Understanding Visual Impairment Trends in the Gulf Council Countries: An Analysis from 1990 to 2019 and Time-Series Predictions for 2020-2024

Understanding Visual Impairment Trends in the Gulf Council Countries: An Analysis from 1990 to 2019 and Time-Series Predictions for 2020-2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Understanding Visual Impairment Trends in the Gulf Council Countries: An Analysis from 1990 to 2019 and Time-Series Predictions for 2020-2024 Ahmed S AL Zomia, Saeed T Alshahrani, Ibrahim Ali AL Zehefa, Abdullah Jallwi Korkoman, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4103271/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This research investigates blindness prevalence trends in Gulf Cooperation Council (GCC) countries from 1990 to 2019 and provides projections up to 2024. The study aimed to inform public health planning, policy formulation, and healthcare delivery in the region. Methods Utilizing data from the Global Burden of Disease 2019 Study, the research employs time-series analysis techniques, including AutoRegressive Integrated Moving Average (ARIMA) models, to analyze blindness prevalence trends. Secondary data sources from GCC countries are used to assess gender-specific, age-related, and country-specific patterns. Projections for 2020–2024 are generated and validated through comparison with observed data. Results The findings reveal consistent upward trends in blindness prevalence across Bahrain, with rates increasing from 3789.39 in 1990 to 5336.64 in 2019. Kuwait exhibits a continuous rise, starting at 3528.19 in 1990 and reaching 4541.37 in 2019. Oman shows a steady increase from 4786.45 in 1990 to 5269.99 in 2019. Qatar experienced a notable trajectory, starting at 14942.65 in 1990 and reaching 102405.15 in 2019. Saudi Arabia indicates an increasing trend, from 866643.40 in 1990 to 1824519.93 in 2019. The United Arab of Emirates (UAE) displays distinct patterns, with prevalence fluctuating but generally increasing from 3090.80 in 1990 to 3854.58 in 2019. Gender disparities are evident, with consistently higher prevalence among females in Bahrain, Kuwait, Oman, Qatar, and Saudi Arabia. Individuals aged 55 and above consistently experience the highest prevalence, with a decline noted within this age group. Disability-adjusted life Years (DALYs) due to blindness show a steady increase, with Saudi Arabia reporting the highest DALYs, reaching 89962.6 in 2019. Projections for 2020–2024 suggest ongoing challenges, with Bahrain, Kuwait, and the UAE anticipating gradual rises, while Qatar and Saudi Arabia face substantial increases. Conclusions The research concludes that proactive and culturally sensitive public health initiatives are urgently needed to address the escalating burden of visual impairment in the GCC region. Gender-specific healthcare strategies, age-related healthcare measures, and improved healthcare infrastructure are essential components of a comprehensive approach. Policymakers should integrate these findings into evidence-based policies, emphasizing continuous monitoring and international collaboration to refine strategies and ensure their effectiveness. The study highlights the dynamic nature of eye health, necessitating adaptive and targeted interventions for sustainable impact in the GCC countries. Biological sciences/Neuroscience Physical sciences/Optics and photonics Blindness prevalence Visual impairment trends Gulf Cooperation Council Disability-Adjusted Life Years Age-related vulnerabilities ARIMA models Public health planning Healthcare infrastructure Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In many countries across the world, the average age of the population is rising, more people are reaching adulthood due to rising sociodemographic status and life expectancy, and the burden of disease is shifting toward non-communicable diseases (NCDs) and disabilities. This epidemiological transition affects the majority of the primary causes of vision impairment, such as cataracts and undercorrected refractive error [ 1 ], and they come at a large financial and societal cost to each individual. [ 2 , 3 ] According to the latest global report on blindness and vision impairment among individuals aged 50 and above, approximately 43.3 million people worldwide are blind, and 295 million people suffer from moderate to severe vision impairment as of 2020. [ 4 ] Blindness and vision loss (BVL) were expected to have caused 22.6 million disability-adjusted life years (DALYs) globally in 2019, making up 0.88% of all DALYs caused by all causes. [ 5 ] Severe personal financial and educational challenges are brought on by BVL,[ 6 ] which also lowers quality of life [ 7 ] and raises mortality. It is possible that about one-third of the patients suffering from visual impairment did not obtain appropriate preventive and therapy. [ 8 ] Saudi Arabia, Kuwait, the United Arab Emirates (UAE), Qatar, Bahrain, and Oman are the six Middle Eastern countries that make up the Gulf Cooperation Council (GCC), a political and economic partnership. In May 1981, the GCC was founded in Riyadh, Saudi Arabia. The GCC aims to unite its members via shared goals and comparable political and cultural identities founded on Islamic principles. [ 9 ] The combined land area of all member states is 2.57 million square kilometers, with a total population of approximately 58.86 million people.[ 10 ] The population over 50 has been analyzed for the updated worldwide and regional prevalence of BVL, which is classified by the severity of visual impairment in addition to eye diseases which provides comprehensive knowledge for understanding the landscape of BVL burden. [ 4 , 11 ] However, the impact of putative risk factors and the burden on the entire population have not yet been evaluated. Using a wide range of data sources and reliable statistical techniques, the most recent Global Burden of Disease (GBD) 2019 Study calculated the annual burden of 369 diseases for 204 nations and territories between 1990 and 2019, which provided a unique opportunity to grasp the progress of the BVL burden. [ 5 ] Our study hypothesis aimed at comprehensively understanding visual impairment trends in the GCC from 1990 to 2019 and forecasting for 2020–2024. We hypothesized that there has been a significant temporal change in the prevalence of BVL within the GCC over the specified period. This study aimed to fill critical gaps in our understanding of BVL trends within the GCC, focusing on the period from 1990 to 2019 and providing predictions for 2020–2024 through robust time-series analysis. By leveraging data from the GBD 2019 study our investigation assessed the evolving burden of visual impairment and its associated risk factors. Methodoloy Utilize secondary data sources extracted from existing databases of GBD Study and other relevant publications. The study focuses on individuals of all age groups within the Gulf Council Countries (Saudi Arabia, Kuwait, the UAE, Qatar, Bahrain, and Oman) from 1990 to 2024. We conducted a detailed temporal analysis of visual impairment prevalence trends from 1990 to 2019, utilizing statistical methods such as descriptive statistics and graphical representations to highlight changes over time. In this study we presented the prevalence rate of BVL in the 7 countries. We described this prevalence rate across sex (male and females) and across different age groups (< 5 years, 4–19 years, 20–54 years, and 55 + yeras). We presented the DALYs as well over this time peroid across countries. DALYs is sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population. We employed time-series analysis techniques to