Purpose: To determine the prevalence and causes of blindness and vision impairment among people 50 years and older in Nepal. Methods: We conducted seven provincial-level Rapid Assessment of Avoidable Blindness (RAAB) cross-sectional, population-based surveys between 2018-2021. Provincial prevalence estimates were weighted to give nationally representative estimates.  Sampling, enumeration, and examination of the population 50 years and older were done at the province level following standard RAAB protocol. Results: Across seven surveys, we enrolled 33,228 individuals, of whom 32,565 were examined (response rate 98%). Females (n=17,935) made up 55% of the sample. The age-sex-province weighted national prevalence of blindness (better eye presenting visual acuity <3/60) was 1.1% (95% confidence interval [CI] 1.0-1.2%), and any vision impairment <6/12 was 20.7% (95% CI 19.9-21.5%). The prevalence of blindness and any vision impairment were both higher in women than men (1.3% [95% CI 1.1-1.5%] vs 0.9% [95% CI 0.7-1.0%]). Age-sex weighted blindness prevalence was highest in Lumbini Province (1.8% [95% CI 1.3-2.2%]) and lowest in Bagmati Province (0.7% [95% CI 0.4-0.9%]) and Sudurpaschim Province (0.7% [95% CI 0.4-0.9%]). Cataract (65.2%) was the leading cause of blindness in our sample, followed by corneal opacity (6.4%), glaucoma (5.8%) and age-related macular degeneration (5.3%). Other posterior segment diseases accounted for 8.4% of cases. Conclusion: The prevalence of blindness was higher among women than men and varied by province. The Lumbini and Madesh Provinces in the Terai (plains) region had higher prevalence of blindness than elsewhere. Cataract was the leading cause of blindness, severe vision impairment and moderate vision impairment while refractive error was the leading cause of mild vision impairment.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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Ethics approval was obtained from the Nepal Health Research Council under the Ministry of Health, Government of Nepal. The survey conformed to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all participants before they enrolled in the study.

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Data is available with Nepal Netra Jyoti Sangh and International Agency for the Prevalence of Blindness, South East Asia office. Also in the RAAB repository