Prevalence of glaucoma in Ponza, Italy: a comparison with other studies

Real-World Analysis on the Characteristics, Therapeutic Paths and Economic Burden for Patients Treated for Glaucoma in Italy

This real-world analysis was performed on administrative databases to evaluate characteristics, therapies, and related economic burden of glaucoma in Italy. Adults with at least 1 prescription for ophthalmic drops (ATC class S01E: antiglaucoma preparations, miotics) during data availability period (January 2010-June 2021) were screened, then patients with glaucoma were included. First date of ophthalmic drops prescription was the index date. Included patients had at least 12 months of data availability before index-date and afterwards. Overall, 18,161 glaucoma-treated patients were identified. The most frequent comorbidities were hypertension (60.2%), dyslipidemia (29.7%) and diabetes (17%). During available period, 70% (N = 12,754) had a second-line therapy and 57% (N = 10,394) a third-line therapy, predominantly ophthalmic drugs. As first-line, besides 96.3% patients with ophthalmic drops, a small proportion reported trabeculectomy (3.5%) or trabeculoplasty (0.4%). Adherence to ophthalmic drops was found in 58.3% patients and therapy persistence reached 78.1%. Mean total annual cost per patient was €1,725, mostly due to all-cause drug expenditure (€800), all-cause hospitalizations (€567) and outpatient services (€359). In conclusion, glaucoma-treated patients were mostly in monotherapy ophthalmic medications, with an unsatisfying adherence and persistence (<80%). Drug expenditures were the weightiest item among healthcare costs. These real-life data suggest that further efforts are needed to optimize glaucoma management.

Primary Open-angle Glaucoma Prevalence in EUROPE: A Systematic Review and Meta-analysis

PRCIS

Primary open-angle glaucoma is a neurodegenerative disease highly prevalent in the European adult population, with cases expected to increase over the next 30 years.

PURPOSE

This study aimed to evaluate the prevalence of primary open-angle glaucoma (POAG) in Europe.

METHODS

Two authors independently conducted a systematic literature search on PubMed/MedLine, Web of Science, and Google Scholar to identify papers analysing the prevalence of POAG in European countries. After removal of duplicates, title and abstract screening, and full-text analysis, data from selected articles were entered in an Excel spreadsheet. We performed risk of bias assessment using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and conducted a meta-analysis using the R software (version 1.4.1106).

RESULTS

We retrieved 9,348 eligible papers from the initial electronic search and included 10 of them in the qualitative and quantitative analyses. A total of 26,993 patients were included in this meta-analysis (11,927 male and 14,556 female). We identified 755 POAG cases (397 male and 348 female), with a pooled prevalence estimate in Europe of 2.60% (95% confidence interval: 1.90-3.56%). Increasing odds for POAG were related to increasing age and some geographic differences in the disease distribution in the continent were identified. Statistically significant sex-related differences in the prevalence rate of POAG were not observed in this cohort.

CONCLUSION

POAG is a neurodegenerative disease that affects a large proportion of the older European population. In the future, the prevalence of POAG is expected to grow in Europe because of the progressive ageing populations of Western countries. Future high-quality epidemiological studies for the evaluation of POAG prevalence rate are warranted.

Comparison of Medical Comorbidity between Patients with Normal-Tension Glaucoma and Primary Open-Angle Glaucoma: A Population-Based Study in Taiwan

The objective was to investigate different comorbidities developed in normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) patients. This was a case-control study, with 1489 people in the NTG group and 5120 people in the POAG group. Patient data were obtained from the Longitudinal Health Insurance Database 2010 (LHID2010) of Taiwan for the 2008-2013 period. The chi-square test was used to compare categorical variables, such as gender, income and urbanisation level, between NTG and POAG patients, and the two-tailed t test was used to compare continuity between the two groups. We use a multivariate logic regression model to assess the risk of each participant. The results are expressed in terms of odds ratio (OR) and 95% confidence intervals (CI). Patients with NTG had significantly higher proportions of hypotension (adjusted OR, 1.984; 95% CI, 1.128-3.490), sleep disturbances (adjusted OR, 1.323; 95% CI, 1.146-1.528), peptic ulcers (adjusted OR, 1.383; 95% CI, 1.188-1.609) and allergic rhinitis (adjusted OR, 1.484; 95% CI, 1.290-1.707) than those with POAG. Conversely, arterial hypertension (adjusted OR, 0.767; 95% CI, 0.660-0.893), diabetes (adjusted OR, 0.850; 95% CI, 0.728-0.993) and atopic dermatitis (adjusted OR, 0.869; 95% CI, 0.763-0.990) had a lower risk in the NTG group than in the POAG group. We found that comorbidities such a hypotension, sleep disturbances and peptic ulcer and allergic rhinitis are more highly associated to NTG than POAG.

Prevalence, incidence, and risk factors of primary open-angle glaucoma - a cohort study based on longitudinal data from a German public health insurance

Background

This study estimates the prevalence and incidence rates of primary open -angle glaucoma (POAG) as well as risk factors based on a dataset from the largest German health insurance company.

Methods

A random sample of 250,000 persons at age 50+ of the Allgemeine Ortskrankenkasse (AOK) from 2010 to 2013 was used. Selected risk factors of POAG incidence were analyzed using multivariate Cox proportional hazard models.

Results

The age-standardized prevalence of POAG at age 50+ in 2010 was 2.79% (95%-CI: 2.72–2.85%). The age-standardized total incidence rate was 0.38 (0.36–0.39) per 100 person-years. Sex differences were significant for total prevalence and total incidence rates, with higher prevalence and incidence rates for women compared to men. The Cox model revealed a strong age effect, a significantly 19% higher incidence for women (p ≤ 0.001), injuries of the eye and orbit (175%, p ≤ 0.001), degeneration of iris and ciliary body (155%, p = 0.022), myopia (155%, p ≤ 0.001), retinal vascular occlusions (134%, p ≤ 0.001), hypertension (13%, p ≤ 0.001) and diabetes mellitus (23%, p ≤ 0.001).

Conclusion

Health claims data are an important data source for estimating POAG occurrence and help overcome the problems of small sample sizes. These results may help to understand the causal pathways of POAG and to develop intervention strategies to increase the awareness of patients and physicians with the aim of reducing POAG incidence.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6935-6) contains supplementary material, which is available to authorized users.

The association between photoreceptor layer thickness measured by optical coherence tomography and visual sensitivity in glaucomatous eyes

PURPOSE

To assess the thickness of the photoreceptor layer in the macular region in glaucomatous eyes.

