where N refers to print size based upon the point system as used in the printing industry, and 6 is a font size equivalent to newspaper print.

Classification of severity of vision impairment is based on visual acuity in the better eye, as outlined in the following table:

Eye Health in the Western Pacific Region xv

Eye health is a universal yet profoundly underprioritized health and development issue in the World Health Organization (WHO) Western Pacific Region. Vision impairment exacts a heavy toll across the life course, limiting educational attainment, workforce participation and quality of life, and elevating the risk of injury, poverty and premature mortality. In 2021 there were approximately 4.5 million years lived with disability due to vision impairment across the Region. In 2024, an estimated 157.9 million people in the Region were living with distance vision impairment, including approximately 10.5 million who were blind, representing roughly one quarter of the global burden. As no reliable regional estimate for near vision impairment is currently available, the true overall vision impairment burden is substantially greater than the distance vision impairment figure suggests.

This burden of vision impairment and blindness is greatest among underserved groups including women, Indigenous communities, people in middle-income countries and older adults. Globally, about 80% of people with vision impairment are aged 50 years and above. However, vision impairment is not limited to older age groups. Approximately one third of children and adolescents now have myopia globally, while in the Western Pacific Region, rates in several East and Southeast Asian countries have increased dramatically.

Looking ahead, the overall burden of vision impairment is projected to rise sharply, driven by population growth, ageing, urbanization and lifestyle changes, including increased near vision activity and reduced time outdoors. At the same time, proven eye care interventions, including cataract surgery and spectacle provision, are among the most cost-effective in all of health care. These interventions generate an estimated US$ 36 return for every US$ 1 invested in low- and middle-income countries, making action on eye health central to improving health outcomes and achieving broader development goals.

This report synthesizes evidence from diverse sources to describe the magnitude and causes of vision impairment in the Western Pacific Region (Section 1), provides a snapshot of eye health system capacity (Section 2), and outlines recommendations, strategies and tools to support countries in advancing integrated people-centred eye care (IPEC) (Section 3).

Uncorrected refractive error and cataract remain the dominant causes of distance vision impairment in the Region. Together they account for approximately 75% of global moderate-to-severe vision impairment and half of all global blindness. Age-related macular degeneration, glaucoma and diabetic retinopathy are also significant contributors. The epidemiological profile is continuing to shift towards noncommunicable eye conditions – a trend that will place mounting pressure on health systems. Diabetic retinopathy is an especially urgent concern. Fuelled by the Region’s high and rising rates of type 2 diabetes, it is the only leading cause of blindness for which global age-standardized prevalence rose between 1990 and 2020. Scenario estimates suggest that of 158 million people living with

Executive summary

Eye Health in the Western Pacific Regionxvi

Executive summary

diabetes in the Western Pacific Region in 2021, approximately 35 million were expected to have diabetic retinopathy and 10 million vision-threatening diabetic retinopathy. By 2050, these could increase to approximately 73 million and 20 million, respectively. Encouragingly, the Region has made substantial progress against trachoma, with eight countries having achieved WHO validation of elimination, most recently, Australia in 2026, and Fiji and Papua New Guinea in 2025. However, trachoma remains a public health problem requiring interventions in three countries: Kiribati, Naoero and Solomon Islands.

The Western Pacific Region has made meaningful strides in strengthening its eye health systems over the past decade. Subregional training programmes have produced more than 370 eye care professionals across 14 Pacific island countries and areas, up from a baseline of around three eye health personnel roughly two decades ago, with about 73% of these graduates still practising in the Pacific. Availability of retinal photocoagulation treatment doubled from 33% in 2015 to 67% in 2023. Advocacy at community, national, regional and global levels − including the landmark 2021 United Nations General Assembly resolution on vision − has raised the profile of eye health as a public health and development priority. Despite this progress, critical gaps persist. Among people aged 50 years and above, effective cataract surgical coverage is estimated at 53.8% and effective refractive error coverage at 63.2% in the Region. This means that almost half of people needing cataract surgery and more than one third requiring spectacle correction are not receiving effective interventions.

Although the proportion of Member States with an operational eye health policy, strategy or action plan has more than doubled since 2021 (from 15% to 33%), only one in three had one in place in 2023. Eye care services remain fragmented and insufficiently integrated into primary health care, out-of-pocket costs present a persistent barrier, and workforce shortages and maldistribution constrain delivery, particularly in geographically isolated communities and middle-income settings. Moreover, weak health information systems undermine evidence- informed planning. Eye health inequities are a recurring theme: women and girls, people with disabilities, Indigenous communities and people living in rural and remote areas face disproportionate barriers to care and experience worse eye health outcomes. The COVID-19 pandemic disrupted eye care services and diverted resources. Climate change is expected to exacerbate eye health challenges further, increasing the incidence of certain eye conditions and hindering access to care in remote and island communities.

The case for action is compelling. With approximately 90% of vision impairment preventable or treatable with existing interventions, every investment in eye care offers transformative returns, for individuals, for health systems and for the broader development agenda. Advancing IPEC and embedding eye care within and beyond health systems to deliver a continuum of promotive, preventive, curative and rehabilitative services where and when people need them, is the essential vehicle for realizing this opportunity. This report echoes and builds on existing recommendations from regional experts and stakeholders, emphasizing strengthened engagement with noncommunicable disease programmes, education and other sectors; systematic identification and documentation of eye health needs; and effective use of WHO eye health tools and resources to implement IPEC.

Eye Health in the Western Pacific Region xvii

Executive summary

The Western Pacific Region stands at a critical juncture. Achievements to date − from policy development and workforce expansion to local innovation and subregional collaboration − demonstrate what sustained commitment can achieve. Yet millions of people remain without access to care. By implementing the recommendations in this report, countries can accelerate progress towards universal health coverage for eye care and the 2030 global targets endorsed by the World Health Assembly. These include a 40-percentage-point increase in effective refractive error coverage and a 30-percentage-point increase in effective cataract surgical coverage between 2020 and 2030, enabling millions more people to see clearly and lead healthy, productive lives. With political commitment, adequate financing and the integration of eye care across health systems and sectors, equitable access to quality-assured eye health services for all people in the Western Pacific Region is within reach and will contribute to better health outcomes and to the Region’s socioeconomic development for decades to come.

Cambodia. A girl experiments with different

lenses for her first pair of glasses at the Khmer–Soviet

Friendship Hospital.

Fiji. A 6-year-old girl celebrates after undergoing cataract surgery at the Pacific Eye Institute.

Eye Health in the Western Pacific Region 1

Eye health is a universal concern – nearly everyone will require eye care services at some point in their life. Yet this remains an underserved area, particularly in the World Health Organization (WHO) Western Pacific Region. As The Lancet Global Health Commission on Global Eye Health reported in 2021, eye health has been marginalized as a luxury for wealthy or urban areas and largely neglected by bilateral and multilateral donors (2). Meanwhile, efforts to address noncommunicable diseases (NCDs) have overlooked the significant impacts of noncommunicable eye conditions (2, 3).

This neglect has resulted in persistently high rates of avoidable vision impairment and blindness, with profound consequences for individuals, families, communities, societies and economies. Vision loss affects every aspect of life – from early childhood development and education to workforce participation and healthy ageing, with heightened risk of falls and road traffic accidents. In older adults, vision impairment is also associated with accelerated cognitive decline and dementia, depression, social isolation and increased mortality risk (2). Early childhood vision impairment has lifelong impacts, disrupting psychomotor and cognitive development during critical periods (2).

