The incidence and seasonal variations of acute primary angle-closure glaucoma
(APACG) was studied. It was based on a retrospective chart review of 121 hospital patients
in Split, Croatia for the fifteen-year period from 1985 through 1999. The average
incidence was 4.1 cases per 100,000 per year in the total population and 7.1 per 100,000
in those aged 30 years and older. APACG affects women almost twice more often than
men. The incidence rate increased with age. No seasonal variations in the occurrence of
APACG and no correlation with the mean duration of light exposure per season were
found

A. Smoljanović

M. Erceg

M. Ivanišević

Ž. Trošić

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Coll. Antropol. 26 (2002) 1: 41–45UDC 617.749-036.2:613.13Original scientific paperThe Incidence and SeasonalVariations of Acute PrimaryAngle-Closure GlaucomaM. Ivani{evi}1, M. Erceg2, A. Smoljanovi}2 and @. Tro{i}31 Eye Clinic, University Hospital »Split«, Split, Croatia2 Public Health Institute of Split-Dalmatia County, Split, Croatia3 Naval Meteorological Center Split of the Croatian Hydro-Meteorological Institute,Split, CroatiaA B S T R A C TThe incidence and seasonal variations of acute primary angle-closure glaucoma(APACG) was studied. It was based on a retrospective chart review of 121 hospital pa-tients in Split, Croatia for the fifteen-year period from 1985 through 1999. The averageincidence was 4.1 cases per 100,000 per year in the total population and 7.1 per 100,000in those aged 30 years and older. APACG affects women almost twice more often thanmen. The incidence rate increased with age. No seasonal variations in the occurrence ofAPACG and no correlation with the mean duration of light exposure per season werefound.IntroductionGlaucoma is one of the leading causesof blindness1,2. Acute primary angle-clo-sure glaucoma (APACG) is an urgentstate in ophthalmology3,4. Over the past40 years there have been few studies pub-lished in the incidence5–7 and seasonalvariations8,9 of APACG in the general po-pulation. At the time this study was initi-ated, there was none from Croatia. In thepresent study we studied the incidenceand seasonal variations of APACG in thecity of Split for the fifteen-year period,from 1985 through 1999. The findings ofthis study are important, as they allowbetter disease evaluation and betterplanning of the ophthalmologic service inthe treatment of APACG.Patients and MethodsThe Eye Clinic and University Hospi-tal »Split« provide the only available oph-thalmologic services in the city of Split,and to its almost 200,000 inhabitants1041Received for publication July 17, 2000(Table 1). This, together with the factthat APACG necessitates either laser orsurgical iridectomy and therefore has tra-ceable records, enabled us to perform atrue incidence study. This retrospectivestudy of 121 consecutive patients wascarried out during 15-year period be-tween January 1, 1985, and December31, 1999. Standard ophthalmic data wererecorded in each case. Those includedage, sex, date of onset of the attack andlaterality of the affected eye. Criteria forAPACG diagnosis and inclusion in thestudy were: ocular pain, blurring of vi-sion, corneal epithelial edema, conjun-ctival injection, elevated intraocularpressure, presence of an occluded angleconfirmed by gonioscopy. Cases of second-ary angle-closure glaucoma such as neo-vascularisation, lens intumescence, orsubluxation, were excluded. We also ana-lyzed the seasonal incidence of APACGand compared to average duration oflight exposure per season of the year(spring: March to May, summer: June toAugust, autumn: September to Novem-ber and winter: December to February)over the same period. The data of sun-shine in the city of Split was given by theNaval Meteorological Center Split of theCroatian Hydro-meteorological Institute.The results were submitted to statisticalanalysis and the chi-square method wasused to calculate significance.ResultsIn the 15-year period