Using the past perfect here makes more sense than using the past simple, because presumably the vision loss was a gradual process rather than a single event in the past.
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Anonymous By the time Amar was 20 years old, he had lost or lost almost all his vision .I think the correct one is past perfect, but could the past simple be used in the main clause and if not why. Thank youYou could say "By the time Amar had reached the age of 20", but not "By the time Amar had been 20".