Eye care interventions are among the most cost-effective in all of health care. Cataract surgery is one of the highest-impact health interventions and approximately US$ 36 is returned for every dollar invested in cataract and refractive error interventions in low- and middle-income countries (4, 5). Annex 5 includes further information about the impacts and cost–effectiveness of eye health investment.

In 2021, vision impairment accounted for approximately 4.5 million years lived with disability (YLD) in the Region (females: 2.5 million; males: 1.9 million) and 21 million YLD globally (6). The highest burden occurs in the 65–74 age cohort, as reflected in Fig. 1.

Introduction

Philippines. A man with a vision impairment receives walking

training with a physical therapist at the Prosthetic and Orthotic Clinic of the University of the East Ramon

Magsaysay College of Rehabilitation Sciences and Department of

Rehabilitation Medicine in Quezon City.

Eye Health in the Western Pacific Region2

Introduction

The burden of vision impairment and blindness falls disproportionately on underserved populations including women, people with disabilities, Indigenous peoples, older adults and rural communities. An estimated nine out of 10 blind people live in low- and middle- income countries, while women represent 55% of all blindness globally (2). Even after age standardization to adjust for longer life expectancy in women, for every 100 men with moderate-to-severe vision impairment, there are approximately 112 women affected (2). Meanwhile, gender disparities in vision impairment rates in many countries of the Western Pacific Region exceed global rates (7).

The COVID-19 pandemic further exacerbated these challenges, causing direct and indirect impacts on eye health. These included ocular manifestations associated with COVID-19 infection, worsening of conditions due to increased time indoors, and deprioritization of eye care (8) (Philippine Department of Health, unpublished report: Eye care situation analysis in the Philippines, 2025). In China, lockdowns were linked to rising childhood myopia, and in Australia, cataract surgeries declined by 71% early in the pandemic (9, 10). Meanwhile, Fiji experienced diabetic eye care backlogs likely to persist for years (11).

Despite these setbacks, eye health has gained recognition as a public health and development priority. A landmark 2021 United Nations General Assembly resolution linked eye health improvements to at least nine of the 17 Sustainable Development Goals (SDGs), affirming that universal access to eye care is essential for advancing the 2030 Agenda for Sustainable Development (12). The World Health Assembly strengthened this momentum through resolutions on integrated people-centred eye care (IPEC) (Box 1) in 2020 and on sensory impairments in 2025.

Fig. 1. YLD due to vision impairment in the Western Pacific, by age and sex, 2021

100

200

300

400

500

600

700

YL D

(in th

ou sa

nd s)

Age

Sex  Female  Male

U nd

er 5

5– 9

10 –1

15 –1

20 –2

25 –2

30 –3

35 –3

40 –4

45 –4

50 –5

55 –5

60 –6

65 –6

70 –7

75 –7

80 –8

85 –8

90 –9

41 68 67 57 51 59 84 91 109 190

300

398 404

628 628

525

399

239

95 28

95 +

Source: Institute for Health Metrics and Evaluation (6).

Eye Health in the Western Pacific Region 3

Introduction

Box 1. Integrated people-centred eye care

WHO defines integrated people-centred eye care (IPEC) as services that are managed and delivered so that people receive a continuum of health interventions covering promotion, prevention, treatment and rehabilitation to address the full spectrum of eye conditions according to their needs; coordinated across the different levels and sites of care within and beyond the health sector; and that recognizes people as participants and beneficiaries of these services, throughout their life course (1, 13). Through IPEC, WHO envisions all people having equitable access to eye health services, which are essential for the achievement of universal health coverage (UHC).

The work of WHO involves supporting the development of global indicators and targets to monitor eye health progress in consultation with Member States. In 2021, the Seventy-fourth World Health Assembly endorsed measurable 2030 targets for effective cataract surgical coverage (eCSC) and effective refractive error coverage (eREC) (Box 2) (14).

Box 2. Global eye health targets for 2030

Member States are encouraged to monitor and report progress towards the following 2030 targets:

• a 40-percentage-point increase in eRECa

• a 30-percentage-point increase in eCSC.b

Effective coverage indicators are WHO’s preferred approach to monitoring health service coverage because they incorporate access and quality dimensions of UHC in a single metric. eCSC provides a snapshot of the availability of high-level surgical services in Member States, while eREC is relevant across the life course and involves ongoing access to, and uptake of, services. The WHO Fourteenth General Programme of Work, 2025– 2028 (GPW 14) includes eREC – the first time an eye health indicator has been included in WHO’s global workplan.

ᵃ Countries with a baseline eREC of 60% or higher should strive for universal coverage. Countries should aim to achieve an equal increase in effective coverage of near and distance refractive error in all relevant population subgroups, independent of baseline estimates. ᵇ Countries with a baseline eCSC of 70% or higher should strive for universal coverage. Countries should aim to achieve an equal increase in effective coverage of cataract surgery in all relevant population subgroups, independent of baseline estimates.

Eye Health in the Western Pacific Region4

Introduction

Mongolia. An ophthalmologist examines a patient at a health centre.

These recent global commitments build on several decades of work by WHO and its partners in eye health, including long-standing support for Member States of the Western Pacific Region. Following a 1975 World Health Assembly resolution on blindness and WHO’s first Prevention of Blindness programme in 1978, a coalition of nongovernmental organizations (NGOs) launched “VISION 2020: The Right to Sight” in 1999. Aiming to eliminate avoidable blindness, this initiative unified national and global advocacy efforts. It was followed by six eye health World Health Assembly resolutions between 2003 and 2025. The most recent resolution, titled “Primary prevention and integrated care for sensory impairments including vision impairment and hearing loss, across the life course”, launched a new integrated approach (15). Evidence supports this approach, as both these sensory impairments often affect the same populations and benefit from similar community-based interventions (16). Furthermore, addressing both sensory impairments simultaneously supports greater alignment of efforts and maximization of resources, particularly in low- and middle- income settings. WHO convened a regional expert meeting in 2025 in the Western Pacific to provide recommendations for sensory function interventions and to draft regional actions on sensory health (17).

Globally, WHO advances eye health through strategies guided by World Health Assembly resolutions and WHO’s World report on vision

Eye Health in the Western Pacific Region 5

Introduction

Marshall Islands. A woman has her eyes examined at Majuro Hospital.

published in 2019, which established a framework for IPEC (1). Current priorities include monitoring progress towards 2030 global targets, supporting the assessment of eye care services and wider eye health systems and integrating eye care within health systems. A further priority is expanding access to refractive error services through the Global SPECS 2030 initiative, as well as annual awareness raising and advocacy through World Sight Day and other projects.

Given that eye health affects people of all ages and cuts across many sectors and programmes, advancing IPEC in the Region requires long-term strategic investment as well as a multi-stakeholder approach involving WHO, governments, development partners, donors and the private sector. Urgent action is required to improve existing interventions and develop and test innovative approaches that deliver quality-assured services at a greater scale. This is particularly crucial given current workforce shortages, ageing populations and changing eye disease epidemiology requiring comprehensive long-term care.

This report responds to that call. It aims to generate evidence, raise awareness and accelerate progress towards IPEC in the Western Pacific Region in the pursuit of UHC and ultimately healthier families, communities and societies.

Eye Health in the Western Pacific Region6

Introduction

Purpose and scope This report synthesizes data from diverse sources to accelerate action to advance IPEC and reduce avoidable vision impairment in the Western Pacific Region. The report addresses, and is structured around, three key areas:

1. Burden and causes: Current estimates of vision impairment prevalence and major causes, including estimates of the future diabetic retinopathy burden in the Region.