METHOD

Humphrey 10-2 visual field (VF) testing was carried out and mean threshold (mTH) was calculated in 118 eyes from 118 patients with open angle glaucoma. Macular optical coherence tomography (OCT) measurements (RS 3000, Nidek Co.ltd., Aichi, Japan) were also carried out in all eyes. Thickness measurements were recorded in the outer segment and retinal pigment epithelium (OS+RPE), the nerve fiber layer (NFL), the ganglion cell layer and inner plexiform layer (GCL+IPL), the inner nuclear layer and outer plexiform layer (INL+OPL) and the outer nuclear layer and inner segment (ONL+IS). The relationship between mTH and the thickness of these five different layers was investigated. Additionally, the influence of OS+RPE on mTH was investigated using partial correlation eliminating the effect of other variables of NFL, GCL+IPL, INL+OPL, ONL+IS, age, gender and axial length.

RESULTS

The thickness of the OS+RPE layer was significantly decreased with the decrease of mTH (coefficient = 0.63 p <0.001). Partial correlation analysis suggested OS+RPE thickness is significantly (coefficient = 0.31, p <0.001) related to mTH, independent from NFL, GCL+IPL, INL+OPL, ONL+IS, age, gender and axial length.

CONCLUSIONS

The thickness of the RPE+OS layer appears to be related to visual sensitivity in glaucoma.

Aging and ocular tissue stiffness in glaucoma

Glaucoma is a progressive and chronic neurodegenerative disorder characterized by damage to the inner layers of the retina and deformation of the optic nerve head. The degeneration of retinal ganglion cells and their axons results in an irreversible loss of vision and is correlated with increasing age. Extracellular matrix changes related to natural aging generate a stiffer extracellular environment throughout the body. Altered age-associated ocular tissue stiffening plays a major role in a significant number of ophthalmic pathologies. In glaucoma, both the trabecular meshwork and the optic nerve head undergo extensive extracellular matrix remodeling, characterized by fibrotic changes associated with cellular and molecular events (including myofibroblast activation) that drive further tissue fibrosis and stiffening. Here, we review the literature concerning the role of age-related ocular stiffening in the trabecular meshwork, lamina cribrosa, sclera, cornea, retina, and Bruch membrane/choroid and discuss their potential role in glaucoma progression. Because both trabecular meshwork and lamina cribrosa cells are mechanosensitive, we then describe molecular mechanisms underlying tissue stiffening and cell mechanotransduction and how these cellular activities can drive further fibrotic changes within ocular tissues. An improved understanding of the interplay between age-related tissue stiffening and biological responses in the trabecular meshwork and optic nerve head could potentially lead to novel therapeutic strategies for glaucoma treatment.

The Evonik-Mainz Eye Care-Study (EMECS): Development of an Expert System for Glaucoma Risk Detection in a Working Population

PURPOSE

To develop an expert system for glaucoma screening in a working population based on a human expert procedure using images of optic nerve head (ONH), visual field (frequency doubling technology, FDT) and intraocular pressure (IOP).

METHODS

4167 of 13037 (32%) employees between 40 and 65 years of Evonik Industries were screened. An experienced glaucoma expert (JW) assessed papilla parameters and evaluated all individual screening results. His classification into "no glaucoma", "possible glaucoma" and "probable glaucoma" was defined as "gold standard". A screening model was developed which was tested versus the gold-standard. This model took into account the assessment of the ONH. Values and relationships of CDR and IOP and the FDT were considered additionally and a glaucoma score was generated. The structure of the screening model was specified a priori whereas values of the parameters were chosen post-hoc to optimize sensitivity and specificity of the algorithm. Simple screening models based on IOP and / or FDT were investigated for comparison.

RESULTS

111 persons (2.66%) were classified as glaucoma suspects, thereof 13 (0.31%) as probable and 98 (2.35%) as possible glaucoma suspects by the expert. Re-evaluation by the screening model revealed a sensitivity of 83.8% and a specificity of 99.6% for all glaucoma suspects. The positive predictive value of the model was 80.2%, the negative predictive value 99.6%. Simple screening models showed insufficient diagnostic accuracy.

CONCLUSION

Adjustment of ONH and symmetry parameters with respect to excavation and IOP in an expert system produced sufficiently satisfying diagnostic accuracy. This screening model seems to be applicable in such a working population with relatively low age and low glaucoma prevalence. Different experts should validate the model in different populations.

Risk Factors for Primary Open Angle Glaucoma (POAG) Progression: A Study Ruled in Torino

Purpose:

Aim of this retrospective, observational study is to describe features of a population sample, affected by primary open angle glaucoma (POAG) in order to evaluate damage progression on the basis of the emerged individual risk factors.

Methods:

We included 190 caucasian patients (377 eyes), evaluating relationship between individual risk factors (explicative variables) and MD (Mean Deviation) of standard automated perimetry. We also considered the dependent variable NFI (Neural Fiber Index) of GDx scanning laser polarimetry. Progression has been evaluated through a statistic General Linear Model on four follow up steps (mean follow up 79 months).

Results:

Factors reaching statistical significance, determining a worsening of the MD variable, are: age (P<0.0001), intraocular pressure (IOP) at follow up (P < 0.0001), female gender (P<0.0001), hypertension (P< 0.0001) and familiarity (P = 0.0006).

Factors reaching statistical significance, determining a worsening of the NFI variable, are only IOP at follow up (P = 0.0159) and depression (P = 0.0104).

Conclusion:

Results of this study confirm and enforce data coming from most recent studies: IOP remains the main risk factor for glaucoma assess and progression; age and familiarity are great risk factors as underlined in the last decades; female sex can be an important risk factors as emerged only in the last years; arterial hypertension should always be evaluated in timing of our clinic follow up.

The Evolution of Teleophthalmology Programs in the United Kingdom: Beyond Diabetic Retinopathy Screening

Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions.

A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey

Background

Glaucoma is the leading cause of irreversible blindness worldwide. There tends to be a lower reporting of glaucoma in Africa compared to other blinding conditions in global burden data. Research findings of glaucoma in Nigeria will significantly increase our understanding of glaucoma in Nigeria, in people of the West African diaspora and similar population groups. We determined the prevalence and types of glaucoma in Nigeria from the Nigeria National Blindness and Visual Impairment cross-sectional Survey of adults aged ≥40 years.

