Glaucoma
The VEHSS team conducted a review of published literature on examination-based population studies reporting the prevalence of glaucoma.
Glaucoma is a general term for a number of eye conditions that progressively damage the optic nerve, consequently causing vision loss.(AOA, 2015) Diagnosis of glaucoma is complex, but is often associated with elevated intraocular pressure, optic nerve damage, and reduction in visual acuity and visual field. The most common form of glaucoma is primary open-angle glaucoma (OAG). If the eye is functioning normally, fluid flows out of the anterior chamber through the open angle between the cornea and iris and out the eye. With OAG, the fluid flows out slowly and builds up, increasing the pressure on the eye that may cause gradual loss of vision. Acute angle-closure glaucoma (ACG), also known as angle-closure or narrow-angle glaucoma, is less common and occurs when the angle is blocked by the iris and may rapidly cause vision loss if left untreated.(AOA, 2015) Other forms of glaucoma include: secondary glaucoma (caused by medical complications such as diabetes or an injury to the eye); congenital glaucoma; and normal tension glaucoma (damage occurs although the eye pressure is normal). Patients with risk factors for glaucoma, such as elevated intraocular pressure, may be diagnosed as glaucoma suspect. Vision loss from glaucoma is permanent, but progression may be slowed or halted through early diagnosis and treatment.
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Glaucoma Literature Review Results
There were 14 studies published between 1991 and 2016 that examined the prevalence of glaucoma. These studies examined a variety of demographic variables including race/ethnicity, age, sex, income, and education level. Results are limited to open-angle glaucoma, acute angle-closure glaucoma, and glaucoma suspect (presence of glaucoma risk factors but no damage to the eye). The sources were:
Table 1. Glaucoma Prevalence Sources.
| Author | Date of Publication | Title | Date of Data Collection | Data Source | Sample Size | Prevalence Data Stratified by: | Type of Glaucoma |
|---|---|---|---|---|---|---|---|
| Park D, Mansberger SL, et al. | 2016 | Prevalence of Age-Related Macular Degeneration in Chinese American Adults: the Chinese American Eye Study | 2006–2009 | Telemedicine Screening Program | 424 | Race | Any |
| Gupta P, Zhao D, et al. | 2016 | Prevalence of Glaucoma in the United States: The 2005-2008 National Health and Nutrition Examination Survey | 2005–2008 | NHANES 2005-2008 | 5,746 | Age, Race/ Ethnicity, Sex | Any |
| Shaikh Y, Yu F, et al. | 2014 | Burden of Undetected and Untreated Glaucoma in the United States | 2005–2008 | NHANES 2005-2008 | 3,850 | Not stratified by demographic variables | Possible, Probable, Definite, and Undiagnosed |
| Maa AY, Evans C, et al. | 2013 | Veteran Eye Disease After Eligibility Reform: Prevalence and Characteristics | January 2008–February 2008 | Atlanta VA Medical Center Chart Review | 658 | Not stratified by demographic variables | OAG, ACG, suspect |
| Cassard SD, Quigley HA, Gower EW, et al. | 2012 | Regional Variations and Trends in the Prevalence of Diagnosed Glaucoma in the Medicare Population | 2002–2008 | Medicare Claims | N/A | Age, Sex, Race/ Ethnicity | OAG, OAG suspect, ACG, ACG suspect |
| Kim E, Varma R. | 2010 | Glaucoma in Latinos/Hispanics. | 2002–2008 | LALES | 6,142 | Age, Sex, Race/ Ethnicity | OAG |
| Friedman DS, Jampel HD, et al. | 2006 | The Prevalence of Open-Angle Glaucoma Among Blacks and Whites 73 Years and Older: The Salisbury Eye Evaluation Glaucoma Study | 2001–2003 | The SEE Glaucoma Study | 1,233 | Age, Race | OAG, ACG |
| EDPRG | 2004 | Prevalence of Open-Angle Glaucoma Among Adults in the United States | 1985–2008 | EDPRG | N/A | Age, Sex, Race/ Ethnicity | OAG |
| Mansberger SL, Romero FC, et al. | 2005 | Causes of Visual Impairment and Common Eye Problems in Northwest American Indians and Alaska Natives | Unknown | Northwest AIAN | 288 | Race | Any |
| Lee PP, Feldman ZW, Ostermann J, et al. | 2003 | Longitudinal Prevalence of Major Eye Diseases | 1999 | National Long-Term Care Survey | Various | Not stratified by demographic variables | OAG, ACG, suspect |
| Quigley HA, West SK, Rodriguez J, et al. | 2001 | The Prevalence of Glaucoma in a Population-Based Study of Hispanic Subjects: Proyecto VER | 1997–1999 | Proyecto VER | 4,774 | Age, Race / Ethnicity | OAG, ACG |
| Haronian E, Wheeler NC | 1993 | Prevalence of Eye Disorders Among the Elderly in Los Angeles | 1982–1990 | UCLA MEC | 431 | Age, Sex | Any |
| Klein B, Klein R, et al. | 1992 | Prevalence of Glaucoma: The Beaver Dam Study | 1988–1990 | BDES | 4,926 | Age, Sex | OAG |
| Tielsch JM, Sommer A, et al. | 1991 | Racial Variations in the Prevalence of Primary Open-Angle Glaucoma: The Baltimore Eye Survey | 1985–1988 | BES | 5,308 | Age, Race | OAG |
Overall Any Glaucoma and Open-Angle Glaucoma Prevalence Rates
Figure 1 below shows the estimated prevalence rate for any glaucoma and open-angle glaucoma derived from the selected studies that reported an overall rate. The high degree of variation among the results in this figure is likely due to in part to methodological, disease definition, and population differences among the studies. This figure excludes studies that did not report an overall rate for the study. The figure is intended to illustrate the range of published prevalence values; direct comparison of the studies is impossible without considering the underlying differences in the studies. Detailed results from each individual study are available in the full report “Published Examination-based Prevalence of Major Eye Disorders.”
General glaucoma rates ranged from 2.1% in NHANES to 25.5% among study participants in the Atlanta VA Chart Review, and open-angle glaucoma rates ranged from 1.86% in the EDPRG to 13.8% among a sub-population of the National Long-Term Care Survey. These studies identified and compared glaucoma prevalence rates across race/ethnicity, age, education level, and income.
The wide disparity in estimates is like due largely to differences in the study sample, and whether the study included glaucoma suspects. Because of these differences, the estimates are not directly comparable. Comparing the studies is challenging because of a number of differences in patient demographics, data collection, and reporting standards. Some studies only looked at the overall glaucoma rate while others examined different glaucoma types including glaucoma suspect, open-angle, and angle closure.
Figure 1. Overall Prevalence Rates of Any and Open-Angle Glaucoma in Selected Studies.
*Estimate only includes open-angle glaucoma.
**Age- or population- adjusted prevalence estimate.