2. System capacity: A snapshot of eye health system capacity using the WHO Eye Care Situation Analysis Tool (ECSAT).

3. Strategies and tools: Key recommendations, strategies and tools to support countries in advancing IPEC.

This report is intended primarily for governments, ministries of health, development partners, professional societies and wider civil society. It aims to inform planning, priority-setting and monitoring of eye health within UHC and related national strategies.

As of 2026, the Western Pacific Region encompasses 38 countries and areas with approximately 2.2 billion people – over a quarter of the world’s population. Spanning from Mongolia to the Pitcairn Islands and south to New Zealand, the Region is home to immense diversity, including in terms of history, language, culture and geography.

This report focuses on the 27 Member States of the Western Pacific Region as of April 2025 (see Table 1). Analysis was completed prior to the reassignment of Indonesia from the WHO South-East Asia Region to the WHO Western Pacific Region in May 2025. Therefore, unless explicitly stated, data for Indonesia are not included in any Western Pacific regional statistics throughout this report.

Countries across the Region vary dramatically: China has 1.4 billion people while Niue has approximately 1800. Populations are either growing or declining, young or rapidly ageing. Ten Member States are classified by the World Bank as lower-middle-income, seven are upper- middle-income, while eight are high-income.6 Health systems range from strong and well resourced to underdeveloped and resource-constrained, creating significant health disparities both between and within countries.

6 Two Member States, Cook Islands and Niue, are not classified because they are not World Bank member countries and do not report validated gross national income per capita data required for inclusion in the World Bank’s annual income classification.

https://iris.who.int/handle/10665/356021 https://iris.who.int/handle/10665/356021 https://www.who.int/westernpacific/about/where-we-work

Eye Health in the Western Pacific Region 7

Introduction

Table 1. Member States of the WHO Western Pacific Region and corresponding World Bank income classification, April 2025

Note: Income groupings reflect FY25 World Bank classification used when the analysis was conducted. In July 2026, Micronesia (Federated States of), the Philippines and Viet Nam were reclassified as upper-middle-income.

Lower-middle- income countries

Upper-middle- income countries

High-income countries

Not classified

Cambodia Kiribati Lao People’s Democratic Republic Micronesia (Federated States of) Papua New Guinea Philippines Samoa Solomon Islands Vanuatu Viet Nam

China Fiji Malaysia Marshall Islands Mongolia Tonga Tuvalu

Australia Brunei Darussalam Japan Naoero New Zealand Palau Republic of Korea Singapore

Cook Islands Niue

Methodology and limitations The report draws on both peer-reviewed and grey literature to provide an overview of the status of eye health across the Region. A targeted literature review was undertaken to identify recent relevant sources of information at global, regional and country levels across both public and non-public databases and repositories. These included the Global Health Observatory; Institutional Repository for Information Sharing; Global Information Full Text; Research4Life; and the Rapid Assessment of Avoidable Blindness repository.

Priority was given to population-based eye health surveys, WHO-endorsed global models and national data validated by ministries of health for the 27 Member States of the Western Pacific Region. Given limited published data in some areas, grey literature sources were incorporated by triangulating information across multiple sources to verify accuracy. Unpublished sources not in the public domain are cited sparingly. However, the majority of these sources are ministry of health-led prevalence studies or health system assessment reports adhering to robust methodologies such as the Rapid Assessment of Avoidable Blindness (RAAB) and ECSAT. Sources published in recent years were prioritized, with the majority published within the last 10 years.

As a result of limiting literature searches to the English language, relevant sources may have been excluded from this report. In addition, relevant data may have been omitted since a targeted literature review rather than a systematic review was conducted.

Additional resources and information are listed in the annexes, including status of recent population-based surveys and eye health system assessments in the Western Pacific Region (Annex 1), key WHO eye health data tools and sources (Annex 3) and examples of integration of eye health across the health system (Annex 4).

https://www.who.int/data/gho https://iris.who.int/home https://fc7jk4ac4t.search.serialssolutions.com/ https://www.research4life.org/ https://www.raab.world/survey-data

China. A child undergoes an eye examination.

Magnitude and causes of vision impairment1

Eye Health in the Western Pacific Region 9

1. Magnitude and causes of vision impairment

1.1 Current magnitude Globally, an estimated 596 million people had a distance vision impairment in 2020; 43 million of these were blind (18).7 Across the Western Pacific Region, despite significant data gaps and variability in eye health surveillance, available evidence indicates a substantial burden of vision impairment and blindness. Using prevalence estimates from the most recent global model (Box 3), applied to national population figures, an estimated 157.9 million people in the Region have a distance vision impairment, including 10.5 million who are blind (18).8 This represented approximately one quarter (25.9%) of global distance vision impairment in 2024, while the Region comprised just under one quarter (23.6%) of the world’s population.9

The 157.9 million figure captures distance vision impairment only and therefore underestimates the total burden of vision impairment in the Region. Near vision impairment is not included, as no sufficiently reliable regional estimate is currently available. The most recent reliable global estimate suggested that approximately 826 million people had a near vision impairment from uncorrected, or inadequately corrected, presbyopia in 2015 (19).10

Fig. 2 illustrates the estimated number of people with distance vision impairment in the Western Pacific Region in 2024 by severity of vision impairment and proportion of burden by country income level.11 This demonstrates that the majority of people with a distance vision impairment live in upper-middle-income countries in the Region.

7 These estimates are based on presenting visual acuity in the better-seeing eye (defined as worse than 6/12 for distance vision impairment); they capture uncorrected and under-corrected refractive error but not refractive error that is already adequately corrected with spectacles or contact lenses. Near vision impairment is reported separately. 8 These estimates use modelled values and should therefore be interpreted with caution, given that many countries in the Region have no direct survey data. They also exclude near vision impairment, which is estimated separately at the global level and for which no reliable regional estimate is currently available. 9 Global distance vision impairment estimates were calculated using the same method as the regional estimates, but are not directly reported as they differ slightly from previously reported global estimates from the Vision Loss Expert Group–Global Burden of Disease 2020 model (VLEG–GBD 2020). 10 Until 2019, the International Classification of Diseases did not have a definition of near vision impairment. 11 Given limited or no data from many countries in the Region to inform the model, the reliability of some estimates is low and these figures should therefore be interpreted with caution.

Fiji. A nurse examines a child’s eyes at the Pacific

Eye Institute.

Eye Health in the Western Pacific Region10

1. Magnitude and causes of vision impairment

Fig. 2. People with distance vision impairment in the Western Pacific, by severity and country income level: Number of people (A) and proportion of people (B), 2024

VI: vision impairment.

Source: Bourne et al., 2021 (18).

Notes: These estimates were calculated using country crude prevalence of distance vision impairment (all ages) from the VLEG–GBD 2020 model (accessed via the International Agency for the Prevention of Blindness (IAPB) Vision Atlas (20)), multiplied by United Nations country population estimates. Data were included for all Member States of the Western Pacific Region as of February 2025, apart from Niue and Tuvalu, which do not have data. Graph (B) excludes the estimates for Cook Islands, given that they are “not classified” by the World Bank. Numbers may not sum to totals due to rounding.