Methods

Multistage stratified cluster random sampling with probability-proportional-to-size procedures were used to select a nationally representative sample of 15,027 persons aged ≥40 years. Participants had logMAR visual acuity measurement, FDT visual function testing, autorefraction, A-scan biometry and optic disc assessment. Participants with visual acuity of worse than 6/12 or suspicious optic discs had detailed examination including Goldmann applanation tonometry, gonioscopy and fundus photography. Disc images were graded by Moorfields Eye Hospital Reading Centre. Glaucoma was defined using International Society of Geographical and Epidemiological Ophthalmology criteria; and classified into primary open-angle or primary angle-closure or secondary glaucoma. Diagnosis of glaucoma was based on ISGEO classification. The type of glaucoma was determined by gonioscopy.

Results

A total of 13,591 participants in 305 clusters were examined (response rate 90.4 %). Optic disc grading was available for 25,289 (93 %) eyes of 13,081 (96 %) participants. There were 682 participants with glaucoma; a prevalence of 5.02 % (95 % CI 4.60–5.47). Among those with definite primary glaucoma that had gonioscopy (n = 243), open-angle glaucoma was more common (86 %) than angle-closure glaucoma (14 %). 8 % of glaucoma was secondary with the commonest causes being couching (38 %), trauma (21 %) and uveitis (19 %). Only 5.6 % (38/682) of participants with glaucoma knew they had the condition. One in every 5 persons with glaucoma (136;20 %) was blind i.e., visual acuity worse than 3/60.

Conclusion

Nigeria has a high prevalence of glaucoma which is largely open-angle glaucoma. A high proportion of those affected are blind. Secondary glaucoma was mostly as a consequence of procedures for cataract. Public health control strategies and high quality glaucoma care service will be required to reduce morbidity and blindness from glaucoma.

Prevalence and risk factors of primary open-angle glaucoma in a city of Eastern China: a population-based study in Pudong New District, Shanghai

Background

The aim of the present study was to investigate the prevalence and characteristics of primary open-angle glaucoma among the urban population of Pudong New District, Shanghai.

Methods

Three residents’ committees were randomly selected from Pudong New District, and residents aged 50 and older were screened for primary open-angle glaucoma (POAG) from March to April 2011. In remote screening, the tests on visual acuity, refraction, intraocular pressure (IOP), and the photographs of anterior segment and fundus were used to identify POAG suspect. The suspected subjects were then reexamined with the tests on IOP, gonioscopy, Humphrey visual field test, and retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT). POAG was diagnosed according to the criteria defined by International Society for Geographic and Epidemiological Ophthalmology (ISGEO). Finally, POAG risk factors were evaluated using logistic regression analysis.

Results

A total of 2528 citizens out of 3,146 eligible residents (80.36 %) participated in this study. Among the citizens, 72 were diagnosed to have POAG, giving the crude prevalence rate of 2.85 % (95 % CI:2.20 %–3.50 %) in general and age- and gender-adjusted prevalence rate of 2.8 % (95 % CI: 2.78 %–2.83 %). Among the 72 POAG patients, only 22 cases had IOP exceeding 21 mmHg while other 50 cases had IOP of 21 mmHg or less; nine cases had one eye blind (12.5 %). Intriguingly, only eight cases (11.11 %) had been diagnosed with POAG before this screening.

Conclusions

More efforts are required for early screening and education on POAG in communities, especially in a POAG high-risk population.

Visual disability and quality of life in glaucoma patients

Glaucoma is an optic neuropathy that can result in progressive and irreversible vision loss, thereby affecting quality of life (QoL) of patients. Several studies have shown a strong correlation between visual field damage and visual disability in patients with glaucoma, even in the early stages of the disease. Visual impairment due to glaucoma affects normal daily activities required for independent living, such as driving, walking, and reading. There is no generally accepted instrument for assessing quality of life in glaucoma patients; different factors involved in visual disability from the disease are difficult to quantify and not easily standardized. This chapter summarizes recent works from clinical and epidemiological studies, which describe how glaucoma affects the performance of important vision-related activities and QoL.

Teleglaucoma: ready to go?

Telemedicine technologies and services allow today's ophthalmic clinicians to remotely diagnose, manage and monitor several ophthalmic conditions from a distance. But is this the case for glaucomas? There has been a proliferation of telemedicine friendly devices in recent years that improves the capabilities of the clinician in managing glaucomas. The existing instruments still need to align themselves with accepted industry standards. There are successful programmes running in several areas of the world. The safety and efficacy of these programmes needs further exploration. The inability of a single device or test to diagnose glaucomas satisfactorily has also hampered progress in remotely diagnosing these conditions. There is, however, significant potential for telemedicine-friendly devices to remotely monitor the progress of glaucoma and, thereby, reduce some of the workload on an overstretched health service.

The Maccabi Glaucoma Study: prevalence and incidence of glaucoma in a large israeli health maintenance organization

PURPOSE

To investigate the prevalence and incidence of glaucoma in a large health maintenance organization (HMO) in Israel.

DESIGN

A population-based retrospective cohort study, conducted using electronic medical database.

METHODS

Collected data included personal and medical characteristics.

SETTING

Maccabi Healthcare Services, the second-largest HMO in Israel, insuring 2 million members and serving 25% of the population with a nationwide distribution.

STUDY POPULATION

Maccabi members from January 2003 to December 2010.

MAIN OUTCOME MEASURES

Prevalence and incidence of glaucoma according to the International Classification of Diseases, 9th revision, Clinical Modification diagnostic codes.

RESULTS

A total of 15,708 prevalent glaucoma patients were identified among active members of Maccabi in December 2010. A total of 15,332 (97.6%) were 40 years or older, with a point prevalence of 2.2%. Prevalence of glaucoma was strongly associated with age, ranging from 0.28% at age 40-50 to 9.2% among elderly aged 80 or above. The 5 most prevalent diagnoses were open-angle glaucoma (1.61%), exfoliation glaucoma (0.20%), unspecified glaucoma (0.17%), angle closure (0.11%), and normal tension glaucoma (0.06%). We identified 6674 incident glaucoma patients diagnosed between 2003 and 2010. The observed incidence density rate among 40+-year-old members was 1.84 (1.79-1.88) new cases per 1000 person-years. Median age at diagnosis was 64 years old. The risk of glaucoma was similar between sexes up to age 70 years, and was significantly (P<.01) higher in men in older ages.

CONCLUSIONS

Glaucoma affects nearly 10% of the elderly population in Maccabi, with the highest risk of diagnosis at age 70-74. Since glaucoma leads to irreversible vision loss, the present estimates of morbidity should be of significant concern.

Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis

PURPOSE

Glaucoma is the leading cause of global irreversible blindness. Present estimates of global glaucoma prevalence are not up-to-date and focused mainly on European ancestry populations. We systematically examined the global prevalence of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and projected the number of affected people in 2020 and 2040.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

Data from 50 population-based studies (3770 POAG cases among 140,496 examined individuals and 786 PACG cases among 112 398 examined individuals).

METHODS

We searched PubMed, Medline, and Web of Science for population-based studies of glaucoma prevalence published up to March 25, 2013. Hierarchical Bayesian approach was used to estimate the pooled glaucoma prevalence of the population aged 40-80 years along with 95% credible intervals (CrIs). Projections of glaucoma were estimated based on the United Nations World Population Prospects. Bayesian meta-regression models were performed to assess the association between the prevalence of POAG and the relevant factors.

MAIN OUTCOME MEASURES

Prevalence and projection numbers of glaucoma cases.

RESULTS

The global prevalence of glaucoma for population aged 40-80 years is 3.54% (95% CrI, 2.09-5.82). The prevalence of POAG is highest in Africa (4.20%; 95% CrI, 2.08-7.35), and the prevalence of PACG is highest in Asia (1.09%; 95% CrI, 0.43-2.32). In 2013, the number of people (aged 40-80 years) with glaucoma worldwide was estimated to be 64.3 million, increasing to 76.0 million in 2020 and 111.8 million in 2040. In the Bayesian meta-regression model, men were more likely to have POAG than women (odds ratio [OR], 1.36; 95% CrI, 1.23-1.52), and after adjusting for age, gender, habitation type, response rate, and year of study, people of African ancestry were more likely to have POAG than people of European ancestry (OR, 2.80; 95% CrI, 1.83-4.06), and people living in urban areas were more likely to have POAG than those in rural areas (OR, 1.58; 95% CrI, 1.19-2.04).

CONCLUSIONS

The number of people with glaucoma worldwide will increase to 111.8 million in 2040, disproportionally affecting people residing in Asia and Africa. These estimates are important in guiding the designs of glaucoma screening, treatment, and related public health strategies.

Cerebrospinal fluid pressure decreases with older age

PURPOSE

Clinical studies implicate low cerebrospinal fluid pressure (CSFP) or a high translaminar pressure difference in the pathogenesis of primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). This study was performed to examine the effect of age, sex, race and body mass index (BMI) on CSFP.

METHODS

Electronic medical records from all patients who had a lumbar puncture (LP) performed at the Mayo Clinic from 1996-2009 were reviewed. Information including age, sex, race, height and weight, ocular and medical diagnoses, intraocular pressure (IOP) and LP opening pressure was obtained. Patients using medications or with medical diagnoses known to affect CSFP, and those who underwent neurosurgical procedures or where more than one LP was performed were excluded from analysis.

RESULTS

Electronic medical records of 33,922 patients with a history of having an LP during a 13-year period (1996-2009) were extracted. Of these, 12,118 patients met all entry criteria. Relative to mean CSFP at age group 20-49 (mean 11.5±2.8 mmHg), mean CSFP declined steadily after age 50, with percent reduction of 2.5% for the 50-54 age group (mean 11.2±2.7 mmHg, p<0.002) to 26.9% for the 90-95 group (mean 8.4±2.4 mmHg, p<0.001). Females had lower CSFP than males throughout all age groups. BMI was positively and independently associated with CSFP within all age groups.

CONCLUSION

There is a sustained and significant reduction of CSFP with age that begins in the 6(th) decade. CSFP is consistently lower in females. BMI is positively and independently associated with CSFP in all age groups. The age where CSFP begins to decline coincides with the age where the prevalence of POAG increases. These data support the hypothesis that reduced CSFP may be a risk factor for POAG and may provide an explanation for the mechanism that underlies the age-related increase in the prevalence of POAG and NTG.

Epidemiology of glaucoma: what's new?

Globally, there are an estimated 60 million people with glaucomatous optic neuropathy and an estimated 8.4 million people who are blind as the result of glaucoma. These numbers are set to increase to 80 million and 11.2 million by 2020. Glaucoma is the second leading cause of blindness globally. The highest prevalence of open-angle glaucoma occurs in Africans, and the highest prevalence of angle-closure glaucoma occurs in the Inuit. Population-based screening for open-angle glaucoma is not recommended. Screening for angle-closure may be feasible.

Epidemiology of major eye diseases leading to blindness in Europe: a literature review

The objective of this work was to study the epidemiology of major eye diseases leading to blindness in Europe through a systematic literature review. The literature search was performed using the Medline database (PubMed), with MeSH and free text search terms. Inclusion criteria for the studies were: (a) performed on a healthy population of Caucasian origin aged between 50 and 75 years; (b) diagnosed by ophthalmological examination in accordance with the International Classification of Diseases 10; (c) contained a detailed description of the sampling and diagnostic procedures and data resources; (d) sample size>500, and (e) published between 1990 and 2008. The results of 57 studies on the prevalence and incidence of age-related macular degeneration, diabetic retinopathy and glaucoma are reported, providing an up-to-date and comprehensive overview of these diseases in Europe from an epidemiological perspective.

Visibility of trabecular meshwork by standard and polarization-sensitive optical coherence tomography

Polarization-sensitive optical coherence tomography (PS-OCT) is known to be advantageous because of its additional tissue-specific contrast of the anterior eye. So far, this advantage has been shown only qualitatively. We evaluate the improved visibility afforded by 3-D PS corneal and anterior eye segment OCT (PS-CAS-OCT) in visualizing the trabecular meshwork (TM) based on statistical evidences. A total of 31 normal subjects participated in this study. The anterior eye segments of both the eyes of the subjects are scanned using a custom-made PS-CAS-OCT and the standard-scattering OCT (S-OCT) and polarization-sensitive phase-retardation OCT (P-OCT) images are obtained. Three graders grade the visibility of the TM using a four-leveled grading system. The intergrader agreement, intermodality differences, and interquadrant dependence of visibility are statistically examined. All three of three combinations of graders show substantial agreement in visibility with P-OCT (ρ = 0.74, 0.70, and 0.68, Spearman's correlation), while only one of three shows substantial agreement with S-OCT (ρ = 0.72). Significant dependence of the visibility on the modality (S-OCT versus P-OCT) and quadrants are found by the analysis of variance. A subsequent Wilcoxon signed-rank test reveals significantly improved visibility. PS-CAS-OCT may become a useful tool for screening angle-closure glaucoma.

