Costs, burdens of glaucoma growing but may be preventable

This interpretative essay published in the October issue of the American Journal of Ophthalmology discusses the epidemiological, economic and individual burdens of glaucoma. The authors propose that early identification and treatment of patients with glaucoma and those with ocular hypertension at high risk of developing vision loss is likely to reduce loss of health-related quality of life and personal and societal economic burdens. They say that while the burden of functional vision loss related to glaucoma is not fully recognized, glaucoma-related visual disabilities should be preventable.

The rationale that the financial burden of glaucoma increases with disease severity makes sense. However, the costs and methods of glaucoma screening must be examined in detail in order to better assess the true societal costs of glaucoma care.

The authors performed a Medline search for relevant articles in English published between 1991 and 2010. They report that an estimated 3 percent of the global population older than 40 years of age currently has glaucoma and the majority is undiagnosed. They say that the number of glaucoma patients is estimated to increase from 60 million in 2010 to nearly 80 million in 2020 as the population ages, with more than half in developed societies remaining undiagnosed and a significantly higher proportion remaining undiagnosed in developing communities.

The authors say that even in the early stages of disease, vision loss from glaucoma has a significant impact on health-related quality of life in multiple ways, affecting common daily activities including driving, walking and reading. This impact includes diagnosed and undiagnosed patients, with the overall burden increasing as glaucomatous damage and vision loss progress. Ongoing visual field loss also may impose an increasing psychological burden on patients and their families.

Meanwhile, the economic burden of glaucoma is significant and increases as the disease worsens. This can include direct costs, such as ocular hypotensive medications, physician and hospital visits, glaucoma-related procedures, transportation, guide dogs and nursing home care. Indirect costs, which reflect lost productivity, include days missed from work and productivity costs borne by caregivers.