Nu m

be r o

f p eo

pl e

(m ill

io ns

)

100

Blind Mild VI

10.5

67.1

80.3

Moderate-to- severe VI

Total: 157.9 million people

Blind Moderate-to- severe VI

Mild VI

12.3% 13.7%

82.1% 73.8%

5.7%

13.3%

77.8%

8.9% 12.5%

Sh ar

e w

ith in

e ac

h se

ve rit

y (%

)

Lower-middle-income

Upper-middle-income

High-income 100

The estimated prevalence rates of vision impairment are unknown in many countries in the Western Pacific due to limited data. However, it is expected that lower-middle-income countries – particularly Pacific island countries and areas (PICs) – have significantly high rates of vision impairment. For example, Papua New Guinea’s 2017 age- and sex-adjusted prevalence of blindness of 5.6% in people aged 50 years and above is one of the highest reported estimates in the world, and a further 21.1% of Papua New Guineans were estimated to have a mild, moderate or severe vision impairment (7).12

12 The Papua New Guinea RAAB study consisted of four subnational surveys, limiting the comparability of prevalence rates with those from national population-based surveys.

Eye Health in the Western Pacific Region 11

1. Magnitude and causes of vision impairment

Fig. 3. National age- and sex-adjusted prevalence in people aged 50+: Blindness, by sex (A) and distance vision impairment, by severity of vision impairment (B), 2015–2024

Several other countries in the Region have reported estimates of vision impairment from comparable population-based surveys since 2015. Fig. 3 presents national prevalence estimates for blindness and distance vision impairment for six Member States. However, caution must be applied when comparing between countries as estimates are not age-standardized.

VI: vision impairment.

Note: There is no reported mild vision impairment estimate for Viet Nam.

Sources: Cambodia: International Centre for Eye Health (21); Lao People’s Democratic Republic: International Centre for Eye Health (22); Papua New Guinea: Lee et al., 2019 (7); Samoa: Samoa Ministry of Health and The Fred Hollows Foundation New Zealand (23); Vanuatu: Vanuatu Ministry of Health and The Fred Hollows Foundation NZ (24); Viet Nam: Ministry of Health Viet Nam (25).

Pr ev

al en

ce (%

)

Papua New Guinea

Cambodia Viet Nam Lao People’s Democratic

Republic

Vanuatu Samoa

3.2

2.2 2.3 1.7 1.7

4.4

1.6 1.2 1

1.7 1.2

Sex  Female  Male Overall

Pr ev

al en

ce (%

)

Severity  Blind  Moderate-to-

severe VI  Mild VI

Papua New Guinea

Cambodia Viet Nam Vanuatu Samoa

7.3 10.7

7 7.7

18.3

13.8

14.3

11.4

9.3 11.7

11.65.6 2.5

1.8

1.7 1.7

1.5

Lao People’s Democratic

Republic

Eye Health in the Western Pacific Region12

1. Magnitude and causes of vision impairment

Box 3 outlines preferred data sources for near and distance vision impairment.

Box 3. Global vision impairment data sources

Distance vision impairment

The most recent reliable global and regional estimates of distance vision impairment are produced by the Vision Loss Expert Group (VLEG) in collaboration with the Global Burden of Disease (GBD) study, known as the VLEG–GBD 2020 model (18).ᵃ This model analysed 512 studies from 112 countries and supersedes earlier VLEG estimates, including those from 2017, which were published in the 2019 WHO World report on vision (1). Estimates from the VLEG–GBD 2020 model are displayed in the IAPB Vision Atlas (20). Due to limited data from many countries in the Western Pacific, some national estimates from the model have low reliability and are therefore not included in this report.

Near vision impairment

For near vision impairment estimates, the 2019 WHO World report on vision included global estimates of near vision impairment due to presbyopia from Fricke et al. (2018), which, as of 2025, remains the latest reliable source (19).

Important limitation

Most estimates of vision impairment from population-based studies are based on measures of “presenting visual acuity” and exclude individuals whose vision impairment is compensated for with spectacles or contact lenses, as visual acuity is measured with the person wearing them (1). While this approach is useful to estimate the number of people with unmet and undermet eye care needs, it does not capture the total number of people with vision impairment. Effective service planning requires data on met, undermet and unmet needs, especially for refractive error where individuals require ongoing eye care services (26).

ᵃ The VLEG is a global network of researchers, primarily ophthalmologists and optometrists with expertise in ophthalmic epidemiology. Originally established to assist the GBD Study with data on prevalence of vision loss, the VLEG plays a leading role in developing robust estimates of vision impairment and blindness worldwide.

https://visionatlas.iapb.org/

Eye Health in the Western Pacific Region 13

1. Magnitude and causes of vision impairment

1.2 Trends and projections Global blindness trends show progress but growing challenges. Between 1990 and 2020, age- standardized prevalence of blindness among people aged 50 years and above fell by 28.5%, a reduction attributed in part to expanded eye care services addressing avoidable causes such as cataract and undercorrected refractive error (2, 18). However, population ageing and growth contributed to a 50.6% increase in the number of adults aged 50 years and above living with blindness and a 91.7% increase in those with moderate and severe vision impairment, over the same period (18). Age-standardized prevalence of moderate and severe vision impairment also rose slightly over the same period (2.5%) (18).

Although regional estimates are unavailable, several countries in the Western Pacific Region have demonstrated substantial reductions in vision impairment prevalence. Examples include:

• Cambodia: Whole-population blindness prevalence was reported to have decreased from 1.2% to 0.4% between 1995 and 2019 (27).

• Lao People’s Democratic Republic: Prevalence of blindness in people aged 50 years and above fell from 2.5% to 1.7%, and prevalence of moderate-to-severe vision impairment fell from 12.8% to 9.3% between 2007 and 2017 (22, 28).

• Malaysia: Blindness prevalence in people aged 50 years and above fell by 0.6 and 1.0 percentage points between 2014 and 2023 in Eastern Zone and Sarawak regions, respectively (29).

• Viet Nam: Blindness and vision impairment steadily declined in prevalence between 2000 and 2015 (25).

Despite gains, global distance vision impairment is projected to reach 895 million by 2050, a 50.2% increase from 2020 (596 million), including 61 million people who will be blind (Fig. 4) (18). Population ageing is a key driver of this trend, particularly for conditions including age-related macular degeneration, cataract, diabetic retinopathy, glaucoma and presbyopia (2). For example, in the Republic of Korea, which has one of the world’s fastest ageing populations, national

Viet Nam. Children receive treatment to

restore their vision at the Viet Nam

National Institute of Ophthalmology.

Eye Health in the Western Pacific Region14

1. Magnitude and causes of vision impairment

Fig. 4. Estimated number of people with distance vision impairment globally, by severity of vision impairment between 2020 and 2050

VI: vision impairment.

Sources: Bourne et al., 2021 (18). Data for 2030 and 2040 years were accessed via the IAPB Vision Atlas (20).

Nu m

be r o

f p eo

pl e

(m ill

io ns

)

200

400

600

800

1000

2020 2030 2040 2050

258 288 327 360

295 340

409 47443

Severity  Blind  Moderate-to-

severe VI  Mild VI

596

676

791

895

While approximately 80% of vision impairment affects people aged 50 years and above, emerging trends among younger populations are concerning (1). Although data are scarce, it was reported that vision impairment prevalence among adolescents and young people aged 10–24 in the Western Pacific increased at an annual rate of 0.56% between 1990 and 2019, contrasting with global declines (32).13

Comprehensive eye health strategies must also address common symptomatic eye conditions that may not cause vision impairment but generate substantial demand for care, including infectious and allergic conjunctivitis, blepharitis and dry eye disease (1, 2). These conditions represent a significant component of eye-related morbidity, contributing to the overall burden on health systems.