Analysis of the retina in the zebrafish model

The zebrafish is one of the leading models for the analysis of the vertebrate visual system. A wide assortment of molecular, genetic, and cell biological approaches is available to study zebrafish visual system development and function. As new techniques become available, genetic analysis and imaging continue to be the strengths of the zebrafish model. In particular, recent developments in the use of transposons and zinc finger nucleases to produce new generations of mutant strains enhance both forward and reverse genetic analysis. Similarly, the imaging of developmental and physiological processes benefits from a wide assortment of fluorescent proteins and the ways to express them in the embryo. The zebrafish is also highly attractive for high-throughput screening of small molecules, a promising strategy to search for compounds with therapeutic potential. Here we discuss experimental approaches used in the zebrafish model to study morphogenetic transformations, cell fate decisions, and the differentiation of fine morphological features that ultimately lead to the formation of the functional vertebrate visual system.

Epidemiology of primary glaucoma: prevalence, incidence, and blinding effects

Certain general conclusions can be drawn from a series of 56 studies on glaucoma prevalence. Even in the most recently published studies the rate of undiagnosed glaucoma is particularly high. Another fairly constant finding is the discrepancy between the clinical and epidemiologic diagnoses of glaucoma. The prevalence of primary open-angle glaucoma (POAG) has been increasing, and this trend is undoubtedly due at least in part to advances in diagnostic technology. The decreasing prevalence of primary angle-closure glaucoma (PACG) is due to the adoption of more stringent criteria for the diagnosis of this form of glaucoma. Prevalence increases proportionately with age for each racial group. African or African origin populations had the highest POAG prevalence at all ages but the increase in prevalence of POAG is steeper for white populations. PACG is commonest in Asian ethnic groups, with the exception of the Japanese. Low-tension glaucoma (LTG) is quite common in the Japanese population. Over 80% of those with PACG live in Asia, while POAG disproportionately affects those of African derivation. Women are more affected by glaucoma. Very few incidence studies have been completed, because the cost of examining large samples is high. There are only two recent studies conducted on persons of African descent in Barbados (West Indies) and on white inhabitants of Rotterdam (Netherlands). Risk of incident glaucoma was highest among persons classified as having suspect POAG at baseline, followed by those with ocular hypertension. No difference in incidence of POAG between men and women was found. The more recent studies which included routine visual-field testing reveal rates of blinding glaucoma <10% in many countries, including those that are developing.

Laser trabeculoplasty for open angle glaucoma

BACKGROUND

Open angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence.

OBJECTIVES

The objective of this review was to study the effects of laser trabeculoplasty for OAG.

SEARCH STRATEGY

We identified trials from CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and manual searching. We also contacted researchers in the field.

SELECTION CRITERIA

We included randomised controlled trials comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery. We also included trials comparing different technical modalities of laser trabeculoplasty.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted the data. We contacted trial investigators for missing information.

MAIN RESULTS

This review included 19 trials involving 2137 participants. Only five trials fulfilled the criteria of good methodological quality. One trial compared laser trabeculoplasty with topical beta-blocker to no intervention in early glaucoma. The risk of glaucoma progression was higher in the control group at six years of follow up (risk ratio (RR) 0.71 95% confidence interval (CI) 0.53 to 0.95). No difference in health-related quality of life was observed between the two groups. Three trials compared laser trabeculoplasty to medication (regimens used before the 1990s) in people with newly diagnosed OAG. The risk of uncontrolled intraocular pressure (IOP) was higher in the medication group compared to the trabeculoplasty group at six months and two years of follow up. Three trials compared laser trabeculoplasty with trabeculectomy. The risk of uncontrolled IOP was significantly higher in the trabeculoplasty group at six months but significant heterogeneity was observed at two years. Diode and selective laser are compared to argon laser trabeculoplasty in three trials and there is some evidence showing a comparable effect in controlling IOP at six months and one year of follow up.

AUTHORS' CONCLUSIONS

Evidence suggests that, in people with newly diagnosed OAG, the risk of uncontrolled IOP is higher in people treated with medication used before the 1990s when compared to laser trabeculoplasty at two years follow up. Trabeculoplasty is less effective than trabeculectomy in controlling IOP at six months and two years follow up. Different laser technology and protocol modalities were compared to the traditional laser trabeculoplasty and more evidence is necessary to determine if they are equivalent or not. There is no evidence to determine the effectiveness of laser trabeculoplasty compared to contemporary medication (prostaglandin analogues, topical anhydrase inhibitors and alpha2-agonists) and also with contemporary surgical techniques. Also there should be further investigation in to the effectiveness of laser trabeculoplasty in specific racial groups, specific diagnostic groups, such as pseudoexfoliation and pigmentary glaucoma and different stages of OAG. More research is also required determining cost-effectiveness of laser trabeculoplasty in the management of glaucoma.

Self-reported glaucoma in Canada: findings from population-based surveys, 1994-2003

BACKGROUND

To provide population estimates and 10-year trends in the self-reported prevalence of glaucoma in Canada, including age and sex profiles, frequency of contact with eye specialists, and associated chronic medical conditions.

METHODS

Analyses were based on cross-sectional, self-reported data for ages >or=20 years from 5 national surveys: the 1994-95, 1996-97, and 1998-99 National Population Health Survey (minimum sample size [n] = 33 153) and the 2000-01 and 2002-03 Canadian Community Health Survey (min n = 113 212). Prevalence estimates were derived from descriptive analyses; multivariate logistic regression analyses examined the association of income, education, and chronic medical conditions with the likelihood of reporting glaucoma.

RESULTS

In 2002-03, an estimated 409,000 Canadians had glaucoma, including 2.7% of those >or=40 years and 11% of those >or=80 years. Overall, the prevalence of self-reported glaucoma increased from 1.1% in 1994-95 to 1.8% in 2002-03 (p < 0.01). Significant increases in age-specific prevalences over time were also observed in 4 of 6 age groups. In total, 14% of respondents with glaucoma reported no recent contact with an eye specialist. Arthritis (and other rheumatic conditions), high blood pressure, migraines, and diabetes were associated with glaucoma.

INTERPRETATION

Our review suggests glaucoma is at least as prevalent in Canada as in other Western nations. It is most common in the over-80 age group and appears to be associated with other medical conditions.

