Ординатура / Офтальмология / Английские материалы / Mechanisms of the Glaucomas_Shields, Tombran-Tink, Barnstable_2008
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Epidemiology of and Risk Factors for Primary Open-Angle Glaucoma |
25 |
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Thailand, Bangkok |
1997–1999 |
Asian |
≥50 |
701 |
2.3 |
|
(38,39) |
|
|
≥40 |
|
|
|
Japan, Tajimi (24) |
2000–2001 |
Asian |
3021 |
3.9 |
|
|
California, La Puente (68) |
2002 |
Hispanic |
≥40 |
6357 |
4.7 |
|
Spain, Segovia (69) |
2003 |
Caucasian |
≥40 |
510 |
2.1 |
|
Bangladesh, Dhaka |
2003 |
Asian |
≥35 |
2347 |
1.8 |
|
Division (40) |
|
|
≥50 |
|
|
|
West Bengal (41) |
2004 |
Asian |
1269 |
3.0 (only open- |
|
|
|
|
|
≥40 |
|
angle glaucoma) |
|
India, Tamil Nadu (42) |
2004 |
Asian |
3924 |
1.6 |
|
|
by applying different diagnostic criteria from several prevalence studies to one single population, which resulted in more than 12-fold variation of prevalence in several age categories as illustrated in Fig. 1 (5). Glaucoma definitions based only on visual field defects might miss early cases, as considerable optic nerve damage might already be present long before a visual field defect is seen (19). Differences in examination techniques cause additional variation in outcome measurements. For example, visual field testing with kinetic (Goldmann) perimetry will identify fewer early cases than automated static perimetry (e.g., Humphrey full threshold perimetry) (20) although it could lead to less false-positives results, which could be beneficial in risk-factor research. Automated stereoscopic optic disc analyses will yield more accurate optic disc characteristics compared to monocular optic disc examination (11,21,22). Finally, POAG is a diagnosis made by exclusion of other causes of optic neuropathy and visual field defects (e.g., retinal diseases, neurophthalmic causes, and other forms of glaucoma). The extent of excluding other possible causes varies per study.
Fig. 1. Variation in prevalence figures caused by different primary open-angle glaucoma (POAG) definitions from various population-based studies applied to the Rotterdam Study cohort (5).
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de Jong et al. |
These non-uniform diagnostic criteria and examination methods hamper reliable comparison and pooling of results in the literature. Despite this, a meta-analysis was performed based on several large population-based studies, resulting in an overall prevalence rate of 1.9% in subjects of 40 years of age and older (23). Similar to most other prevalence studies, a clear increase in prevalence was seen with increasing age
(5,23–28).
Prevalence studies with a partial black, African descent population showed four to six times higher prevalence rates of OAG compared to white subjects (29–32). Subjects of Hispanic descent showed an intermediate prevalence between blacks and whites, but possibly had a steeper increase with age (27). Reports on prevalence of POAG in Asians differ. Most show similar prevalence rates as in whites (33–42), but the Tajimi study showed a prevalence more comparable with blacks. This could be due to the use of frequency doubling perimetry, possibly a more sensitive visual field screening technique (24).
INCIDENCE OF OPEN-ANGLE GLAUCOMA
FROM POPULATION-BASED STUDIES
The incidence of OAG has been determined in at least five population-based studies (15,43–46). Table 3 summarizes the most important characteristics (age and ethnicity) of the various study populations and the resulting incidences. As can be seen in this table, the cumulative incidence of POAG is typically 1–2% per 5 years. The results of the various studies are in good agreement, despite methodological differences. The higher incidence reported in the Barbados study might be related to a different ethnicity of the study population (see risk factors). The higher incidence in one population-based study could be due to their high (23%) prevalence of pseudoexfoliation (44). After exclusion of pseudoexfoliation, their incidence (5-year risk) drops to approximately 1%. Pseudoexfoliation is an established risk factor for OAG (47–51), and the prevalence of pseudoexfoliation (about 20%) in the Scandinavian countries (44,52–54) is higher than the 2% in the USA (55,56). Two possible explanations for the difference between the two Swedish studies are exclusion of pseudo-exfoliation by one (43) or regional differences within Sweden (57).