from 1985through 1999, 121 cases of APACG werediagnosed and treated among residents ofthe city of Split. In 67 patients (55.4%),only the right eye was affected, and, inanother 47 patients (38.8%), only the lefteye was involved. There were 7 bilateral(5.8%), simultaneous attacks. The age atdiagnosis ranged from 37 to 88 years(mean  SD, 66.4  10.8 years, for women65.8  11.4 and for men 67.5  9.7 years).The sex distribution showed 79 women(65.5%) and 42 men (34.7%). The women:men ratio was 1.8: 1. The annual inci-dence was 4.1 per 100,000 in the totalpopulation and 7.1 per 100,000 in thoseaged 30 years and older. The incidenceshowed a step rise with age. The highest42M. Ivani{evi} et al.: Seasonal Variations of Acute Glaucoma, Coll. Antropol. 26 (2002) 1: 41–45TABLE 1POPULATION OF SPLIT IN 1991Age (yrs.) Women Men Total<30 41.9 42.7 84.630–39 16.9 15.8 32.740–49 14.2 13.2 27.450–59 12.4 12.4 24.860–69 9.6 8.1 17.7>69 6.6 4.1 10.7Total 101.6 96.3 197.9* All figures are given as thousandsTABLE 2AGE AND SEX RELATED ANNUAL INCIDENCES OF APACG*Age (yrs.) Women Men Women/men ratio Total<30 0.0 0.0 – 0.030–39 0.4 (1) 0.0 – 0.2 (1)40–49 3.3 (7) 0.0 – 1.7 (7)50–59 7.0 (13) 5.9 (11) 1.2 6.5 (24)60–69 16.7 (24) 10.7 (13) 1.6 13.9 (37)>69 34.3 (34) 29.3 (18) 1.2 32.4 (52)Total 5.2 (79) 2.9 (42) 1.8 4.1 (121)* Values are given as incidence per 100,000 persons per year (number of cases)incidence was observed in both sexes inthe group 70 years and older. The inci-dence was higher (chi-square = 5.77, p =0.01) among women (5.2/100,000 peryear) than among men (2.9/100,000 peryear) (Table 2). The 15-year cumulativenumber of patients seen per season was31 in spring, 22 in summer, 31 in autumnand 37 in winter. Although. the frequencyof onset of APACG was little greater inwinter than in the other seasons therewere statistically insignificant (p = 0.57)seasonal variations in the occurrence ofAPACG. The average number of sunshinehours in Split was 602 in spring, 1020 insummer, 588 in autumn and 517 in win-ter and it showed this to be statisticallysignificant difference (p < 0.001).The study revealed no correlation ofthe seasonal incidence of APACG and theseasonal variations of light hours per sea-son (Table 3).DiscussionThe literature contains very few re-ports of authors examining the incidenceof APACG in the general population. In1985, David et al. reported 126 cases ofAPACG that occurred over a 12-year pe-riod in the 250,000 of the Israel Nagevregion5. This constitutes an incidence of4.2 / 100,000 / year in the total populationand 11.1 / 100,000 in the over-30 popula-tion. Teikari et al. reported an annual in-cidence of 3.8 cases / 100,000 per year inthe population of Finland during a 10-year period6. The incidence of APACG inour study (4.1 per 100,000 population)was very similar to the incidence men-tioned in the previous studies. The inci-dence of APACG is more common in yel-low race than in whites7,11. So, among1,551,000 Singaporeans mostly Chineseaged 30 years and older during the 1-yearstudy period, 189 persons with APACGwere seen. These represent the annualincidence of 12.2 per 100,0007.The observation that APACG affectsfemales more often than males is not sur-prising because the prevalence of gonio-scopically narrow angles and primary an-gle-closure glaucoma is greater amongwomen than men of many races12. Thereis age-related increase in incidence ofAPACG because the anterior chambershallows with age13.Our epidemiological study of relati-vely confirmed group reveals an annualincidence of about one case of APACG forevery 24,390 people in the general popu-lation. If one assumes that an incidencesimilar to that found in this study (4.1per 100,000 population) is representativeof the population of Croatia, than approx-imately 100 cases of APACG should occurper year.The theory that meteorological factorsact as a trigger for APACG in anatomi-cally predisposed persons has been pro-posed8,9. It is considered that this pecu-43M. Ivani{evi} et al.: Seasonal Variations of Acute Glaucoma, Coll. Antropol. 