generate predictions for visual impairment prevalence in the GCC for the years 2020–2024. Excel was used to compile the data and ensure its uniformity and completeness. R version 4.2 for Windows was used to examine, clean, and code the data. With line graphs displayed using points on the X-Y axis—where X is the time in year (from 1990 to 2019) and Y is the value of the selected indicator for each year in number or percent—the patterns of each chosen indicator and their evolution were described mathematically and graphicallyThe moving average's order was denoted by MA (q), the autoregression's order by AR(p), and the difference's degree by I. (d). In order to predict the number of cases for the year 2020–2024 we constructed AutoRegressive Integrated Moving Average (ARIMA) models using data reported in GCC from 1990 to 2019. We constructed an ideal model based on Akaike's information criterion (AIC) and Schwartz's Bayesian criterion, and we used the autocorrelation function (ACF) and partial autocorrelation function (PACF) graphs to compute the degree of ARIMA (SBC). We verified that the forecast errors were normally distributed, had a mean of zero, and had constant variance in order to validate the predictive model. We validate the accuracy of predictions through comparison with observed data.[ 12 ] Results The data reveals a consistent upward trend of BVL, with prevalence values steadily increasing from 3789.39 (95%CI, 4263.32–3350.32) in 1990 to 5336.64 (95%CI, 6198.79–4611.47) in 2019. The prevalence of BVL in Kuwait exhibits a consistent upward trend throughout the observed period, starting at 3528.19 (95%CI, 3952.34- 3098.41) in 1990 and steadily rising to 4541.37(95%CI, 5155.83–3967.48) in 2019. The prevalence of BVL in Oman shows a consistent upward trend from 1990 to 2019. In 1990, the prevalence was 4786.45 (95% CI, 5345.37–4268.96), and it steadily increased over the subsequent years, reaching 5269.99 (95% CI, 5837.82–4688.31) in 2019. The prevalence of BVL in Qatar demonstrates a notable trajectory from 1990 to 2019. Commencing at 14942.65 (95% CI, 16960.86–13061.37) in 1990, the prevalence steadily increased over the years. The observed trends indicate a consistent rise, reaching 102405.15 (95% CI, 117817.99–88627.79) in 2019. The prevalence figure of BVL indicates an increasing trend over the observed period, starting at 866643.40 [95%CI, 947354.4774–787898.3192] in 1990 and steadily rising to 1824519.93 [95%CI, 2026299.456- 1641659.387] in 2019. The prevalence of BVL in the United Arab Emirates (UAE) reveals distinct patterns over the years from 1990 to 2019. In 1990, the prevalence stood at 3090.80 (95% CI, 3501.21–2693.78), marking the beginning of the observed period. Subsequently, the prevalence exhibited fluctuating trends, reaching its lowest point in 2007 at 2868.01 (95% CI, 3272.86–2472.47). Following this dip, the prevalence experienced a notable rise, reaching 3854.58 (95% CI, 4468.08–3261.26) in 2019. Figure 1 Sex difference Bahrain : In 1990, the prevalence of BVL was higher among females 4033.15 (95%CI, 4510.2–3583.6) compared to males 3612.36 (95%CI, 4097.4–3173.4). Over the years, both genders experienced an increasing trend in blindness prevalence. The prevalence among females consistently surpassed that of males throughout the observed period. Kuwait : In 1990, both females 3484.03 (95%CI, 3899.0–3075.2) and males 3561.09(95%CI, 4023.5–3118.0) had relatively similar prevalence rates. Over the years, there has been a noticeable increase in blindness prevalence for both genders. Oman : In 1990, the prevalence of blindness was higher among females 4920.2 (95%CI, 5540.5–4373.7) compared to males 4690.9 (95% CI, 5233.0–4167.8). Over the years, both genders experienced an increasing trend in blindness prevalence. The prevalence among females consistently surpassed that of males throughout the observed period. Qatar : The pattern in Qatar was like Oman and Saud Arabia, the prevalence was higher among females than males in 1990, 3557.0 995%CI, 3952.5-3144.8) vs 3257.5(95%CI, 3753.6- 2804.2). The pattern was increasing over time with more cases reported among females than males in most of the studied periods. Kingdom of Saudi Arabia : Female predominance persisted in Saudi Arabia. The prevalence among female in 1990 was 5496.9(95%CI, 6002.9- 5015.9) while in males it was 5325.9 (5845.6- 4814.8). The prevalence showed a marked decrease between 2001 and 2014 then it increased steadily since then. UAE : the pattern was different in UAE males’ prevalence was higher than females 3100.8 (95%CI, 3531.5-2682.3) VS 3072.5 (95%CI, 3441.9- 2699.9). A sharp decline was reported between 2007 and 2010 then a steady increase was observed. Figure 2 Figure 3 illustrates that the highest prevalence of BVL was reported among individuals aged 55 years and above, surpassing the rates observed in other age groups. This pattern remained consistent across all the countries examined. Notably, within this age group, there was a discernible decline in the prevalence of blindness in the studied countries. undefined Figure 3: Prevalence of blindness across different age groups in GCC The DALYs due to blindness showed a steady increase since 1990. In Bahrain DALYs increased from 854.8 (95%CI, 1175.0- 588.0) to be 2870.8 (95%CI, 4060.5–1974.1) in 2019. In Kuwait, the pattern increased from 2571.1 (95%CI, 3581.1–1767.4) in 1990 to 7646.3 (10814.5- 5182.3) in 2019. In Oman, it should steady increase from 4259.9 (95%CI, 5899.8–2967.9) in 1990 to 10623.0 (95%CI, 14582.1–7367.5) in 2019. Qatar followed a similar pattern, DALYs in 1990 was 660.70 (95%CI, 918.9- 459.5) in 1990 and increased to 3839.8 (5445.1–2602.3) in 2019. In Saudi Arabia, DALYs was the highest compared to other GCC, it was 57064.5 (95%CI, 77819.6–40709.6) in 1990 reaching 89962.6 (95%ci, 122805.6–63397.4) in 2019. In UAE, DALYs was 2487.5 (3435.4–1703.3) in 1990 and increased to 13430.4 (18933.8–9158.5). Figure 4 Forecasting of BVL for 2020–2024 The predicted prevalence of BVL in Bahrain ranges from 5528.8 (95%CI, 5502.8 to 5554.7) in 2020 to 6297.3 (95CI, 6605.6 in 2024) in 2024. Kuwait's forecast suggested a rise in blindness prevalence from 4602.1 (95%CI, 4548.9 to 4655.4) in 2020 to 4827.9(95%CI, 4524.6 to 5131.1) in 2024. Oman's predicted prevalence of BVL remains relatively stable, ranging from 5225.1 in 2022 to 5225.4 in 2023. The confidence intervals (5088.0 to 5362.2 in 2022; 4987.7 to 5462.8 in 2024) indicate a consistent level of confidence across the forecasted years. Qatar exhibited a substantial increase in forecasted BVL prevalence, starting from 107310.2 (95%CI, 106962.2 to 107658.2) in 2020 to 126162.9 (95%CI, 118927.5 to 133398.3) in 2024. Kingdom of Saudi Arabia showed a substantial rise in forecasted BVL prevalence, increasing from 1880842.0 (95%CI, 1876566.0 to 1885118.0) in 2020 to 2096529.0(95%CI, 2039773.0 to 2153286.0) in 2024. The forecast for the UAE showed a gradual increase in BVL prevalence, ranging from 5528.8 (95CI, 5502.8 to 5554.7) in 2020 to 6297.3 (95%CI, 5988.9 to 6605.6) in 2024. Table 1 Table 1 Predicted prevalence of blindness in GCC countries Country Year Forecast lower CI Higher CI Bahrain 2020 5528.8 5502.8 5554.7 2021 5720.9 5643.2 5798.6 2022 5913.0 5769.5 6056.5 2023 6105.1 5884.3 6326.0 2024 6297.3 5988.9 6605.6 Kuwait 2020 4602.1 4548.9 4655.4 2021 4660.9 4550.0 4771.7 2022 4717.8 4544.4 4891.3 2023 4773.4 4535.3 5011.6 2024 4827.9 4524.6 5131.1 Oman 2020 5260.6 5228.1 5293.1 2021 5238.9 5155.8 5322.0 2022 5225.1 5088.0 5362.2 2023 5225.4 5038.8 5412.0 2024 5225.3 4987.7 5462.8 Qatar 2020 107310.2 106962.2 107658.2 2021 112074.8 110861.7 113287.9 2022 116767.9 114089.1 119446.6 2023 121450.5 116733.2 126167.8 2024 126162.9 118927.5 133398.3 KSA 2020 1880842.0 1876566.0 1885118.0 2021 1935820.0 1923665.0 1947974.0 2022 1989910.0 1966212.0 2013608.0 2023 2043413.0 2004755.0 2082071.0 2024 2096529.0 2039773.0 2153286.0 UAE 2020 5528.8 5502.8 5554.7 2021 5720.9 5643.2 5798.6 2022 5913.0 5769.5 6056.5 2023 6105.1 5884.3 6326.0 2024 6297.3 5988.9 6605.6 Discussion This study aimed to fill critical gaps in our understanding of BVL trends within the GCC, focusing on the period from 1990 to 2019 and providing predictions for 2020–2024 through robust time-series analysis. Time series analysis was proven to be effective in prediction of different health outcomes.