**Background:** Vision loss is a major public health issue affecting quality of life and increasing mortality risk. The Middle East and North Africa (MENA) region has a higher prevalence of blindness than the global average, yet no prior study had specifically examined the burden of vision loss across all MENA countries over a 30-year period. This study aimed to document the burden of vision loss in MENA from 1990 to 2019 by age, sex, underlying cause, and sociodemographic index (SDI).
**Methods:** Data were obtained from the Global Burden of Disease (GBD) 2019 study, covering all 21 MENA countries: Afghanistan, Algeria, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, Turkey, United Arab Emirates, and Yemen. Vision loss was defined as visual acuity less than 6/18 on the Snellen chart. The study used DisMod-MR 2.1 to model prevalence of presenting vision loss (moderate, severe, blindness, and near vision loss) and cause-specific vision loss (e.g., cataract, diabetic retinopathy, glaucoma, refractive error). Years lived with disability (YLDs) were calculated by multiplying prevalence estimates with disability weights. Estimates were reported as raw counts and age-standardized rates per 100,000 with 95% uncertainty intervals (UIs). Smoothing splines were used to assess the relationship between YLD rates and SDI.
**Key Results:** In 2019, the MENA region had 32.5 million (95% UI: 28.6–36.6) prevalent cases of vision loss, with an age-standardized point prevalence of 7040.0 (6195.0–8002.7) per 100,000—11.1% lower than in 1990. The region recorded 1.4 million (1.0–1.9) YLDs, with an age-standardized YLD rate of 314.5 (222.1–427.6) per 100,000, a 24.3% decrease since 1990. Country-level variation was substantial: Oman had the highest age-standardized point prevalence (9139.0 per 100,000) and Turkey the lowest (5923.4 per 100,000). Afghanistan had the highest YLD rate (469.6 per 100,000) and Turkey the lowest (210.7 per 100,000). Most countries showed declines in both measures from 1990 to 2019, except Oman, Afghanistan, and Yemen, which had non-significant increases or minimal decreases. The largest decreases were in Saudi Arabia (point prevalence: -20.9%; YLD rate: -42.2%). The burden peaked in the 65–69 age group for both sexes. Females had higher YLD rates than males in 20 of 21 countries. Refractive disorders were the leading cause of vision loss among children, adolescents, and middle-aged adults, while near vision loss and cataracts predominated in older adults. The YLD rate showed a negative association with SDI across the study period.
**Clinical Implications:** Despite a 30-year decline, vision loss remains a significant burden in MENA, particularly among the elderly and in lower-SDI countries. The high prevalence of preventable or treatable causes—refractive disorders and cataracts—underscores the need for targeted public health interventions, including improved access to eye care, screening programs, and education. The lack of improvement in Oman, Afghanistan, and Yemen calls for urgent attention. Policymakers should prioritize elderly populations and low-income countries, implement strategies such as community education, increasing the number of ophthalmologists, and ensuring insurance coverage for eye care. The study's limitations include data sparsity in low-income countries, reliance on modeled estimates, and lack of sub-national or urban/rural data.