Epidemiology of Near Vision Impairment among Adults Aged 50 Years and Older in Northern Togo: Results from a 2024 RAAB Survey

Objective: To describe the epidemiology of near vision impairment among adults aged 50 years and older in northern Togo in 2024. Methods: A population-based cross-sectional study was conducted using the Rapid Assessment of Avoidable Blindness (RAAB) methodology between 18 November and 13 December 2024 in northern Togo. The primary outcome was presenting near visual acuity (PNVA) measured at 40 cm with available correction. Near vision impairment was defined as near visual acuity worse than N6 at 40 cm according to WHO definitions. A multistage cluster sampling design was used. Data on sociodemographic characteristics, ownership of near-vision spectacles, and household socioeconomic status were collected. Prevalence estimates were generated using the RAAB7 automated analysis platform, which accounts for the cluster sampling design and provides 95% confidence intervals. Results: A total of 4290 participants were examined (response rate: 99.8%), of whom 63.8% were women. The mean age was 63.1 ± 10.4 years. The overall prevalence of near vision impairment was 81.9% (95% CI: 80.7 - 83.0). NVI was significantly more common among women than men (86.1%, 95% CI: 84.8 - 87.4 vs 74.6%, 95% CI: 72.4 - 76.7). Only 18.3% of participants owned near-vision spectacles (95% CI: 17.1 - 19.5). Among those who had never used spectacles, the main reasons for non-use were lack of perceived need (63.1%), financial constraints (20.9%), and unavailability of spectacles (16.0%). Most participants with NVI reported socioeconomic vulnerability, including insufficient household income (57.4%) and inadequate or just adequate food supply (97.9%). Conclusion: Near vision impairment is highly prevalent among adults aged 50 years and older in northern Togo. The high burden of uncorrected NVI and the very low coverage of near-vision spectacles highlight the urgent need to integrate presbyopia services into primary eye care and expand access to affordable spectacle provision.