[ 13 – 15 ] Study main findings The comprehensive analysis of blindness prevalence trends in GCC countries from 1990 to 2019, with forecasts up to 2024, reveals distinctive patterns across the studied countries. Bahrain, Kuwait, Oman, Qatar, and Saudi Arabia consistently exhibit an upward trajectory in prevalence rates, emphasizing the growing burden of visual impairment over the observed years. Notably, gender differences are evident, with prevalence consistently higher among females in most countries, except for the UAE where males show a higher prevalence. Age-wise, individuals aged 55 and above consistently experience the highest prevalence of blindness across all countries, although a noticeable decline is observed within this age group. The DALYs due to blindness show a concerning increase, with Saudi Arabia reporting the highest DALYs in 2019. The forecasted prevalence for 2020–2024 suggests ongoing challenges, with Bahrain, Kuwait, and the UAE anticipating a gradual rise, while Qatar and Saudi Arabia face substantial increases. Interpretation of the main findings In this study there is increasing prevalence BVL in the GCC countries. In the same line, a study conducted in the eastern Mediterranean region found that Oman and Saudi Arabi reported the highest prevalence of vision loss. [ 16 ] It is worth noting that few studies assessed visual impairment in GCC countries. However, a different prevalence of BVL was reported in these few studies. Al-Shaaln et al., [ 17 ] conducted a study on 620 Saudi adults aged 18 and older from Aljouf primary health care centers found that 13.9% of them had visual impairment. A lower prevalence was reported in UAE. A cross-sectional eye health study conducted in Dubai between 2019–2020 aimed to understand the prevalence, causes, and risk factors of visual impairment (VI) among 892 Emiratis and non-Emiratis citizens. The prevalence of mild, moderate, and severe VI was 4.7% for Emiratis and 3.6% for non-Emiratis. [ 18 ] A lower prevalence of VI at 4.0% and blindness at 0.8% was derived from a hospital-based study conducted in the city of Al-Ain, situated in the emirate of Abu Dhabi.[ 19 ] Alabdulwahhab et al., [ 20 ] investigated the causes of vision impairment and blindness in schools in Qassim province, Saudi Arabia. A cross-sectional study found that retinitis pigmentosa (26%), optic atrophy (16%), glaucoma (7%), head trauma (6%), nystagmus (6%), retinopathy of prematurity (6%), ocular albinism (4%), corneal opacities (4%), amblyopia (3%) and other causes (22%) were the leading causes of disability. Another study conducted in Aljouf reported that the main medical causes were refractive errors (36.0%), followed by cataract (29.1%) and diabetic retinopathy (20.9%). [ 17 ] Gender-based difference: In this study we found that female’s prevalence was higher than males. Moreover, we found that the prevalence was higher among those who were aged 50 years and above.[ 21 ] In the same line, a systematic review and meta-analysis revealed that blindness is approximately 40% more prevalent in women than in men, irrespective of age. This gender imbalance is particularly pronounced among individuals aged 50 and above, where women consistently exhibit higher prevalence rates compared to men. Gender based differences. The current study found that there was female predominance through the study period. UAE had a reversed pattern with higher male prevalence. In the same line, Pandova et al, reported higher affection among females than males, [ 22 ] and in UAE [ 18 ]. Impact of BVL on quality of life In this BVL had a great impact on the GCC countries. In a systematic review comprising 138 studies, which investigated vision impairment (VI) stemming from unspecified causes or seven prevalent global causes (cataract, uncorrected refractive error, diabetic retinopathy, glaucoma, age-related macular degeneration, corneal opacity, and trachoma), the average quality assessment score was determined to be 78%. [ 23 ]A study conducted in United Kingdom (UK) found that the direct costs within the health care system reached £3.0 billion, with inpatient and day care expenses accounting for £735 million (24.6%), and outpatient costs making up £771 million (25.8%). Additionally, indirect costs associated with these conditions amounted to £5.65 billion (ranging from £5.12 to £6.22 billion).[ 24 ] Implication of the study findings This study has important implications for public health and policy in the Gulf Cooperation Council countries. The consistent rise in blindness prevalence highlights the urgent need for targeted interventions and public health planning. Given the observed disparities in prevalence between males and females, gender-specific strategies are required. Age-related healthcare measures, particularly for individuals aged 55 and above, must be prioritized to address the specific needs of this vulnerable demographic. The socio-cultural context plays a crucial role, emphasizing the importance of culturally sensitive interventions, awareness campaigns, and healthcare accessibility. Strengthening healthcare infrastructure is imperative to accommodate the increasing burden of visual impairment, necessitating improvements in facilities, workforce skills, and service accessibility. Policymakers should incorporate these findings into policy formulation, allocating resources for eye care programs and integrating eye health into primary healthcare systems. Continued monitoring and research are vital for refining forecasting models and assessing intervention effectiveness. International collaboration and community engagement are essential components of a comprehensive approach to tackle the complex challenges posed by the rising prevalence of blindness in the GCC region. Strengths and limitations This study has various strengths that add to its importance in evaluating visual impairment trends in the GCC countries. An extensive time period from 1990 to 2019 allows for a complete examination of long-term trends. In addition, forecasting capabilities for the years 2020–2024 increase the study's practical value for future public health planning. The reliance on data from the GBD 2019 Study lends credibility to the findings. The methodology of the study is robust, utilizing time-series analysis techniques such as ARIMA models, and the validation process ensures that predictions are aligned with observed data. However, study is not without its limitations. Dependence on secondary data sources introduces potential biases, as the accuracy of findings hinges on the quality of data from the GBD 2019 Study and other publications. Because of differences in healthcare systems, socioeconomic conditions, and cultural factors, generalization of results beyond the GCC countries may be limited. The study's modeling approach has inherent limitations, particularly in capturing sudden, unpredictable events, and assumptions about temporal changes in visual impairment