Ethnicity and glaucoma: higher environmental temperatures may accelerate the onset, and increase the prevalence, of primary open-angle glaucoma

Publications on the age-related prevalence of primary open-angle glaucoma (POAG) show that African and African-descended patients and others living in warm climates present a higher prevalence of POAG than do those in temperate zones. The data have been analysed in order to discover whether temperature plays a role. The relation between AOO, the youngest age diagnosed with POAG, and prevalence has also been examined. Prevalences at the age of 70 years P(70) were calculated from logarithmic plots, and logP(70), plotted as a function of the average monthly maximum temperature T degrees C, and tested with the LINEST programme. AOO declined, but logP(70) rose, with T degrees C. The data are consistent with the view that high temperatures accelerate the onset, and increase the prevalence, of POAG. A consideration of evolution suggests that the reduced Caucasian prevalence may result from originally African tribes migrating to locations with more temperate climates: this would have caused a constriction of superficial capillaries to preserve body heat; hence the aqueous outflow channels might dilate, and reduce a predisposition for POAG. Suggestions are made for testing the hypothesis.

Screening for prevention of optic nerve damage due to chronic open angle glaucoma

BACKGROUND

Open angle glaucoma (OAG) is a primary, progressive optic neuropathy; the onset is without symptoms and progression occurs silently until the advanced stages of the disease, when it affects central vision. The blindness caused by OAG is irreversible. It has often been assumed to be a condition that fulfils the criteria for population screening, although this has not been supported by other in-depth non-systematic reviews. The focus of this review was to examine the evidence for the effectiveness of screening for OAG.

OBJECTIVES

To determine the impact of screening for OAG compared with opportunistic case findings or current referral practices on the prevalence of and the degree of optic nerve damage due to OAG in screened and unscreened populations.

SEARCH STRATEGY

We included any randomised controlled trial (RCT) evaluating population-based screening programmes for OAG with a minimum one year follow up. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (which contains the Cochrane Eyes and Vision Trials Register) (Issue 1, 2006), MEDLINE (1950 to February 2006) and EMBASE (1988 to February 2006). We also searched the National Research Register (Issue 1, 2006) and Zetoc for grey literature (29 June 2006). There were no language or date restrictions in the electronic searches.

SELECTION CRITERIA

We planned to include RCTs, including cluster RCTs.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the study abstracts identified by the electronic searches. We did not find any trials that met the inclusion criteria.

MAIN RESULTS

As no trials were identified, no formal analysis was performed.

AUTHORS' CONCLUSIONS

On the basis of current evidence, population-based screening for chronic OAG cannot be recommended, although much can be done to improve awareness and encourage at risk individuals to seek testing. In wealthy countries with equitable access to high quality eye care and health education, blindness from chronic OAG should become increasingly rare; much greater challenges face poor and emerging economies and countries where there are substantial health and wealth inequalities. Effectiveness of screening for OAG can be established only by high quality RCTs.

Progression of visual field loss in open angle glaucoma in the Melbourne Visual Impairment Project

PURPOSE

To quantify the progression of visual field loss in participants with open angle glaucoma.

METHODS

Cluster random samples of 3271 participants participated in this study. Each participant underwent a standardized ophthalmic examination, which included intraocular pressure measurement, Humphrey 24-2 Fastpac visual field testing and stereophotography of the optic disc. At baseline 118 participants were identified as possible, probable or definite open angle glaucoma and 74 (62.7%) of these were seen again at the follow-up examination. Progression of visual field loss was defined using three methods: the Advanced Glaucoma Intervention Study criteria, the modified Anderson criteria and the Blumenthal method.

RESULTS

In total, 49% of subjects showed progressive visual field loss with at least one method. The Blumenthal criteria yielded the highest rate of progression (37%), followed by the modified Anderson method (33%) and the Advanced Glaucoma Intervention Study method (16%). The progressive visual field loss was associated with baseline glaucoma status (P = 0.02); 65% of the definite glaucoma progressed, compared with 57% of the probable glaucoma and 25% of the possible glaucoma. Participants who had been previously diagnosed with glaucoma had a higher rate of progression (54%) when compared with those who had not been diagnosed previously (47%). In total, 50% (four of eight) of those receiving glaucoma medication at baseline had progressive visual field loss; all were in the definite glaucoma category.

CONCLUSION

Despite use of glaucoma medications the majority of glaucoma patients managed by their regular ophthalmologist experienced progressive visual field loss over a 5-year period.

The number of people with glaucoma worldwide in 2010 and 2020

AIM

To estimate the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020.

METHODS

A review of published data with use of prevalence models. Data from population based studies of age specific prevalence of OAG and ACG that satisfied standard definitions were used to construct prevalence models for OAG and ACG by age, sex, and ethnicity, weighting data proportional to sample size of each study. Models were combined with UN world population projections for 2010 and 2020 to derive the estimated number with glaucoma.

RESULTS

There will be 60.5 million people with OAG and ACG in 2010, increasing to 79.6 million by 2020, and of these, 74% will have OAG. Women will comprise 55% of OAG, 70% of ACG, and 59% of all glaucoma in 2010. Asians will represent 47% of those with glaucoma and 87% of those with ACG. Bilateral blindness will be present in 4.5 million people with OAG and 3.9 million people with ACG in 2010, rising to 5.9 and 5.3 million people in 2020, respectively.

CONCLUSIONS

Glaucoma is the second leading cause of blindness worldwide, disproportionately affecting women and Asians.

What is practical in glaucoma management?

This article addresses some important issues in the detection and management of glaucoma using examples from the developing world, particularly drawing on experiences and research in sub-Saharan Africa.

The Tajimi Study Report 2

PURPOSE

To determine the prevalence of primary angle-closure glaucoma (PACG), secondary glaucoma (SG), and all glaucoma in a Japanese population as a part of the Tajimi Study.

DESIGN

Population-based epidemiological survey.

PARTICIPANTS

A random sample of residents 40 years or older from Tajimi, Japan.

INTERVENTION

Each subject underwent a screening program comprising an interview and an ophthalmic examination, including Goldmann applanation tonometry, slit-lamp examination, a van Herick test, fundus photography, and a screening visual field (VF) test using frequency-doubling technology. If glaucoma was suspected, the subject was referred for a definitive examination that included slit-lamp examination, gonioscopy, intraocular pressure measurement, a VF test, and optic disc and fundus examination. A diagnosis of PACG or SG was made based on slit-lamp examination, gonioscopy, optic disc appearance, and perimetric results.

MAIN OUTCOME MEASURES

Prevalences of PACG, SG, and all cases of glaucoma.