13 This analysis uses GBD 2019 data, as opposed to the VLEG–GBD model data used in other data reported throughout this report.

health insurance statistics showed that cataract became the top cause of hospitalization in 2024, with 337 270 cases, surpassing childbirth (30). The Western Pacific Region is undergoing rapid demographic transition: the population aged 65 years and above (245 million in 2022; 14%) is projected to double by 2050 (31). Combined with rising NCD prevalence, this demographic shift is creating compounding pressure on eye health systems and underscores the strategic importance of aligning eye care with the healthy ageing agenda, including the United Nations Decade of Healthy Ageing (2021–2030) and the Regional Action Plan on Healthy Ageing in the Western Pacific (see Annex 4).

Eye Health in the Western Pacific Region 15

1. Magnitude and causes of vision impairment

1.3 Causes of vision impairment Vision impairment stems from diverse causes requiring interventions across the care spectrum and throughout the life course. Globally, two conditions dominate: cataract and uncorrected refractive error account for approximately 75% of moderate-to-severe vision impairment and 50% of total blindness (33). In adults, glaucoma, age-related macular degeneration and diabetic retinopathy are also major contributors.

Data on prevalence and causes of vision impairment in children and young people are scarce in the Western Pacific because the most common population-based survey methodology used across the Region, the RAAB, only measures vision impairment in people aged 50 years and above. However, global leading causes of vision impairment in children include uncorrected refractive error, cataract, retinopathy of prematurity, congenital ocular anomalies, corneal scarring and cerebral visual impairment (2).

The global age-standardized prevalence of all leading causes of blindness in people aged 50 years and above decreased between 1990 and 2020, apart from diabetic retinopathy, which increased by 14.9% (33).14 Meanwhile, all leading causes of distance vision impairment increased in absolute terms between 1990 and 2020.15 Fig. 5 presents the global estimated number of people with, and global prevalence of, blindness and moderate-to-severe vision impairment in 1990 and 2020 in people aged 50 years and above, by leading cause.

14 The modelled leading causes of distance vision impairment were cataract, undercorrected refractive error, age-related macular degeneration, glaucoma, diabetic retinopathy and other causes (that is, residual causes of vision loss). Although Steinmetz et al. (2021) (33) used the term “undercorrected refractive error”, the definition was consistent with commonly used epidemiological definitions of “uncorrected refractive error”, encompassing both individuals without correction and those with inadequate correction. Therefore, the report uses “uncorrected refractive error” to report data on “undercorrected refractive error” from this study. 15 Estimates of causes of distance vision impairment include moderate-to-severe vision impairment and blindness, but exclude mild vision impairment, due to lack of data.

Papua New Guinea. A man has his eyes examined during

an outreach activity.

Eye Health in the Western Pacific Region16

1. Magnitude and causes of vision impairment

Fig. 5. People aged 50+ with blindness and moderate-to-severe vision impairment globally, by leading cause: Number of people (A) and age-standardized prevalence (B), 1990 and 2020

URE: uncorrected refractive error.

Source: Steinmetz et al., 2021 (34).

100

1990 2020 1990 2020 0

 Cataract  URE

 Glaucoma  Diabetic retinopathy

 Other causes  Age-related macular

degeneration

1.6 3.8 1.9 2

38.4

44.1

88.4

19.6

3.6 8.1

3.9 7.7

48.7

51.850.9

23.6

20.5

4.5 4.45.1 4.3

Nu m

be r o

f p eo

pl e

(m ill

io ns

)

Pr ev

al en

t c as

es (p

er 1

00 0)

A B

The distribution of causes of vision impairment varies substantially between and within countries, influenced by factors including service availability, affordability and population education levels (35). For example:

• In middle-income countries, the proportion of vision impairment due to cataract is higher. • In high-income countries, diseases such as glaucoma, age-related macular degeneration

and diabetic retinopathy occur more frequently. • In both adults and children and across nearly all country income levels, uncorrected

refractive error is a leading cause of vision impairment. However, lower-middle-income countries have the greatest unmet need.

• Among children, retinopathy of prematurity is more common in middle-income countries.

Systematic data on causes of vision impairment are limited in the Western Pacific Region. However, Fig. 6 presents national estimates of the leading five causes of blindness from population-based data in six countries: Cambodia, the Lao People’s Democratic Republic, Papua New Guinea, Samoa, Vanuatu and Viet Nam. Cataract was the leading cause of blindness across all countries, ranging from 70.8% in Samoa to 88.6% in Papua New Guinea, while “other posterior segment disease” was also a leading cause in all six countries, ranging from 2.6% in the Lao People’s Democratic Republic to 11.1% in Samoa. “Other corneal opacity” caused 3.9–4.4% of blindness in three countries, while glaucoma caused 4.0% of blindness in Viet Nam and 11.8% in the Lao People’s Democratic Republic. Pterygium was a cause of 4.2% of blindness in Samoa, but was not a leading cause in any of the other five countries.

Eye Health in the Western Pacific Region 17

1. Magnitude and causes of vision impairment

Fig. 6. Proportion of blindness in people aged 50+ in six Western Pacific Member States, by leading cause, 2015–2024

CNS: central nervous system; URE: uncorrected refractive error.

Note: The graph displays the five leading causes of blindness for each country; causes outside of the top five are categorized in “All other”.

Pr op

or tio

n of

b lin

dn es

s ( %

)

100

4 1.5 1.4 2.7 3.3 7

80.4

88.6

70.8

82.4 74

3.4 1.1

2.8

2.4 4.6

2.6 2.8

2.4 11.8

4 2.1

4.4 3.9 4.1

4.4 2.6 2.9

5.6

2.4

3.4 2.6 3.9

11.1

4.7 6.34.2 2.4

Cambodia Lao People’s Democratic

Republic

Papua New Guinea

Samoa Vanuatu Viet Nam

Cause  URE  Pterygium  Other posterior segment disease  Other globe or CNS abnormalities  Other corneal opacity  Non-trachomatous corneal opacity

 Glaucoma  Diabetic retinopathy  Cataract surgical complications  Cataract  All other

Eye Health in the Western Pacific Region18

1. Magnitude and causes of vision impairment

These country studies also report causes across the full severity range of distance vision impairment. Cataract remained the leading cause of blindness, severe vision impairment and moderate vision impairment in all five countries reporting these estimates, while uncorrected refractive error overtook cataract as the leading cause of mild vision impairment in all but one country (the Lao People’s Democratic Republic).

Causes may also vary considerably within countries. Malaysia’s recent subnational RAAB surveys illustrate this heterogeneity (Fig. 7): diabetic retinopathy was the second leading cause of blindness in Eastern Zone (9.1%) but only caused early to severe vision impairment in Sarawak (29).

Cause  Phthisis  Other posterior segment disease  Glaucoma  Diabetic retinopathy  Cataract  All other

Eastern Zone Sarawak 0

100

Pr op

or tio

n of

b lin

dn es

s ( %

)

2.3 6.3

77.3 75

9.1

4.5

3.1

4.5

9.4

2.3 6.2

Fig. 7. Proportion of overall blindness in two regions in Malaysia, by leading cause, 2023

Note: The graph displays the five leading causes of blindness; causes outside of the top five are categorized in “All other”.

Source: Salowi et al., 2024 (29).

Certain subpopulations also experience different burden patterns. Early results from the Australian Eye and Ear Health Survey (2025) reveal that diabetic retinopathy prevalence remains higher among Aboriginal and Torres Strait Islander (Indigenous) Australians, while age-related macular degeneration remains more prevalent in non-Indigenous Australians (36).