prevalence may be influenced by the stability of risk factors over time. Despite efforts to validate predictions, forecasting uncertainties persist, and external factors not taken into account in the model may have an impact on future prevalence rates. Furthermore, the study does not evaluate the efficacy of specific interventions or policies, which limits insights into potential areas for improvement. Conclusions In conclusion, this research provides a comprehensive examination of blindness prevalence trends in GCC countries from 1990 to 2019, with projections up to 2024. The consistent and substantial upward trends in blindness prevalence across the GCC highlight the urgent need for targeted public health interventions. Gender disparities, with varying prevalence patterns between males and females, emphasize the necessity for gender-specific healthcare strategies. Age-related vulnerabilities, particularly among individuals aged 55 and above, underscore the importance of tailored healthcare measures for this demographic. The increasing burden of DALYs due to blindness further emphasizes the profound impact of visual impairment on overall health. Projections for 2020–2024 suggest ongoing challenges, with some countries anticipating a continued rise in prevalence. These findings collectively underscore the critical importance of proactive and culturally sensitive public health initiatives, improved healthcare infrastructure, and evidence-based policymaking to address the escalating burden of visual impairment in the GCC region. Continuous monitoring and international collaboration are essential for refining strategies and ensuring the effectiveness of interventions in the dynamic landscape of eye health. Declarations Author Contribution A.S.A. Conceptualization, S.T.A. methodology, I.A.A. software, A.J.k. validation, A.A.A. investigation, M.A.A. visualization, Ma.T.M. supervision, Mo.T.M. writing, R.A.A. review and editing, R.A. formal analysis, S.A.A. writing, Su.A.A. software. 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University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Saad","middleName":"Ali","lastName":"Alshahrani","suffix":""},{"id":286284761,"identity":"4f8dc7f2-70ab-4f99-a18c-a492491734b6","order_by":11,"name":"Sultan Abdulrahman Alyali","email":"","orcid":"","institution":"Riyadh First Health Cluster","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sultan","middleName":"Abdulrahman","lastName":"Alyali","suffix":""}],"badges":[],"createdAt":"2024-03-14 20:29:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4103271/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4103271/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53975907,"identity":"4f1989aa-c1b1-4fd9-9326-942e1100eedf","added_by":"auto","created_at":"2024-04-03 00:35:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":131120,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of blindness across GCC countries\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4103271/v1/d9e6605d066198e35858e3e6.png"},{"id":53975908,"identity":"151fa031-eca6-404d-a6f5-a0b3a65f4833","added_by":"auto","created_at":"2024-04-03 00:35:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":223573,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of blindness and vision loss across gender in GCC countries\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4103271/v1/933369244f7b8bf9830b13e4.png"},{"id":53975910,"identity":"5d0104d8-3d2f-4597-bc27-88045895c564","added_by":"auto","created_at":"2024-04-03 00:35:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":149676,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of blindness across different age groups in GCC\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4103271/v1/411739e3562cf0d12f764888.png"},{"id":53975905,"identity":"a1a35a71-5f50-4b6e-988b-98d1a74203e3","added_by":"auto","created_at":"2024-04-03 00:35:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":99689,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDLYs of blindness in GCC countries across different age groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4103271/v1/8398343fb6c6cd5aee07c289.png"},{"id":59593662,"identity":"9d6c512c-3709-4400-8680-af997a35f4dc","added_by":"auto","created_at":"2024-07-03 15:20:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":960401,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4103271/v1/b0b6ad75-91e0-4c84-aec1-9aa3b1550dfc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding Visual Impairment Trends in the Gulf Council Countries: An Analysis from 1990 to 2019 and Time-Series Predictions for 2020-2024","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn many countries across the world, the average age of the population is rising, more people are reaching adulthood due to rising sociodemographic status and life expectancy, and the burden of disease is shifting toward non-communicable diseases (NCDs) and disabilities. This epidemiological transition affects the majority of the primary causes of vision impairment, such as cataracts and undercorrected refractive error [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and they come at a large financial and societal cost to each individual. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to the latest global report on blindness and vision impairment among individuals aged 50 and above, approximately 43.3\u0026nbsp;million people worldwide are blind, and 295\u0026nbsp;million people suffer from moderate to severe vision impairment as of 2020. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Blindness and vision loss (BVL) were expected to have caused 22.6\u0026nbsp;million disability-adjusted life years (DALYs) globally in 2019, making up 0.88% of all DALYs caused by all causes. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Severe personal financial and educational challenges are brought on by BVL,[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] which also lowers quality of life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and raises mortality. It is possible that about one-third of the patients suffering from visual impairment did not obtain appropriate preventive and therapy. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSaudi Arabia, Kuwait, the United Arab Emirates (UAE), Qatar, Bahrain, and Oman are the six Middle Eastern countries that make up the Gulf Cooperation Council (GCC), a political and economic partnership. In May 1981, the GCC was founded in Riyadh, Saudi Arabia. The GCC aims to unite its members via shared goals and comparable political and cultural identities founded on Islamic principles. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The combined land area of all member states is 2.57\u0026nbsp;million square kilometers, with a total population of approximately 58.86\u0026nbsp;million people.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe population over 50 has been analyzed for the updated worldwide and regional prevalence of BVL, which is classified by the severity of visual impairment in addition to eye diseases which provides comprehensive knowledge for understanding the landscape of BVL burden. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] However, the impact of putative risk factors and the burden on the entire population have not yet been evaluated. Using a wide range of data sources and reliable statistical techniques, the most recent Global Burden of Disease (GBD) 2019 Study calculated the annual burden of 369 diseases for 204 nations and territories between 1990 and 2019, which provided a unique opportunity to grasp the progress of the BVL burden. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur study hypothesis aimed at comprehensively understanding visual impairment trends in the GCC from 1990 to 2019 and forecasting for 2020\u0026ndash;2024. We hypothesized that there has been a significant temporal change in the prevalence of BVL within the GCC over the specified period. This study aimed to fill critical gaps in our understanding of BVL trends within the GCC, focusing on the period from 1990 to 2019 and providing predictions for 2020\u0026ndash;2024 through robust time-series analysis. By leveraging data from the GBD 2019 study our investigation assessed the evolving burden of visual impairment and its associated risk factors.\u003c/p\u003e"},{"header":"Methodoloy","content":"\u003cp\u003eUtilize secondary data sources extracted from existing databases of GBD Study and other relevant publications. The study focuses on individuals of all age groups within the Gulf Council Countries (Saudi Arabia, Kuwait, the UAE, Qatar, Bahrain, and Oman) from 1990 to 2024. We conducted a detailed temporal analysis of visual impairment prevalence trends from 1990 to 2019, utilizing statistical methods such as descriptive statistics and graphical representations to highlight changes over time.\u003c/p\u003e \u003cp\u003eIn this study we presented the prevalence rate of BVL in the 7 countries. We described this prevalence rate across sex (male and females) and across different age groups (\u0026lt;\u0026thinsp;5 years, 4\u0026ndash;19 years, 20\u0026ndash;54 years, and 55\u0026thinsp;+\u0026thinsp;yeras). We presented the DALYs as well over this time peroid across countries. DALYs is sum of the years of life lost to due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population. We employed time-series analysis techniques to generate predictions for visual impairment prevalence in the GCC for the years 2020\u0026ndash;2024.\u003c/p\u003e \u003cp\u003eExcel was used to compile the data and ensure its uniformity and completeness. R version 4.2 for Windows was used to examine, clean, and code the data. With line graphs displayed using points on the X-Y axis\u0026mdash;where X is the time in year (from 1990 to 2019) and Y is the value of the selected indicator for each year in number or percent\u0026mdash;the patterns of each chosen indicator and their evolution were described mathematically and graphicallyThe moving average's order was denoted by MA (q), the autoregression's order by AR(p), and the difference's degree by I. (d). In order to predict the number of cases for the year 2020\u0026ndash;2024 we constructed AutoRegressive Integrated Moving Average (ARIMA) models using data reported in GCC from 1990 to 2019. We constructed an ideal model based on Akaike's information criterion (AIC) and Schwartz's Bayesian criterion, and we used the autocorrelation function (ACF) and partial autocorrelation function (PACF) graphs to compute the degree of ARIMA (SBC). We verified that the forecast errors were normally distributed, had a mean of zero, and had constant variance in order to validate the predictive model. We validate the accuracy of predictions through comparison with observed data.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe data reveals a consistent upward trend of BVL, with prevalence values steadily increasing from 3789.39 (95%CI, 4263.32\u0026ndash;3350.32) in 1990 to 5336.64 (95%CI, 6198.79\u0026ndash;4611.47) in 2019. The prevalence of BVL in Kuwait exhibits a consistent upward trend throughout the observed period, starting at 3528.19 (95%CI, 3952.34- 3098.41) in 1990 and steadily rising to 4541.37(95%CI, 5155.83\u0026ndash;3967.48) in 2019. The prevalence of BVL in Oman shows a consistent upward trend from 1990 to 2019. In 1990, the prevalence was 4786.45 (95% CI, 5345.37\u0026ndash;4268.96), and it steadily increased over the subsequent years, reaching 5269.99 (95% CI, 5837.82\u0026ndash;4688.31) in 2019. The prevalence of BVL in Qatar demonstrates a notable trajectory from 1990 to 2019. Commencing at 14942.65 (95% CI, 16960.86\u0026ndash;13061.37) in 1990, the prevalence steadily increased over the years. The observed trends indicate a consistent rise, reaching 102405.15 (95% CI, 117817.99\u0026ndash;88627.79) in 2019. The prevalence figure of BVL indicates an increasing trend over the observed period, starting at 866643.40 [95%CI, 947354.4774\u0026ndash;787898.3192] in 1990 and steadily rising to 1824519.93 [95%CI, 2026299.456- 1641659.387] in 2019. The prevalence of BVL in the United Arab Emirates (UAE) reveals distinct patterns over the years from 1990 to 2019. In 1990, the prevalence stood at 3090.80 (95% CI, 3501.21\u0026ndash;2693.78), marking the beginning of the observed period. Subsequently, the prevalence exhibited fluctuating trends, reaching its lowest point in 2007 at 2868.01 (95% CI, 3272.86\u0026ndash;2472.47). Following this dip, the prevalence experienced a notable rise, reaching 3854.58 (95% CI, 4468.08\u0026ndash;3261.26) in 2019. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSex difference\u003c/h2\u003e \u003cp\u003e \u003cb\u003eBahrain\u003c/b\u003e: In 1990, the prevalence of BVL was higher among females 4033.15 (95%CI, 4510.2\u0026ndash;3583.6) compared to males 3612.36 (95%CI, 4097.4\u0026ndash;3173.4). Over the years, both genders experienced an increasing trend in blindness prevalence. The prevalence among females consistently surpassed that of males throughout the observed period. \u003cb\u003eKuwait\u003c/b\u003e: In 1990, both females 3484.03 (95%CI, 3899.0\u0026ndash;3075.2) and males 3561.09(95%CI, 4023.5\u0026ndash;3118.0) had relatively similar prevalence rates. Over the years, there has been a noticeable increase in blindness prevalence for both genders. \u003cb\u003eOman\u003c/b\u003e: In 1990, the prevalence of blindness was higher among females 4920.2 (95%CI, 5540.5\u0026ndash;4373.7) compared to males 4690.9 (95% CI, 5233.0\u0026ndash;4167.8). Over the years, both genders experienced an increasing trend in blindness prevalence. The prevalence among females consistently surpassed that of males throughout the observed period. \u003cb\u003eQatar\u003c/b\u003e: The pattern in Qatar was like Oman and Saud Arabia, the prevalence was higher among females than males in 1990, 3557.0 995%CI, 3952.5-3144.8) vs 3257.5(95%CI, 3753.6- 2804.2). The pattern was increasing over time with more cases reported among females than males in most of the studied periods. \u003cb\u003eKingdom of Saudi Arabia\u003c/b\u003e: Female predominance persisted in Saudi Arabia. The prevalence among female in 1990 was 5496.9(95%CI, 6002.9- 5015.9) while in males it was 5325.9 (5845.6- 4814.8). The prevalence showed a marked decrease between 2001 and 2014 then it increased steadily since then. \u003cb\u003eUAE\u003c/b\u003e: the pattern was different in UAE males\u0026rsquo; prevalence was higher than females 3100.8 (95%CI, 3531.5-2682.3) VS 3072.5 (95%CI, 3441.9- 2699.9). A sharp decline was reported between 2007 and 2010 then a steady increase was observed. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 3\u003c/b\u003e illustrates that the highest prevalence of BVL was reported among individuals aged 55 years and above, surpassing the rates observed in other age groups. This pattern remained consistent across all the countries examined. Notably, within this age group, there was a discernible decline in the prevalence of blindness in the studied countries.