RESULTS

Of 3870 eligible people, 3021 (78.1%) participated in the study. Estimated prevalences of PACG and SG in those over 40 years were 0.6% (95% confidence interval [CI], 0.4%-0.9%) and 0.5% (95% CI, 0.2%-0.7%), respectively. Prevalences of all glaucoma and glaucoma/suspected glaucoma were estimated to be 5.0% (95% CI, 4.2%-5.8%) and 7.5% (95% CI, 6.5%-8.4%), respectively.

CONCLUSIONS

Prevalences were 0.6%, 0.5%, and 5.0%, respectively, for PACG, SG, and all glaucoma in subjects over 40 years from Tajimi, Japan.

Incidence of open-angle glaucoma in a general elderly population: the Rotterdam Study

PURPOSE

To determine the incidence of open-angle glaucoma (OAG) in a general elderly white population.

DESIGN

Population-based cohort study.

PARTICIPANTS

Participants 55 years and older from the Rotterdam Study, The Netherlands.

METHODS

Participants at risk for incident OAG underwent at baseline (1990-1993) and follow-up (1997-1999) the same ophthalmic examination, including measurement of intraocular pressure, visual field testing, and stereo optic disc photography. The diagnosis of probable or definite OAG was made with an algorithm based on optic disc parameters and on visual field testing, independent of the intraocular pressure.

MAIN OUTCOME MEASURES

Five-year risk and incidence rates of OAG.

RESULTS

In total, 3842 participants were examined (participation rate at follow-up, 78%). After a mean follow-up time of 6.5 years, probable (n = 58) or definite OAG (n = 29) developed in 87 persons. The 5-year risk of probable OAG was 1.2% and that of definite OAG 0.6%, and the rate rose for both together from 1% at age 60 years to approximately 3% at age 80 years. Bilateral OAG occurred 5 times more often after than before age 75 years. In participants with prevalent OAG in 1 eye, the 5-year risk of OAG in the fellow eye was 5 times higher than in fellow eyes of non-OAG eyes. Only 37% of the incident cases received treatment for OAG at the time of the reexamination.

CONCLUSIONS

The incidence of OAG rose significantly with age. Most of the patients with incident OAG were unaware of having OAG.

Incidence of visual loss in the Ponza Eye Study, Italy

AIM

To study the incidence of visual loss over a 12-year period in the survivors of an original cohort aged 40 years or older at baseline.

METHODS

Visual acuity (VA) was measured by means of a standardized logMAR chart. World Health Organization definition of blindness and low vision was adopted (respectively, best-corrected VA >1.3 logMAR or a visual field <10 degrees around central fixation, and best-corrected VA >0.5-1.3 logMAR or a visual field <20 degrees around central fixation). Moreover, binocular visual loss incidence (VA>0.5 logMAR) was calculated in a 'healthy' group who had uncorrected VA of 0.0 logMAR or better in both eyes at baseline and absence of eye diseases.

RESULTS

Of the 584 eligible survivors, 411 (70.7%) had a 12-year follow-up visit. The overall incidence figures were as follows: best-corrected binocular blindness (0.7%), binocular low vision (3.9%), monocular blindness (2.7%), and monocular low vision (5.0%), respectively. The results for presenting VAs were 1.2, 9.5, 4.2, and 15.3%. Figures for uncorrected, best-corrected, and presenting binocular visual loss incidence in the 'healthy' group were respectively 12.7, 0.9, and 3.7%.

CONCLUSION

The discrepancy between the ideal and real situations that emerges from this study has important implications for health-care planning. Over a period of 12 years, a substantial percentage of 'healthy' subjects will have to seek medical care. Incident visual loss was caused mainly by untreated cataract, glaucoma, myopia, and age-related macular degeneration.

Prevalence of Primary Open-Angle Glaucoma in a Spanish Population

PURPOSE

To determine the prevalence of primary open-angle glaucoma (POAG) in Segovia, Spain.

METHODS

We conducted a cross-sectional, population-based epidemiologic study, the target population of which was residents of Segovia, Spain, aged 40 to 79 years. A sample of 569 subjects was randomly selected in a stratified manner according to gender and age groups. All participants underwent a complete ophthalmic examination that included measurement of visual acuity and refraction, tonometry, anterior segment biomicroscopy, funduscopy, stereoscopic photographs of the optic nerve head, and automated white-on-white visual field testing. Two independent observers evaluated the optic nerve photographs and visual fields. The diagnosis of POAG was established when any eye had an open angle and a glaucomatous optic nerve and glaucomatous visual field. The prevalence of POAG in the population was estimated from the prevalence in the complete sample and the patients already diagnosed at the only glaucoma service in the city.

RESULTS

The estimated prevalences (99% confidence interval) in the population were, respectively, 2.1% (1.9-2.3%), and 1.7% (1.6-1.8%) for POAG and ocular hypertension. The prevalence of POAG increased with age (P < 0.005) and tended to be greater (P = 0.054) in men (2.4%) than women (1.7%).

CONCLUSION

The prevalence of POAG in this Segovia population is 2.1%, similar to that estimated in previous studies performed in predominantly Caucasian populations.

The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study

PURPOSE

To assess the prevalence of primary open-angle glaucoma (POAG) and its association with intraocular pressure (IOP) in Tajimi City in central Japan.

DESIGN

A cross-sectional epidemiologic study in a defined population.

PARTICIPANTS

Subjects randomly selected from the population older than 40 years in Tajimi City.

INTERVENTION

Each subject underwent a screening examination comprised of an interview and ophthalmic examinations, including measurement of IOP by a Goldmann applanation tonometer, central corneal thickness (CCT), slit-lamp examination, fundus photography, and a screening visual field test using frequency doubling technology. When ocular diseases were suspected, the subjects were referred for definitive examination. During the definitive examination, slit-lamp examination, IOP measurement, a visual field test using Humphrey Field Analyzer 30-2 SITA Standard program (Humphrey Instruments, San Leandro, CA), optic disc and fundus examination, and gonioscopy were performed and stereoscopic disc photographs were obtained. A diagnosis of glaucoma was made based on optic disc appearance, perimetric results, and other ocular findings.

MAIN OUTCOME MEASURES

Prevalence of POAG, mean IOP, and mean CCT.