The cause profile of vision impairment is shifting globally. Infectious conditions such as trachoma and onchocerciasis, which previously contributed substantially to preventable blindness, have largely been replaced by noncommunicable causes including glaucoma, diabetic retinopathy and age-related macular degeneration (2, 37). Globally, the proportion of blindness due to infectious eye diseases fell from 20% to 2% within two decades (1994−2014) –

Eye Health in the Western Pacific Region 19

1. Magnitude and causes of vision impairment

reflecting the epidemiological transition that occurred in high-income countries and is now under way in low- and middle-income countries (2, 3). By 2020, the five leading causes of global blindness in adults aged 50 years and over − cataract, glaucoma, undercorrected refractive error, age-related macular degeneration and diabetic retinopathy − were all noncommunicable, while trachoma and onchocerciasis fell within the residual “other causes” category (33).

As The Lancet Global Health Commission on Global Eye Health: vision beyond 2020 (2021) highlights, multiple biological, socioeconomic and environmental factors interact to determine the development and trajectory of eye health throughout the life course, as described in Box 4.

Box 4. Eye health during the life course

The Lancet Global Health Commission on Global Eye Health: vision beyond 2020 states (2): The socioeconomic environment into which a child is born has profound effects on eye health over the individual’s life course. Maternal nutritional and vaccination status, and development of intrauterine infections (rubella, toxoplasmosis, syphilis, Zika) are important determinants. Preterm birth can lead to retinopathy of prematurity and cerebral visual impairment. Low birthweight, fetal growth restriction, antenatal maternal smoking and alcohol misuse, and social deprivation in childhood can also cause vision impairment. Congenital eye conditions frequently have strong genetic components. Over the life course, biological and social determinants interact to determine visual function.

Visual acuity develops rapidly after birth and reaches full development at around age 8 years. Early childhood is a crucial period because visual cortex plasticity progressively diminishes after age 2 years. Since vision is important for early child development, early onset vision impairment can lead to psychomotor and cognitive developmental delay. Visual stimulus deprivation between birth and age 8 years can lead to permanent vision impairment (amblyopia) if not managed in a timely manner. As the eyes grow and change shape there is a further sensitive period from childhood to adolescence when a combination of genetic and environmental factors, such as light exposure and time spent outdoors, can lead to myopia. Several infectious diseases (trachoma, toxoplasmosis, onchocerciasis) begin in childhood and lead to vision impairment later in life from accumulated pathology.

Many conditions are age-related. Presbyopia starts developing from age 35 years, as the lens ages. Some conditions (e.g. glaucoma and age-related macular degeneration) have a complex polygenetic background, which can interact with nutrition and other biological factors. Diabetes and diabetic retinopathy are influenced by multiple social and environmental determinants (diet, activity, obesity). Cataract arises from multiple factors across the life course that promote lens ageing: ultraviolet light exposure, smoking, poor nutrition, diabetes, and severe dehydration.

The life course trajectory of visual function is not fixed. Many conditions and risk factors are amenable to interventions, including social determinants, along the spectrum of promotion, prevention, treatment, and rehabilitation. These are complex issues, requiring multisectoral approaches (nutrition, housing, social security, education), long-term policies, and health system investment for greater health equity.

Eye Health in the Western Pacific Region20

1. Magnitude and causes of vision impairment

1.3.1 Uncorrected refractive error In 2020, approximately 161 million people globally had a distance vision impairment due to uncorrected refractive error, including 3.7 million who were blind (34).16 Despite global declining age-standardized prevalence between 2000 and 2020 (–2.4% for moderate-to-severe vision impairment and –30.5% for blindness), absolute case numbers increased substantially due to population growth and ageing. Moderate-to-severe vision impairment and blindness from uncorrected refractive error rose by 72% and 21.8%, respectively (38).

Epidemiological data on refractive error remain scarce and existing methodologies have significant limitations. For example, the RAAB, a widely used standardized population-based eye health survey, is restricted to adults aged 50 years and above and therefore does not capture the burden of refractive error in younger populations, among whom refractive error is increasingly prevalent. Despite limited surveillance, available evidence indicates substantial burden in the Region, with myopia a particular public health concern. Myopia has reached epidemic levels in parts of the Region, with rates among 20-year-olds in some East and Southeast Asian countries approaching 80%, a dramatic rise from roughly 20–30% in the mid- 20th century (2, 27) (Box 5). This rapid rise in some parts of the Region has reflected economic development and associated lifestyle changes, including high educational pressure, increased near vision activities, reduced outdoor time and urbanization (2). Globally, the prevalence of myopia in children and adolescents rose from approximately 24% in 1990 to 36% in 2023 and is projected to reach nearly 40% by 2050, affecting approximately one third of children and adolescents today (39).

Box 5. Addressing childhood myopia in China

Childhood myopia has been recognized by the Chinese Government as a major public health problem. In response, in 2018 eight government ministries jointly issued the Comprehensive Implementation Plan for the Prevention and Control of Myopia in Children and Adolescents, signalling a strong multisectoral commitment to myopia prevention. The plan set measurable targets through 2030 and assigned shared responsibility across the health, education, sports, finance, media and human resources sectors – providing a model of intersectoral action aligned with IPEC (40, 41). Core measures include a daily mandate for at least one hour of outdoor activity during the school day and reduced academic burden, including no written homework in the first two elementary school years (40, 41).

16 This figure excludes mild vision impairment, due to a lack of data.

Eye Health in the Western Pacific Region 21

1. Magnitude and causes of vision impairment

Box 6. The rising threat of myopia

During childhood, when eyes are still developing, myopia progresses rapidly before stabilizing around age 18–20. Without intervention, progressive myopia can lead to high myopia with increased risk of permanent vision impairment and blindness, secondary to myopic macular degeneration, retinal detachment, glaucoma and amblyopia (2).

While genetics influence myopia susceptibility, decades of research have established strong links with environmental and behavioural factors, particularly time spent indoors and intensive near vision activities including reading, studying and digital screen use, while time outdoors provides protection (2, 45). Environmental risk factors are intensifying across populations due to urbanization, rising educational attainment and rapid digital transformation. Research on digital screen time indicates dose-dependent effect, with each additional hour of screen time associated with increased myopia risk (46).

WHO recommends regular refractive error screening for preschool and school-age children, coupled with increased availability and accessibility of spectacles and contact lenses (47). To support behavioural prevention efforts, WHO and the International Telecommunication Union have also developed the MyopiaEd toolkit, which provides guidance for implementing large-scale myopia education and behaviour-change programmes using mobile health technology (44).

Evidence supports several interventions to prevent or delay myopia onset and delay and slow myopia progression. These include lifestyle modification such as spending at least two hours per day outdoors during daylight hours; taking regular breaks during near vision activities; and the use of evidence-based pharmacological or optical treatment (that is, atropine eye drops, myopia control spectacles or contact lenses) (48). Rapid developments are occurring in this field and more interventions may become available in the future.

The COVID-19 pandemic probably accelerated myopia progression due to reduced outdoor activity and increased screen exposure (Box 6) (8). Although data are limited in the Region, global screen time appears to remain elevated post-pandemic, with adolescents and young adults aged 16−24 years spending approximately 40–42.75 hours per week consuming online media, against a backdrop of an increasing proportion of the population using the internet, rising from 54.8% in 2019 to 73.2% in 2025 (42).

The trajectory is concerning: global myopia is projected to increase from 2.6 billion people in 2020 to 3.36 billion in 2030, while 517 million people are expected to have high myopia by 2030 (43, 44). By 2050, this trajectory would mean approximately 5 billion people – more than half of the projected global population – will have myopia (43, 44). Alarmingly, high myopia, which carries greater risk of vision-threatening complications, is not only increasing but is developing at younger ages (2).

