Review: Glaucoma

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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.

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.

Figure 3.0 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 20062009 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 20052008 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 20052008 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 2008February 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 20022008 Medicare Claims N/A Age, Sex, Race/ Ethnicity OAG, OAG suspect, ACG, ACG suspect
Kim E, Varma R. 2010 Glaucoma in Latinos/Hispanics. 20022008 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 20012003 The SEE Glaucoma Study 1,233 Age, Race OAG, ACG
EDPRG 2004 Prevalence of Open-Angle Glaucoma Among Adults in the United States 19852008 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 19971999 Proyecto VER 4,774 Age, Race / Ethnicity OAG, ACG
Haronian E, Wheeler NC 1993 Prevalence of Eye Disorders Among the Elderly in Los Angeles 19821990 UCLA MEC 431 Age, Sex Any
Klein B, Klein R, et al. 1992 Prevalence of Glaucoma: The Beaver Dam Study 19881990 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 19851988 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.

Figure 3.1 Overall Prevalence Rates of Any and Open-angle Glaucoma in Selected Studies. Telemedicine Screening Program: 3 percent. NHANES 2005-2008: 2 percent. VA Chart Review: 4 percent. Medicare Beneficiaries: approximately between 6 and 7 percent. LALES: approximately 5 percent. EDPRG: approximately 2 percent. AIAN VI Study: approximately 6 percent. National Long-Term Care Survey: approximately 14 percent. Proyecto VER: approximately 6 percent. BDES: approximately 2 percent. The Baltimore Eye Survey: approximately 2 percent.

*Estimate only includes open-angle glaucoma.
**Age- or population- adjusted prevalence estimate.