Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): a systematic review and meta-analysis.

Systematic review of published population based surveys to examine the relationship between primary open angle glaucoma (POAG) prevalence and demographic factors. A literature search identified population-based studies with quantitative estimates of POAG prevalence (to October 2014). Multilevel binomial logistic regression of log-odds of POAG was used to examine the effect of age and gender among populations of different geographical and ethnic origins, adjusting for study design factors. Eighty-one studies were included (37 countries, 216 214 participants, 5266 POAG cases). Black populations showed highest POAG prevalence, with 5.2% (95% credible interval (CrI) 3.7%, 7.2%) at 60 years, rising to 12.2% (95% CrI 8.9% to 16.6%) at 80 years. Increase in POAG prevalence per decade of age was greatest among Hispanics (2.31, 95% CrI 2.12, 2.52) and White populations (1.99, 95% CrI 1.86, 2.12), and lowest in East and South Asians (1.48, 95% CrI 1.39, 1.57; 1.56, 95% CrI 1.31, 1.88, respectively). Men were more likely to have POAG than women (1.30, 95% CrI 1.22, 1.41). Older studies had lower POAG prevalence, which was related to the inclusion of intraocular pressure in the glaucoma definition. Studies with visual field data on all participants had a higher POAG prevalence than those with visual field data on a subset. Globally 57.5 million people (95% CI 46.4 to 73.1 million) were affected by POAG in 2015, rising to 65.5 million (95% CrI 52.8, 83.2 million) by 2020. This systematic review provides the most precise estimates of POAG prevalence and shows omitting routine visual field assessment in population surveys may have affected case ascertainment. Our findings will be useful to future studies and healthcare planning

Candidate high myopia loci on chromosomes 18p and 12q do not play a major role in susceptibility to common myopia

BACKGROUND: To determine whether previously reported loci predisposing to nonsyndromic high myopia show linkage to common myopia in pedigrees from two ethnic groups: Ashkenazi Jewish and Amish. We hypothesized that these high myopia loci might exhibit allelic heterogeneity and be responsible for moderate /mild or common myopia. METHODS: Cycloplegic and manifest refraction were performed on 38 Jewish and 40 Amish families. Individuals with at least -1.00 D in each meridian of both eyes were classified as myopic. Genomic DNA was genotyped with 12 markers on chromosomes 12q21-23 and 18p11.3. Parametric and nonparametric linkage analyses were conducted to determine whether susceptibility alleles at these loci are important in families with less severe, clinical forms of myopia. RESULTS: There was no strong evidence of linkage of common myopia to these candidate regions: all two-point and multipoint heterogeneity LOD scores were < 1.0 and non-parametric linkage p-values were > 0.01. However, one Amish family showed slight evidence of linkage (LOD>1.0) on 12q; another 3 Amish families each gave LOD >1.0 on 18p; and 3 Jewish families each gave LOD >1.0 on 12q. CONCLUSIONS: Significant evidence of linkage (LOD> 3) of myopia was not found on chromosome 18p or 12q loci in these families. These results suggest that these loci do not play a major role in the causation of common myopia in our families studied

Anterior chamber depth measurement by optical pachymetry: systematic difference using the Haag‐Streit attachments

BACKGROUND/AIM: Haag‐Streit recommends that for the most accurate anterior chamber depth (ACD) results, the corneal thickness, as determined with attachment No I, should be deducted from a measurement from corneal epithelium to the anterior lens surface, made with attachment No II (method A). Often ophthalmologists use the measurement made from the corneal endothelium to the anterior lens surface, using only attachment No II (method B), which is a simpler and faster method. This study examined agreement between methods A and B. METHODS: Two studies were conducted independently by each author. PHA measured 127 (27 men, 100 women; mean age, 66.9 years) consecutive Danish patients referred for evaluation because of possible angle closure. RRB measured 109 subjects (30 men, 79 women; mean age, 61.3 years) consecutively from a population based glaucoma survey in Rom Klao, Thailand. RESULTS: Using method A, mean ACD was 1.97 mm (SD 0.29) in the Danish study and 2.59 mm (SD 0.27) in the Thai study. ACD measured with method B was significantly (p<0.001) deeper than method A in both studies (Danes: difference = 0.118 (95% CI: 0.109 to 0.127); Thais: difference = 0.166 mm (95% CI: 0.158 to 0.174)). With an increase in ACD of 1 mm, the methodological difference increased by 0.052 mm (regression formula: difference (B − A)  =  0.0667 × mean ACD – 0.0148; R(2) = 0.31). This positive correlation did not differ significantly between the two studies. CONCLUSIONS: The relevance and importance of estimating ACD as a risk factor in primary angle closure glaucoma suspects and patients has been repeatedly emphasised. This is the first empirical study to quantify the difference in ACD using these two methods in two samples, one clinic based (angle closure suspects) and the other population based. The size of the methodological difference has a level that corresponds to the age reduction of ACD per decade, or to about 6% of ACD in a given eye. These findings highlight the importance of clinicians recognising that these two methods will give different results and recommend that one should standardise ACD measurements using the Haag‐Streit optical pachymeter

Can we prevent angle-closure glaucoma?

PURPOSE: Glaucoma is the second cause, after cataract, of world blindness. Approximately half is thought to be primary angle-closure glaucoma (ACG). This review asks whether ACG can be prevented on a population basis. METHODS AND POPULATIONS: Review of published information from the Inuit of Greenland, Canada and Alaska, and descriptions of recent studies in Asian populations in Mongolia, China and South-East Asia. RESULTS: The Greenland Inuit have the shallowest anterior chamber depths (ACDs) so far recorded. The proportion of blindness due to ACG was reduced from 64% to 9% over 37 years by systematic optical measurement of central ACD and the van Herick test in the older Inuit, followed by gonioscopy and prophylactic iridectomy or laser iridotomy when indicated. In Mongolia, ultrasound measurement of central ACD had good sensitivity and specificity as a screening test. A randomized controlled trial of screening and prophylactic laser is being completed. In China and South-East Asia, the mechanism of angle closure appears to be more varied and complex and its detection may require more elaborate imaging. CONCLUSIONS: The mechanism of angle closure and potential for prevention by screening are likely to have to be determined specifically for each population at risk