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eundefined\u003c/h3\u003e\n \u003cp\u003e \u003cb\u003eFigure 3: Prevalence of blindness across different age groups in GCC\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe DALYs due to blindness showed a steady increase since 1990. In Bahrain DALYs increased from 854.8 (95%CI, 1175.0- 588.0) to be 2870.8 (95%CI, 4060.5\u0026ndash;1974.1) in 2019. In Kuwait, the pattern increased from 2571.1 (95%CI, 3581.1\u0026ndash;1767.4) in 1990 to 7646.3 (10814.5- 5182.3) in 2019. In Oman, it should steady increase from 4259.9 (95%CI, 5899.8\u0026ndash;2967.9) in 1990 to 10623.0 (95%CI, 14582.1\u0026ndash;7367.5) in 2019. Qatar followed a similar pattern, DALYs in 1990 was 660.70 (95%CI, 918.9- 459.5) in 1990 and increased to 3839.8 (5445.1\u0026ndash;2602.3) in 2019. In Saudi Arabia, DALYs was the highest compared to other GCC, it was 57064.5 (95%CI, 77819.6\u0026ndash;40709.6) in 1990 reaching 89962.6 (95%ci, 122805.6\u0026ndash;63397.4) in 2019. In UAE, DALYs was 2487.5 (3435.4\u0026ndash;1703.3) in 1990 and increased to 13430.4 (18933.8\u0026ndash;9158.5). Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eForecasting of BVL for 2020\u0026ndash;2024\u003c/h2\u003e \u003cp\u003eThe predicted prevalence of BVL in Bahrain ranges from 5528.8 (95%CI, 5502.8 to 5554.7) in 2020 to 6297.3 (95CI, 6605.6 in 2024) in 2024. Kuwait's forecast suggested a rise in blindness prevalence from 4602.1 (95%CI, 4548.9 to 4655.4) in 2020 to 4827.9(95%CI, 4524.6 to 5131.1) in 2024. Oman's predicted prevalence of BVL remains relatively stable, ranging from 5225.1 in 2022 to 5225.4 in 2023. The confidence intervals (5088.0 to 5362.2 in 2022; 4987.7 to 5462.8 in 2024) indicate a consistent level of confidence across the forecasted years. Qatar exhibited a substantial increase in forecasted BVL prevalence, starting from 107310.2 (95%CI, 106962.2 to 107658.2) in 2020 to 126162.9 (95%CI, 118927.5 to 133398.3) in 2024. Kingdom of Saudi Arabia showed a substantial rise in forecasted BVL prevalence, increasing from 1880842.0 (95%CI, 1876566.0 to 1885118.0) in 2020 to 2096529.0(95%CI, 2039773.0 to 2153286.0) in 2024. The forecast for the UAE showed a gradual increase in BVL prevalence, ranging from 5528.8 (95CI, 5502.8 to 5554.7) in 2020 to 6297.3 (95%CI, 5988.9 to 6605.6) in 2024. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredicted prevalence of blindness in GCC countries\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eForecast\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003elower CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigher CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eBahrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5528.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5502.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5554.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5720.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5643.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5798.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5913.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5769.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6056.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6105.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5884.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6326.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6297.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5988.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6605.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eKuwait\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4602.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4548.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4655.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4660.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4550.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4771.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4717.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4544.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4891.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4773.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4535.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5011.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4827.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4524.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5131.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eOman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5260.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5228.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5293.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5238.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5155.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5322.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5225.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5088.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5362.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5225.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5038.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5412.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5225.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4987.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5462.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eQatar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107310.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e106962.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e107658.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112074.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110861.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e113287.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116767.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114089.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e119446.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121450.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e116733.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e126167.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126162.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e118927.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e133398.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eKSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1880842.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1876566.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1885118.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1935820.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1923665.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1947974.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1989910.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1966212.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2013608.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2043413.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2004755.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2082071.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2096529.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2039773.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2153286.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eUAE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5528.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5502.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5554.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5720.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5643.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5798.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5913.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5769.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6056.