Prevalence of Glaucoma in an Old Population: The Ural Very Old Study.

PURPOSE

To assess glaucoma prevalence and its determinants in an aged population.

DESIGN

Population-based cohort study.

PARTICIPANTS

The population-based Ural Very Old Study was performed in a rural area and urban region of Bashkortostan/Russia and consisted of 1526 (81.1%) out of 1882 eligible individuals aged 85+ years.

METHODS

The study participants underwent a structured interview and a detailed ocular and systemic examination. The presence and degree of glaucoma were assessed on conventional color fundus photographs, red-free fundus images, and OCT images.

MAIN OUTCOME MEASURES

Prevalence and associations of glaucoma.

RESULTS

Among 961 individuals with available fundus images, glaucomatous optic neuropathy was detected in 116 of 840 right eyes (13.8%; 95% confidence interval [CI]: 11.3-16.3) and 122 of 841 left eyes (14.5%; 95%

CI

12.0-17.0), with overall 148 participants (15.4%) having glaucoma. Out of 111 right and 116 left eyes with glaucoma and measurement of best-corrected visual acuity (BCVA), 18 (16%) and 20 (17%) eyes were blind, respectively (BCVA: <3/60), and 61 (55%) and 63 (54%) eyes had moderate-to-severe vision impairment (MSVI), respectively (BCVA: <6/18 and ≥3/60). In 24 of 38 glaucomatous blind eyes (63%) and 50 of the 124 glaucomatous eyes (40.3%) with MSVI, vision loss was caused by glaucoma. The ratio of open-angle glaucoma to angle-closure glaucoma was 71% to 29%. The prevalence of angle-closure glaucoma was markedly higher in phakic glaucomatous eyes (62/113; 54.9%) than in pseudophakic glaucomatous eyes (6/125; 4.8%). Best-corrected visual acuity did not differ (P = 0.56) between open-angle glaucoma and angle-closure glaucoma. Among 148 participants with glaucoma, 54 (36.5%) individuals were under therapy. Intraocular pressure (IOP) was ≤21 mmHg in 83% of glaucomatous eyes without antiglaucomatous therapy. Higher prevalence (and severity) of glaucoma correlated with longer axial length (odds ratio [OR]: 1.43; 95%

CI

1.14-1.78; P = 0.002), higher IOP (OR: 1.14; 95%

CI

1.07-1.22; P < 0.001), higher prevalence of pseudoexfoliation (OR: 1.39; 95%

CI

1.17-1.65; P < 0.001), and older age (OR: 1.15; 95%

CI

1.04-1.27; P = 0.008).

CONCLUSIONS

In this population-based recruited multiethnic cohort aged 85+ years, the prevalence factors of glaucoma-related blindness and MSVI were relatively high, and the majority of glaucomatous eyes were untreated and had single IOP readings of ≤21 mmHg. As in younger cohorts, higher glaucoma prevalence was associated with longer axial length, in addition to higher IOP and older age. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.