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  • Global Prevalence of Undetected Glaucoma

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, October 2021

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    The global extent of undetected glau­coma is still unclear despite insight from recent population-based studies on prevalence and risk factors. Soh et al. explored the extent of undetected glaucoma among communities world­wide to shed light on the effectiveness of current strategies used to find cases and to plan appropriate public health initiatives and resource allocation. They found that rates of undetected glaucoma remain high, exceeding 50% worldwide; prevalence was highest in Asia and Africa.

    For this systematic review and meta-analysis, the authors searched multiple sources, including online databases and reports from nongovernmental organizations. The main outcome mea­sure was the proportion of previously undetected glaucoma cases. “Manifest glaucoma” denoted any form of glau­coma reported in the studies, including primary open-angle glaucoma (POAG), primary angle-closure glaucoma, secondary glaucoma, or combinations thereof. “Undetected glaucoma” was defined as glaucoma that had not been identified before its diagnosis in the study. Cases of “possible” or “suspect” glaucoma were excluded. A random-effects meta-analysis was performed to estimate the pooled proportion of undetected glaucoma.

    Altogether, the authors identified 61 articles (55 population-based studies), representing 189,359 par­ticipants and 6,949 cases of manifest glaucoma. Globally, more than half of all glaucoma cases had not been detected previously. Compared with Europe, undetected glaucoma was more common in Africa (odds ratio [OR], 12.70) and Asia (OR, 3.41). Countries with a low Human Development Index (HDI; <0.55) had higher percentages of undetected manifest glaucoma than did countries with medium, high, or very high HDI (≥0.55; p < .001 for each comparison). For 2020, it was projected that nearly 48 million cases of POAG were undetected; of these, 76.7% were in Africa and Asia.

    These findings confirm that more strategies are needed to improve glaucoma detection.

    The original article can be found here.