RESULTS

Of 3870 eligible people, 3021 (78.1%) participated in the study. The estimated prevalence of POAG in the population older than 40 years was 3.9% (95% confidence interval [CI]), 3.2%-4.6%). The prevalence of cases of POAG with IOP levels of 21 mmHg or less was 3.6% (95% CI, 2.9%-4.3%), whereas the prevalence for those with IOP levels of more than 21 mmHg was 0.3% (95% CI, 0.1%-0.5%). The average IOP for eyes with POAG was 15.4+/-2.8 (standard deviation) in the right eye (n = 115) and 15.2+/-2.8 mmHg in the left eye (n = 115), which was significantly higher than that of nonglaucoma subjects (14.5+/-2.5 in the right eye; n = 2759; P = 0.0004; and 14.4+/-2.6 mmHg in the left eye; n = 2757; P = 0.0026). The mean CCT of POAG eyes with IOP levels of 21 mmHg or less was 518+/-29 (n = 109) in the right eye and 519+/-29 microm (n = 110) in the left eye, levels that were not significantly different from that of nonglaucoma eyes (520+/-32 microm [n = 2690]; and 522+/-32 microm [n = 2692]; P>0.05).

CONCLUSIONS

The prevalence of POAG in this population was 3.9%. In 92% patients with POAG, the IOP was 21 mmHg or less.

Approaches to study neurogenesis in the zebrafish retina

Similar to other vertebrate species, the zebrafish retina is simpler than other regions of the central nervous system (CNS). Relative simplicity, rapid development, and accessibility to genetic analysis make the zebrafish retina an excellent model system for the studies of neurogenesis in the vertebrate CNS. Numerous genetic screens have led to isolation of an impressive collection of mutations affecting the retina and the retinotectal projection in zebrafish. Mutant phenotypes are being studied using a rich variety of markers: antibodies, RNA probes, retrograde and anterograde tracers, as well as transgenic lines. Particularly impressive progress has been made in the characterization of the zebrafish genome. Consequently, positional and candidate cloning of mutant genes are now fairly easy to accomplish in zebrafish. Many mutant genes have, in fact, already been cloned and their analysis has provided important insights into the gene circuitry that regulates retinal neurogenesis. Genetic screens for visual system defects will continue in the future and progressively more sophisticated screening approaches will make it possible to detect a variety of subtle mutant phenotypes in retinal development. The remarkable evolutionary conservation of the vertebrate eye provides the basis for the use of the zebrafish retina as a model of human disorders. Some of the genetic defects of the zebrafish retina indeed resemble human retinopathies. As new techniques are being introduced and improved at a rapid pace, the zebrafish will continue to be an important organism for the studies of the vertebrate visual system.

The zebrafish as a tool for understanding the biology of visual disorders

Retinal degenerations are the commonest cause of blindness in the Western world, affecting 5% of the population, yet remain largely untreatable. A better understanding of the mechanisms of disease is needed. Zebrafish fill a gap in the current repertoire of models, offering genetic tractability in a vertebrate. Their retina has many similarities with a human retina. Importantly, unlike rodents, they have rich colour vision, offering the potential to model the macular degenerations. A variety of physiological assays, genetic manipulations and histological tools have been developed and useful models of human disease created.

[Glaucoma and ocular hypertension in primary care]

OBJECTIVES

To find the distribution of intra-ocular pressure (IOP) in our population over 40 and the prevalence of glaucoma (G) and ocular hypertension (OH).

DESIGN

Descriptive.

SETTING

Primary care.

SUBJECTS

990 people >= 40 years old.Measurements. Age, sex, body mass index (BMI), ophthalmic history, risk factors, visual sharpness (optotype), ophthalmoscopy and IOP (applanation tonometry). Patients with back-of-eye disorders and/or IOP >= 21 mmHg were referred to the ophthalmologist for assessment (campimeter).

RESULTS

870 people, average age 54.66 and 45.4% of them men. Mean IOP was 12.96 in the right eye and 13.27 in the left, with significant differences between them, but not between sexes or age-groups. 70 patients were referred (11 for IOP >= 21, 54 for disturbance perceived by ophthalmoscope and 5 for both reasons). The ophthalmologist classified 9 as G, 12 as OH and 15 as suspected G. We calculated 1.81% (95% CI, 0.98-2.63) prevalence of G in the >= 40s, including 9 cases already known. OH prevalence was 1.61% (95% CI, 0.82-2.39). Through logistical regression, we found greater risk of G in people with myopia (OR adjusted for age and sex = 3.01) and Hypertriglyceridaemia (ORa, 6.34). OH risk was significantly greater in patients with BMI >= 30 (ORa, >= 4.20).

CONCLUSIONS

Glaucoma prevalence confirms published findings from other similar populations, while IOP and OH prevalence were much less here. Given that half G cases are undiagnosed, we believe its early detection in primary care should be highlighted, at least in at-risk groups.

Meta-analysis of the effect of latanoprost and brimonidine on intraocular pressure in the treatment of glaucoma

OBJECTIVE

The purpose of this study was to indirectly quantify and compare the intraocular pressure (IOP)-lowering effects of latanoprost and brimonidine eye drops at baseline and after 3 and 6 months in the treatment of primary open-angle glaucoma.

METHODS

This meta-analysis combined data from all randomized controlled trials comparing the effects on IOP of latanoprost and brimonidine treatment in adults with a baseline IOP > or =20 mm Hg. MEDLINE and EMBASE were searched for reports of the ophthalmic administration of either drug versus the other, placebo, or active therapy. Included studies reported IOP as either means or differences (with SD or SE) and sample sizes. A random-effects model was used to pool data within each drug group. As a proxy for success rates, area under the curve (AUC) was calculated for the proportion of patients having an IOP <20 mm Hg.

RESULTS

One hundred fifty-five articles reporting on 158 trials were identified; 147 papers were rejected (141 were not randomized controlled trials, 5 were duplicates, and 1 had nonextractable data), leaving 9 trials from 8 articles. A total of 2152 patients were included in the meta-analysis: 597 received latanoprost, 571 received brimonidine, and the remainder received timolol or betaxolol. Baseline IOPs were similar in patients randomized to latanoprost or brimonidine (25.3 and 24.6 mm Hg, respectively). At 3 months, latanoprost and brimonidine reduced IOP by 8.4 and 6.5 mm Hg, respectively (P = 0.004 latanoprost vs brimonidine), and at 6 months by 8.0 and 6.2 mm Hg, respectively (P = 0.045). AUC was 0.834 and 0.675 at 3 months for latanoprost and brimonidine, respectively, and 0.817 and 0.715 at 6 months, respectively (both, P < 0.001).

CONCLUSIONS

This indirect comparison of data from the available randomized clinical trials showed latanoprost to be statistically superior to brimonidine in reducing IOP in adults with primary open-angle glaucoma. Additional long-term, head-to-head comparisons of the efficacy, safety, and cost of latanoprost and brimonidine are needed to support and supplement these findings.