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6105.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5884.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6326.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6297.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5988.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6605.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to fill critical gaps in our understanding of BVL trends within the GCC, focusing on the period from 1990 to 2019 and providing predictions for 2020\u0026ndash;2024 through robust time-series analysis. Time series analysis was proven to be effective in prediction of different health outcomes.[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eStudy main findings\u003c/h3\u003e\n\u003cp\u003eThe comprehensive analysis of blindness prevalence trends in GCC countries from 1990 to 2019, with forecasts up to 2024, reveals distinctive patterns across the studied countries. Bahrain, Kuwait, Oman, Qatar, and Saudi Arabia consistently exhibit an upward trajectory in prevalence rates, emphasizing the growing burden of visual impairment over the observed years. Notably, gender differences are evident, with prevalence consistently higher among females in most countries, except for the UAE where males show a higher prevalence. Age-wise, individuals aged 55 and above consistently experience the highest prevalence of blindness across all countries, although a noticeable decline is observed within this age group. The DALYs due to blindness show a concerning increase, with Saudi Arabia reporting the highest DALYs in 2019. The forecasted prevalence for 2020\u0026ndash;2024 suggests ongoing challenges, with Bahrain, Kuwait, and the UAE anticipating a gradual rise, while Qatar and Saudi Arabia face substantial increases.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation of the main findings\u003c/h2\u003e \u003cp\u003eIn this study there is increasing prevalence BVL in the GCC countries. In the same line, a study conducted in the eastern Mediterranean region found that Oman and Saudi Arabi reported the highest prevalence of vision loss. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] It is worth noting that few studies assessed visual impairment in GCC countries. However, a different prevalence of BVL was reported in these few studies. Al-Shaaln et al., [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] conducted a study on 620 Saudi adults aged 18 and older from Aljouf primary health care centers found that 13.9% of them had visual impairment. A lower prevalence was reported in UAE. A cross-sectional eye health study conducted in Dubai between 2019\u0026ndash;2020 aimed to understand the prevalence, causes, and risk factors of visual impairment (VI) among 892 Emiratis and non-Emiratis citizens. The prevalence of mild, moderate, and severe VI was 4.7% for Emiratis and 3.6% for non-Emiratis. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] A lower prevalence of VI at 4.0% and blindness at 0.8% was derived from a hospital-based study conducted in the city of Al-Ain, situated in the emirate of Abu Dhabi.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlabdulwahhab et al., [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] investigated the causes of vision impairment and blindness in schools in Qassim province, Saudi Arabia. A cross-sectional study found that retinitis pigmentosa (26%), optic atrophy (16%), glaucoma (7%), head trauma (6%), nystagmus (6%), retinopathy of prematurity (6%), ocular albinism (4%), corneal opacities (4%), amblyopia (3%) and other causes (22%) were the leading causes of disability. Another study conducted in Aljouf reported that the main medical causes were refractive errors (36.0%), followed by cataract (29.1%) and diabetic retinopathy (20.9%). [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGender-based difference: In this study we found that female\u0026rsquo;s prevalence was higher than males. Moreover, we found that the prevalence was higher among those who were aged 50 years and above.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] In the same line, a systematic review and meta-analysis revealed that blindness is approximately 40% more prevalent in women than in men, irrespective of age. This gender imbalance is particularly pronounced among individuals aged 50 and above, where women consistently exhibit higher prevalence rates compared to men.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGender based differences.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe current study found that there was female predominance through the study period. UAE had a reversed pattern with higher male prevalence. In the same line, Pandova et al, reported higher affection among females than males, [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and in UAE [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImpact of BVL on quality of life\u003c/strong\u003e \u003cp\u003eIn this BVL had a great impact on the GCC countries. In a systematic review comprising 138 studies, which investigated vision impairment (VI) stemming from unspecified causes or seven prevalent global causes (cataract, uncorrected refractive error, diabetic retinopathy, glaucoma, age-related macular degeneration, corneal opacity, and trachoma), the average quality assessment score was determined to be 78%. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]A study conducted in United Kingdom (UK) found that the direct costs within the health care system reached \u0026pound;3.0\u0026nbsp;billion, with inpatient and day care expenses accounting for \u0026pound;735\u0026nbsp;million (24.6%), and outpatient costs making up \u0026pound;771\u0026nbsp;million (25.8%). Additionally, indirect costs associated with these conditions amounted to \u0026pound;5.65\u0026nbsp;billion (ranging from \u0026pound;5.12 to \u0026pound;6.22\u0026nbsp;billion).[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eImplication of the study findings\u003c/h2\u003e \u003cp\u003eThis study has important implications for public health and policy in the Gulf Cooperation Council countries. The consistent rise in blindness prevalence highlights the urgent need for targeted interventions and public health planning. Given the observed disparities in prevalence between males and females, gender-specific strategies are required. Age-related healthcare measures, particularly for individuals aged 55 and above, must be prioritized to address the specific needs of this vulnerable demographic. The socio-cultural context plays a crucial role, emphasizing the importance of culturally sensitive interventions, awareness campaigns, and healthcare accessibility. Strengthening healthcare infrastructure is imperative to accommodate the increasing burden of visual impairment, necessitating improvements in facilities, workforce skills, and service accessibility. Policymakers should incorporate these findings into policy formulation, allocating resources for eye care programs and integrating eye health into primary healthcare systems. Continued monitoring and research are vital for refining forecasting models and assessing intervention effectiveness. International collaboration and community engagement are essential components of a comprehensive approach to tackle the complex challenges posed by the rising prevalence of blindness in the GCC region.