Eye Health in the Western Pacific Region22

1. Magnitude and causes of vision impairment

50 100 150 200 250 300

China Niue

Philippines Palau

Cook Islands Japan

Fiji Republic of Korea

New Zealand Cambodia

Australia Micronesia (Federated States of)

Mongolia Papua New Guinea

Marshall Islands Kiribati

Brunei Darussalam Naoero

Malaysia Lao People’s Democratic Republic

YLD (crude rate per 100 000 population) 350

Fig. 8. Change in crude rate of YLD due to uncorrected refractive error in Western Pacific Member States between 2000 and 2021

Notes: National crude rates were calculated using YLD and population estimates as provided by the WHO Global Health Estimates. These estimates are not directly comparable with the Institute for Health Metrics and Evaluation estimates presented in Fig. 1, owing to differences in methods and definitions.

Source: World Health Organization (49).

Data on presbyopia are scarce in the Region, but the most recent global estimate suggested that approximately 1.8 billion people had presbyopia in 2015, of whom 826 million had near vision impairment because they had no, or inadequate, vision correction (19). The number of people with presbyopia is projected to peak at approximately 2.1 billion around 2030 (48).

The burden of uncorrected refractive error is significant; YLD attributable to uncorrected refractive error increased between 2000 and 2021 in all Member States of the Western Pacific Region with available data (Fig. 8).

Eye Health in the Western Pacific Region 23

1. Magnitude and causes of vision impairment

Viet Nam. A woman recovers with family after her second

cataract surgery.

1.3.2 Cataract Unoperated cataract causes more blindness than any other condition globally, despite being entirely treatable through surgery. An estimated 100 million people globally had a distance vision impairment due to cataract in 2020, including 17 million people who were blind (34).17 Increased cataract surgical rates in low- and middle-income countries over the last two decades have produced only modest reductions in cataract-related vision impairment, indicating that surgical volume has not kept pace with population ageing and incidence (50).

A study examining age-standardized prevalence of age-related cataract in adults aged 19 years and above found the Western Pacific Region had the second-highest rate, at 35.6%, just below the South-East Asia Region (36.6%) and more than double the global average of 17.2% (51).18

Within the Western Pacific Region, disparities exist between country income levels. Lower- middle-income countries face critical service gaps. For example, in Papua New Guinea in 2017, unoperated cataract caused an estimated 88.6% of blindness among those aged 50 years and above, while nearly half of examined eyes were found to have cataracts severe enough to result in a moderate or severe vision impairment (7). Malaysia reported cataract to be responsible for approximately three quarters of blindness in two regions in 2023 (29). Viet Nam identified cataract as the persistent leading cause of blindness between 2000 and 2015, attributing this to growing at-risk populations outpacing surgical capacity (25). On the other hand, high-income countries show lower prevalence due to better access to surgery. For example, the Republic of Korea shows declining prevalence, with an overall rate of 3.2%, which rises to 11.2% among those aged 60 years and above, down from 14.2% in 2015–2016 among the same age group (52).

Despite surgical advances, YLD from unoperated cataract increased between 2000 and 2021 in nearly all Western Pacific Member States with data (Fig. 9), a trend driven by population ageing and persistent coverage gaps.

17 This figure excludes mild vision impairment, due to a lack of data. 18 Age-related cataract is the dominant share of the cataract burden and develops as a result of ageing, rather than from congenital causes, trauma, medications or systemic diseases.

Eye Health in the Western Pacific Region24

1. Magnitude and causes of vision impairment

Fig. 9. Change in crude rate of YLD due to cataract in Western Pacific Member States between 2000 and 2021

0 20 40 60 80 100 120 140

Niue Cook Islands

Cambodia Malaysia

Palau Fiji

Papua New Guinea China

Philippines Micronesia (Federated States of)

Kiribati Japan

Marshall Islands New Zealand

Australia Naoero

Republic of Korea Mongolia

Lao People’s Democratic Republic Brunei Darussalam

YLD (crude rate per 100 000 population)

Source: World Health Organization (49).

1.3.3 Age-related macular degeneration In 2020, an estimated 8.1 million people globally had a distance vision impairment due to age-related macular degeneration, including 1.8 million who were blind (34).19 For every person with vision impairment from age-related macular degeneration, many more have early-stage disease. Regular monitoring, risk factor modification (such as smoking cessation) and timely access to treatment for those who progress to late-stage disease are central to limiting vision loss.

Regional data on age-related macular degeneration are limited, but indicate a substantial burden in populations with high proportions of older adults. With approximately 245 million people in the Western Pacific Region aged 65 years and above, and with rapid population ageing across the Region, age-related macular degeneration is expected to become a growing contributor to vision loss – placing increased demand on long-term retinal services. For example, in the Republic of Korea, the number of patients diagnosed with macular degeneration recorded in national health insurance data nearly tripled between 2020 and 2024, rising from 201 370 to 563 390 (30).

19 This figure excludes mild vision impairment, due to a lack of data.

Eye Health in the Western Pacific Region 25

1. Magnitude and causes of vision impairment

1.3.4 Glaucoma In 2020, an estimated 7.7 million people globally had a distance vision impairment due to glaucoma, including 3.6 million who were blind (34).20 Although there are limited data on glaucoma prevalence in the Region, it is expected to pose issues across all country income levels, particularly in countries with rapidly ageing populations. Upper-middle- and high- income countries also tend to have a higher proportion of blindness attributable to glaucoma, reflecting better control of other causes such as cataract. For example, in Malaysia 6.6% of all blindness in 2014 was attributed to glaucoma (53). A recent study in the Republic of Korea reported that glaucoma prevalence increased from 0.70% (2015–2016) to 1.15% (2021), with prevalence among those aged 60 years and above rising from 2.44% to 3.68% (52). Meanwhile, the number of patients with glaucoma recorded in national health insurance data in the Republic of Korea increased from 0.97 million in 2020 to 1.22 million in 2024 (30).

These figures substantially underestimate the true burden. RAAB-based surveys identify glaucoma only when it has caused vision impairment, and dense cataracts can obscure diagnosis. Administrative and survey-based data capture only patients who have been diagnosed or are receiving care – and a substantial proportion of glaucoma worldwide remains undiagnosed because early disease is asymptomatic. True prevalence, including undetected early-stage glaucoma, therefore remains unknown across the Region. Enhanced screening and surveillance are needed to capture the full disease burden and prevent irreversible vision impairment.

1.3.5 Diabetic retinopathy Diabetic retinopathy – the most common microvascular complication of diabetes – is the only modelled cause of blindness that increased in global age-standardized prevalence between 1990 and 2020 (33). It is the leading cause of preventable blindness in working-age populations and, concerningly, is increasingly affecting younger people (54, 55). In 2020, an estimated 4.3 million people globally had distance vision impairment due to diabetic retinopathy, including 1.1 million who were blind (34).21

Diabetic retinopathy is a particular concern in the Western Pacific, given that there are high and rising rates of type 2 diabetes in the majority of countries in the Region, particularly in PICs. Seven PIC Member States are among the top 10 countries and areas globally for age-standardized prevalence of diabetes: the Marshall Islands, Cook Islands, Niue, Palau, Fiji, Naoero and Samoa (56). As countries move from low- to middle- or high-income levels, the burden of type 2 diabetes tends to rise, resulting in an increased need for diabetic retinopathy services. For example, in China there was a 14-fold increase in the prevalence of diabetes between 1980 and 2008, and a 50% increase between 2005 and 2023 (57). Moreover, forecasting based on existing trends shows that the 2023 prevalence of 13.7% will more than double by 2050, reaching 29.1% (57). Meanwhile in Viet Nam, the proportion of blindness due to diabetic retinopathy increased between 2000 and 2015 (25). Fig. 10 shows the significant rise in diabetes rates in the Region between 1990 and 2022 and the age-standardized and crude prevalence rates of diabetes by age group and sex.