Table 3
Incidence of Open-Angle Glaucoma in Population-Based Studies
Study |
Years |
Race |
Age (years) |
N |
Incidence |
|
|
|
|
|
(5-year risk,%) |
|
|
|
|
|
|
Sweden, Dalby (43) |
1977–1986 |
White |
≥55 |
1295 |
1.2 |
Sweden, Tierp (44) |
1984/1986–1988/1991 |
White |
65–74 |
413 |
3.1 |
Barbados (45) |
1988/1992–1992/1997 |
Black |
≥40 |
3427 |
2.8 |
Australia, |
1992/1994–1997/1999 |
White |
≥40 |
3257 |
1.1 |
Melbourne (46) |
|
|
≥55 |
|
|
The Netherlands, |
1990/1993–1997/1999 |
White |
3842 |
1.8 |
Rotterdam (15)
Epidemiology of and Risk Factors for Primary Open-Angle Glaucoma |
27 |
RISK FACTORS FOR GLAUCOMA
Two major risk factors for POAG are IOP and age. Many studies reported these risk factors based on both prevalent and incident data (5,15,51,58). Less known risk factors for glaucoma have been studied in many case–control studies and in several population-based studies. Table 4 gives an overview of the results for these risk factors from population-based studies. As can be seen in this table, myopia, family history, and ethnicity appear to be associated with an increased risk of OAG, whereas an ambiguous association was found for diabetes mellitus and systemic hypertension. The fact that there seems to be a direct relationship between blood pressure and IOP (25,59,60) complicates the interpretation of hypertension as a risk factor for glaucoma. Also one may see that associations within studies changed when incidence data became available. No associations were found for atherosclerosis, body mass index, C reactive protein, migraine, or smoking. Ethnicity could only be studied in the Baltimore study, being the only study with an approximately even distribution of black (45%) and white (55%) participants. The higher incidence of POAG in the Barbados study, with a vast majority of black participants, as compared to other studies on whites is in line with this finding (see Table 3).
Table 4
Risk Factors for Open-Angle Glaucoma from Population Based Studies
Risk factor |
Study |
P/I |
|
OR/RR (CI) |
|
|
|
|
|
|
|
|
Or association with |
|
Atherosclerosis |
The Netherlands, Rotterdam (70) |
I |
No association |
|
Body mass |
Barbados (58) |
P |
Association with low BMI |
|
index (BMI) |
Japan, Tajimi (71) |
P |
No association |
|
C-reactive |
The Netherlands, Rotterdam (70) |
I |
No association |
|
protein |
USA, Beaver Dam (72) |
|
|
|
Diabetes mellitus |
P |
1.7 |
(1.1–2.5) |
|
|
USA, Baltimore (73) |
P |
1.0 |
(0.9–1.3) |
|
Barbados (58) |
P |
No association |
|
|
The Netherlands, Rotterdam (74) |
P |
3.1 |
(1.1–8.7) |
|
Australia, Blue Mountains (75) |
P |
2.1 |
(1.2–3.8) |
|
Japan, Tajimi (71) |
P |
No association |
|
|
USA, Nurses Health Study (76)b |
I |
1.8 |
(1.2–3.7) |
|
The Netherlands, Rotterdam (77) |
I |
0.7 |
(0.3–1.6) |
Ethnicity |
USA, Baltimore (31) |
P |
4.3a |
|
Black versus |
|
P |
|
|
white |
USA, Baltimore (78) |
|
2.9 |
(1.8–4.5) |
Family history |
P |
|
|
|
|
Barbados (58) |
|
2.4 |
(1.4–4.2) |
|
The Netherlands, Rotterdam (79) |
P |
9.2 |
(1.2–73.9) |
|
Australia, Blue Mountains (80) |
P |
3.2 |
(1.8–5.6) |
(Continued)
28 |
|
|
|
de Jong et al. |
Table 4 |
|
|
|
|
(Continued) |
|
|
|
|
|
|
|
|
|
Risk factor |
Study |
P/I |
|
OR/RR (CI) |
|
|
|
|
|
|
Japan, Tajimi (71) |
P |
No association |
|
|