26 (2002) 1: 41–45TABLE 3SEASONAL DISTRIBUTION OF APACGSeason Number ofpatients %Sunshine(h) %Spring 31 25.6 602 22.1Summer 22 18.2 1020 37.4Autumn 31 25.6 588 21.6Winter 37 30.6 517 18.9Total 121 100.0 2727 100.0liarity has been associated with thepupillary dilatation owing to diminishedlight.In Finland, Teikari et al. reported thatAPACG incidences were higher in winterand in autumn compared to spring andsummer14. In Israel, David et al. found asignificant preponderance of attacks oc-curred during summer and winter, coin-ciding with periods of extreme tempe-ratures5. They consider that cold weatherand hot desert summer tends to drive ev-eryone, especially elderly, indoors, wherepoorer light acts as a darkroom provoca-tive test. In contrast to the previouslypublished studies, our study shows noseasonal variations in the onset ofAPACG and no significant associationwas found between frequency of APACGand mean seasonal sunshine hours.In our study there is incidence ofAPACG similar like in other Caucasians.Elderly women being the highest riskgroup. According to our results of exami-nation, seasonal variations of the yearand seasonal differences in insolation areprobably of no essential importance forthe occurrence of APACG.The findings from this study will con-tribute to a better understanding of theepidemiology of APACG and, thereby, abetter distribution of manpower resour-ces to treat this disease.R E F E R E N C E S1. LIM, A. S. M., B. R. JONES, Vision, 1 (1982) 1.— 2. KRUMPASZKY, H. G., Klin. Monatsbl.Augenheilkd., 210 (1997) 9. — 3. AMERICAN ACA-DEMY OF OPHTHALMOLOGY: Glaucoma: Basicand science course. Section 10, 1995–1996. (AAO,San Francisco, 1995). — 4. IVANI[EVI], M.: Crvenooko, dijagnoza i lije~enje. (Jedinica za znanstveni radKB Split, Split, 1988). — 5. DAVID, R., Z. TESSLER,Y. YASSUR, Ophthalmologica, 191 (1985) 4. — 6.TEIKARI, J., I. RAIVIO, M. NURMEINEN, Graefe'sArch. Clin. Exp. Ophthalmol., 225 (1987); 357. — 7.SEAH, S. K. L., P. J. FOSTER, P. T. K. CHEW, A. J. A.P., F. OEN, H. B. FAM, A. S. M. LIM, Arch. Ophthal-mol., 115 (1997) 1436. — 8. TUPLING, M. R., E. J.JUNET, Trans. Ophthalmol. Soc. UK, 97 (1977) 185.— 9. HILLMAN, J. S., J. D. C. TURNER, Br. J. Oph-thalmol., 61 (1977) 512. — 10. ANONYMOUS: STA-TISTI^KI LJETOPIS HRVATSKIH @UPANIJA 1993.(Dr`avni zavod za statistiku Republike Hrvatske,Zagreb, 1994). — 11. FUJITA, K., K. NEGISHI, K.FUJIKI, K. KOHYAMA, S. KONSONBOOM, Jpn. J.Clin. Ophthalmol., 37 (1996); 625. — 12. ALSBIRK, P.H., Acta Ophthalmol., 54 (1976) 5. — 13. FOSTER, P.J., P. H. ALSBIRK, J. BAASANHU, D. MUNKHBA-ZAR, D. URANCHIMEG, G. J. JOHNSON, Am. J.Ophthalmol., 124 (1997) 53. — 14. TEIKARI, J. M., J.O'DONNELL, M. NURMINEN, I. RAIVIO, J. Epide-miol. Community Health, 4 (1991) 291.M. Ivani{evi}Eye Clinic, University Hospital »Split«, [oltanska 2, 21000 Split, Croatia44M. Ivani{evi} et al.: Seasonal Variations of Acute Glaucoma, Coll. Antropol. 26 (2002) 1: 41–45INCIDENCIJA I SEZONSKE VARIJACIJE AKUTNOG PRIMARNOGGLAUKOMA ZATVORENOG KUTAS A @ E T A KIspitivana je incidencija i sezonske varijacije akutnog primarnog glaukoma zatvo-renog kuta u retrospektivnoj studiji na 121 bolni~kih bolesnika u Splitu u Hrvatskojtijekom 15 godina, u razdoblju od 1985. do 1999. godine. Prosje~na godi{nja incidencijabila je 4.1 na 100,000 stanovnika u ukupnoj populaciji, odnosno, 7.1 na 100,000 sta-novnika starijih od 30 godina. Akutni primarni glaukom zatvorenog kuta zahva}a `enegotovo dva puta ~e{}e nego mu{karce. Incidencija akutnog glaukoma raste sa staros-nom dobi. Nije prona|ena korelacija izme|u pojave akutnog primarnog glaukomazatvorenog kuta s prosje~nim trajanjem insolacije godi{njih doba.45M. Ivani{evi} et al.: Seasonal Variations of Acute Glaucoma, Coll. Antropol. 26 (2002) 1: 41–45

The Incidence and Seasonal Variations of Acute Primary Angle-Closure Glaucoma

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