20 This figure excludes mild vision impairment, due to a lack of data. 21 This figure excludes mild vision impairment, due to a lack of data.

Eye Health in the Western Pacific Region26

1. Magnitude and causes of vision impairment

1990 2000 2010 2020 4

5.56

9.66

5.33

12.62

Pr ev

al en

ce (%

)

1990 2000 2010 2020 4

4.89

11.85

4.48

14.08

1990 2000 2010 2020 4

7.41

12.06

6.99

15.32

1990 2000 2010 2020 4

7.14

13.72

6.42

16.21

Sex  Female  Male

18 years and above 30 years and above

Age-standardized Crude

Fig. 10. Crude and age-standardized prevalence of diabetes in the Western Pacific between 1990 and 2022 in people aged 18+ and 30+, by sex

Source: World Health Organization (58).

A 2021 global meta-analysis of diabetic retinopathy prevalence among people with diabetes reported rates of 22.27% for diabetic retinopathy and 6.17% for vision-threatening diabetic retinopathy (59). Data on diabetic retinopathy in the Western Pacific Region remain scarce and reported prevalence varies between countries. In countries or areas with limited treatment options available and lower rates of diabetes control, such as many PICs, the prevalence of diabetic retinopathy is expected to be high. For example, in people aged 50 years and above with known or suspected diabetes in the National Capital District of Papua New Guinea, almost half (46.4%) had some form of diabetic retinopathy or maculopathy (7).22

Based on estimates from the GBD Diabetes Collaborators (2021), 158 million people were living with diabetes in 2021, and of these, approximately 35 million were estimated to be living with diabetic retinopathy (Fig. 11). This is expected to rise to approximately 73 million people with diabetic retinopathy by 2050. Of those with diabetic retinopathy, 10 million were estimated to have vision-threatening diabetic retinopathy in 2021. This is expected to rise to approximately 20 million by 2050. This is more than double the diabetic retinopathy burden. Given that

22 This estimate is from one subnational RAAB survey and is therefore not comparable with national prevalence rates.

Eye Health in the Western Pacific Region 27

1. Magnitude and causes of vision impairment

these estimates assume homogeneity in diabetic retinopathy prevalence between countries and that its prevalence remains constant over time, they should be interpreted as scenario estimates rather than predictions.

It is important to note that for every person with vision impairment due to diabetic retinopathy, there are expected to be many more living with early stages of the condition, particularly given that a significant proportion of people with both diabetes and diabetic retinopathy are unaware of their condition (61, 62).

158 million with diabetes

35 million with some form of DR

10 million with vision-threatening DR

2021

326 million with diabetes

73 million with some form of DR

20 million with vision-threatening DR

2050

Fig. 11. Estimated number of people with diabetes, diabetic retinopathy and vision-threatening diabetic retinopathy in the Western Pacific, 2021 and 2050

DR: diabetic retinopathy.

Sources: Teo et al., 2021 (59); Ong et al., 2023 (60).

Notes: Calculated using 2021 estimates of diabetes prevalence and 2050 projections of diabetes burden from GBD Diabetes Collaborators (2021); estimates of diabetic retinopathy and vision-threatening diabetic retinopathy prevalence from Teo et al. (2021); and United Nations country population estimates. Data were included for all Member States of the Western Pacific Region as of February 2025.

Eye Health in the Western Pacific Region28

1. Magnitude and causes of vision impairment

1.3.6 Other causes Approximately 37% of global blindness stems from causes beyond the top five. In 2020, an estimated 56 million people had a distance vision impairment due to other causes (that is, residual causes of vision loss), including 16 million with blindness (34).23 It is important to note that individuals may have multiple conditions contributing to vision impairment, though epidemiological studies typically report only the primary cause.

Other causes of vision impairment include corneal and conjunctival conditions such as microbial keratitis, corneal ectasia, corneal scarring from vitamin A deficiency or measles in children, and pterygium (which caused 4.2% of blindness in Samoa in 2024); trauma-related injuries such as (road-traffic) accidents and violence; developmental and neurological conditions such as amblyopia and cerebral visual impairment; inflammatory conditions such as uveitis and scleritis; and neonatal conditions, which include retinopathy of prematurity (2, 23). Retinopathy of prematurity is becoming increasingly prevalent in middle-income countries where neonatal services are expanding without adequate eye screening and treatment capacity (2). Data on many of these conditions, particularly retinopathy of prematurity, are extremely limited, as most epidemiological surveys assess only populations aged 50 years and above.

Trachoma, a disease caused by infection with Chlamydia trachomatis and transmitted through contact with infected eye and nose discharges – which can be spread by particular species of flies – can cause blindness through repeated infections leading to trachomatous trichiasis (63). While not thought to be a major cause of vision impairment in the Western Pacific Region, it remains a public health problem requiring interventions in Kiribati, Naoero and Solomon Islands (Table 2). Eight countries in the Region have achieved WHO validation of elimination of trachoma as a public health problem: Australia, Cambodia, China, Fiji, the Lao People’s Democratic Republic, Papua New Guinea, Vanuatu and Viet Nam (Box 7) (58). Meanwhile,

23 This figure excludes mild vision impairment, due to a lack of data.

Samoa. A woman from Tokelau has her eyes examined at Tupua Tamasese Meaole Hospital.

Eye Health in the Western Pacific Region 29

1. Magnitude and causes of vision impairment

Table 2. Status of elimination of trachoma as a public health problem in the Western Pacific, May 2026

Source: World Health Organization (58).

Validated as having eliminated

Known to require interventions

May require interventions, investigation needed

Thought to not require interventions

Australia (2026) Cambodia (2017) China (2019) Fiji (2025) Lao People’s Democratic Republic (2017) Papua New Guinea (2025) Vanuatu (2022) Viet Nam (2024)

Kiribati Naoero Solomon Islands

Micronesia (Federated States of)

Brunei Darussalam Cook Islands Japan Malaysia Marshall Islands Mongolia New Zealand Niue Palau Philippines Republic of Korea Samoa Singapore Tonga Tuvalu

15 Member States are thought not to require interventions, while one may require interventions but investigation is needed (Table 2) (58). As outlined in the Regional Action Framework for Control and Elimination of Neglected Tropical Diseases in the Western Pacific, the 2030 target is for complete elimination of trachoma as a public health problem (64, 65).

Box 7. Elimination of trachoma in Viet Nam

In 2024, Viet Nam became the fifth country in the Western Pacific Region to be validated by WHO to have eliminated trachoma as a public health problem. This followed decades of control efforts including rigorous control measures and the provision of treatment for hundreds of thousands of people. Once prevalent in four provinces, with 1.7% of residents in high-risk areas 30 years ago needing surgery, the prevalence of trachomatous trichiasis has now fallen below the WHO elimination threshold of 0.2% (66). This success is credited to intersectoral collaboration, sustained surveillance and the implementation of WHO’s SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) since 1999 (66).

Eye Health in the Western Pacific Region30

1. Magnitude and causes of vision impairment

Environmental factor Potential eye health implications

Ultraviolet radiation Photokeratitis, photoconjunctivitis, pterygium, climatic droplet keratopathy, cataract (particularly cortical) and eyelid cancers.

Air pollution Allergic conjunctivitis, dry eye disease and associations with glaucoma, age-related macular degeneration, uveitis and possible retinal vascular changes.

Hotter and drier conditions Increased dry eye d

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Источник Всемирная организация здравоохранения