Australia, Melbourne (51) |
I |
2.1 |
(1.0–4.2) |
Hypertension |
USA, Baltimore (81) |
P |
1.0 |
(0.7–1.4) |
(systemic) |
Barbados (58) |
P |
Low diastolic BP |
|
|
The Netherlands, Rotterdam (59) |
P |
1.9 |
(1.0–3.7) |
|
Italy, Egna-Neumarkt (82) |
P |
1.4 |
(0.9–2.3) |
|
Australia, Blue Mountains (83) |
P |
1.6 |
(1.0–2.4) |
|
Japan, Tajimi (71) |
P |
No association |
|
|
The Netherlands, Rotterdam (84) |
P |
|
|
|
Elevated pulse pressure and htOAG |
|
1.3 |
(1.0–1.7) |
|
Low diastolic perfusion pressure and |
|
0.3 |
(0.1–0.6) |
|
ntOAG |
|
|
|
|
Low diastolic perfusion pressure and |
|
4.7 |
(1.3–17.0) |
|
htOAG |
|
|
|
|
Barbados (85) |
I |
0.5 |
(0.3–0.9) |
Medication |
|
|
|
|
Systemic |
The Netherlands, Rotterdam (92) |
I |
0.6 |
(0.3–1.0) |
beta-blockers |
The Netherlands, Rotterdam (92) |
|
|
|
Calcium channel |
I |
1.8 |
(1.0–3.2) |
|
antagonists |
The Netherlands, Rotterdam (92) |
I |
1.2 |
(0.7–1.9) |
Migraine |
USA, Beaver Dam (86) |
P |
0.95 (p = 0.87) |
|
|
Australia, Blue Mountains (87) |
P |
1.2 |
(0.7–1.9) |
|
Japan, Tajimi (71) |
P |
No association |
|
Myopia |
Australia, Blue Mountains (88) |
P |
2.3 |
(1.3–4.1) to3.3 (1.7–6.4) |
|
USA, Beaver Dam (89) |
P |
1.6 |
(1.1–2.3) |
|
Sweden, Malmo (90) |
P |
1.6a |
|
|
Japan, Tajimi (71) |
P |
1.9 |
(1.0–3.3) to 2.6 (1.6–4.4) |
Smoking |
Japan, Tajimi (71) |
P |
No association |
|
|
USA, Nurses Health Study (91)b |
I |
No association |
|
P, based on prevalence data; I, based on incidence data; OR, odds ratio; RR, relative risk; CI, 95% confidence interval.
aNot mentioned or possible to calculate CI. bNo strict population-based data
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The Reykjavik Eye Study on Prevalence of Glaucoma in Iceland and Identified Risk Factors
Fridbert Jonasson, md, Arsaell Arnarsson, msc, and Thor Eysteinsson, phd
CONTENTS
Introduction
Material and methods
Examination
Definitions
Results
Discussion
References
INTRODUCTION
The Icelandic population is almost exclusively Caucasian mostly of North European origin, descendants of settlers who arrived some eleven hundred years ago. During the 20th century, several glaucoma surveys have been conducted in Iceland (1–6). In 1950, glaucoma was the most common cause of blindness amounting to 50% of all cases (5). Surveys in the 1980s indicated that glaucoma was responsible for approximately 18% of blindness, and in 2005, this figure was about 8% (7). These older surveys provide fairly accurate estimates of severe visual handicap and blindness. Definitions and diagnostic criteria of glaucoma have, however, changed over time, and the less recent studies included intra ocular pressure (IOP) as a part of the definition of glaucoma (1,3–5) and in some instances based their diagnosis on glaucoma drug consumption (2). Distribution of IOP in random samples from the populations has shown a big overlap of IOP in open angle glaucoma (OAG) and non-OAG eyes in the Reykjavik Eye Study (6), the Rotterdam Eye Study (8), the Beaver Dam Eye Study (9,10), and the Blue Mountain Eye Study (11). Prevalence surveys have therefore lead
From: Ophthalmology Research: Mechanisms of the Glaucomas
Edited by: J. Tombran-Tink, C. J. Barnstable, and M. B. Shields © Humana Press, Totowa, NJ
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