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study has various strengths that add to its importance in evaluating visual impairment trends in the GCC countries. An extensive time period from 1990 to 2019 allows for a complete examination of long-term trends. In addition, forecasting capabilities for the years 2020\u0026ndash;2024 increase the study's practical value for future public health planning. The reliance on data from the GBD 2019 Study lends credibility to the findings. The methodology of the study is robust, utilizing time-series analysis techniques such as ARIMA models, and the validation process ensures that predictions are aligned with observed data. However, study is not without its limitations. Dependence on secondary data sources introduces potential biases, as the accuracy of findings hinges on the quality of data from the GBD 2019 Study and other publications. Because of differences in healthcare systems, socioeconomic conditions, and cultural factors, generalization of results beyond the GCC countries may be limited. The study's modeling approach has inherent limitations, particularly in capturing sudden, unpredictable events, and assumptions about temporal changes in visual impairment prevalence may be influenced by the stability of risk factors over time. Despite efforts to validate predictions, forecasting uncertainties persist, and external factors not taken into account in the model may have an impact on future prevalence rates. Furthermore, the study does not evaluate the efficacy of specific interventions or policies, which limits insights into potential areas for improvement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, this research provides a comprehensive examination of blindness prevalence trends in GCC countries from 1990 to 2019, with projections up to 2024. The consistent and substantial upward trends in blindness prevalence across the GCC highlight the urgent need for targeted public health interventions. Gender disparities, with varying prevalence patterns between males and females, emphasize the necessity for gender-specific healthcare strategies. Age-related vulnerabilities, particularly among individuals aged 55 and above, underscore the importance of tailored healthcare measures for this demographic. The increasing burden of DALYs due to blindness further emphasizes the profound impact of visual impairment on overall health. Projections for 2020\u0026ndash;2024 suggest ongoing challenges, with some countries anticipating a continued rise in prevalence. These findings collectively underscore the critical importance of proactive and culturally sensitive public health initiatives, improved healthcare infrastructure, and evidence-based policymaking to address the escalating burden of visual impairment in the GCC region. Continuous monitoring and international collaboration are essential for refining strategies and ensuring the effectiveness of interventions in the dynamic landscape of eye health.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.S.A. Conceptualization, S.T.A. methodology, I.A.A. software, A.J.k. validation, A.A.A. investigation, M.A.A. visualization, Ma.T.M. supervision, Mo.T.M. writing, R.A.A. review and editing, R.A. formal analysis, S.A.A. writing, Su.A.A. software.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFlaxman, S.R.; Bourne, R.R.A.; Resnikoff, S.; Ackland, P.; Braithwaite, T.; Cicinelli, M.V.; Das, A.; Jonas, J.B.; Keeffe, J.; Kempen, J.H.; et al. Global causes of blindness and distance vision impairment 1990\u0026ndash;2020: a systematic review and meta-analysis. 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BMC Health Services Research 2018, \u003cem\u003e18\u003c/em\u003e, 63, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-018-2836-0\u003c/span\u003e\u003cspan address=\"10.1186/s12913-018-2836-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Blindness prevalence, Visual impairment trends, Gulf Cooperation Council, Disability-Adjusted Life Years, Age-related vulnerabilities, ARIMA models, Public health planning, Healthcare infrastructure","lastPublishedDoi":"10.21203/rs.3.rs-4103271/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4103271/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis research investigates blindness prevalence trends in Gulf Cooperation Council (GCC) countries from 1990 to 2019 and provides projections up to 2024. The study aimed to inform public health planning, policy formulation, and healthcare delivery in the region.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUtilizing data from the Global Burden of Disease 2019 Study, the research employs time-series analysis techniques, including AutoRegressive Integrated Moving Average (ARIMA) models, to analyze blindness prevalence trends. Secondary data sources from GCC countries are used to assess gender-specific, age-related, and country-specific patterns. Projections for 2020\u0026ndash;2024 are generated and validated through comparison with observed data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings reveal consistent upward trends in blindness prevalence across Bahrain, with rates increasing from 3789.39 in 1990 to 5336.64 in 2019. Kuwait exhibits a continuous rise, starting at 3528.19 in 1990 and reaching 4541.37 in 2019. Oman shows a steady increase from 4786.45 in 1990 to 5269.99 in 2019. Qatar experienced a notable trajectory, starting at 14942.65 in 1990 and reaching 102405.15 in 2019. Saudi Arabia indicates an increasing trend, from 866643.40 in 1990 to 1824519.93 in 2019. The United Arab of Emirates (UAE) displays distinct patterns, with prevalence fluctuating but generally increasing from 3090.80 in 1990 to 3854.58 in 2019. Gender disparities are evident, with consistently higher prevalence among females in Bahrain, Kuwait, Oman, Qatar, and Saudi Arabia. Individuals aged 55 and above consistently experience the highest prevalence, with a decline noted within this age group. Disability-adjusted life Years (DALYs) due to blindness show a steady increase, with Saudi Arabia reporting the highest DALYs, reaching 89962.6 in 2019. Projections for 2020\u0026ndash;2024 suggest ongoing challenges, with Bahrain, Kuwait, and the UAE anticipating gradual rises, while Qatar and Saudi Arabia face substantial increases.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe research concludes that proactive and culturally sensitive public health initiatives are urgently needed to address the escalating burden of visual impairment in the GCC region. Gender-specific healthcare strategies, age-related healthcare measures, and improved healthcare infrastructure are essential components of a comprehensive approach. Policymakers should integrate these findings into evidence-based policies, emphasizing continuous monitoring and international collaboration to refine strategies and ensure their effectiveness. The study highlights the dynamic nature of eye health, necessitating adaptive and targeted interventions for sustainable impact in the GCC countries.\u003c/p\u003e","manuscriptTitle":"Understanding Visual Impairment Trends in the Gulf Council Countries: An Analysis from 1990 to 2019 and Time-Series Predictions for 2020-2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 00:35:09","doi":"10.21203/rs.3.rs-4103271/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52b622f1-114f-461a-9905-69fe17e5a520","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30132009,"name":"Biological sciences/Neuroscience"},{"id":30132010,"name":"Physical sciences/Optics and photonics"}],"tags":[],"updatedAt":"2024-07-03T15:11:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-03 00:35:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4103271","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4103271","identity":"rs-4103271","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}