Elsevier

Ophthalmology

Volume 121, Issue 11, November 2014, Pages 2081-2090
Ophthalmology

Original article
Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.ophtha.2014.05.013Get rights and content

Purpose

Glaucoma is the leading cause of global irreversible blindness. Present estimates of global glaucoma prevalence are not up-to-date and focused mainly on European ancestry populations. We systematically examined the global prevalence of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and projected the number of affected people in 2020 and 2040.

Design

Systematic review and meta-analysis.

Participants

Data from 50 population-based studies (3770 POAG cases among 140 496 examined individuals and 786 PACG cases among 112 398 examined individuals).

Methods

We searched PubMed, Medline, and Web of Science for population-based studies of glaucoma prevalence published up to March 25, 2013. Hierarchical Bayesian approach was used to estimate the pooled glaucoma prevalence of the population aged 40–80 years along with 95% credible intervals (CrIs). Projections of glaucoma were estimated based on the United Nations World Population Prospects. Bayesian meta-regression models were performed to assess the association between the prevalence of POAG and the relevant factors.

Main Outcome Measures

Prevalence and projection numbers of glaucoma cases.

Results

The global prevalence of glaucoma for population aged 40–80 years is 3.54% (95% CrI, 2.09–5.82). The prevalence of POAG is highest in Africa (4.20%; 95% CrI, 2.08–7.35), and the prevalence of PACG is highest in Asia (1.09%; 95% CrI, 0.43–2.32). In 2013, the number of people (aged 40–80 years) with glaucoma worldwide was estimated to be 64.3 million, increasing to 76.0 million in 2020 and 111.8 million in 2040. In the Bayesian meta-regression model, men were more likely to have POAG than women (odds ratio [OR], 1.36; 95% CrI, 1.23–1.52), and after adjusting for age, gender, habitation type, response rate, and year of study, people of African ancestry were more likely to have POAG than people of European ancestry (OR, 2.80; 95% CrI, 1.83–4.06), and people living in urban areas were more likely to have POAG than those in rural areas (OR, 1.58; 95% CrI, 1.19–2.04).

Conclusions

The number of people with glaucoma worldwide will increase to 111.8 million in 2040, disproportionally affecting people residing in Asia and Africa. These estimates are important in guiding the designs of glaucoma screening, treatment, and related public health strategies.

Section snippets

Systematic Review Process

The review followed the Meta-Analysis of Observational Studies in Epidemiology guidelines for reporting our systematic reviews and meta-analyses.36 We performed a literature search in the electronic databases of PubMed, Medline, and Web of Science. We limited our search to English publications and made a final search on March 25, 2013.

In our literature search, we included a combination of keywords, such as glaucoma, prevalence, epidemiology, population, and survey, in the form of title words or

Results

Figure 1 shows the article selection process for studies included in the final meta-analyses. In brief, a total of 3035 individual studies were identified and underwent review, and 2985 studies were excluded (Fig 1). Ultimately, 50 glaucoma prevalence–related articles were included in the final meta-analysis. In the event where age group, gender, and ethnic group–specific data were not readily available from published articles, we further contacted respective authors for request of relevant

Discussion

Our analysis provides comprehensive, up-to-date estimations on the current worldwide glaucoma prevalence and future projections on the number of people with glaucoma. We estimated the global prevalence of glaucoma to be 3.54%, with the highest prevalence in Africa. The number of people with glaucoma worldwide (aged 40–80 years) will increase from 64.3 million in 2013 to 111.8 million in 2040, disproportionally affecting people residing in Asia and Africa.

Acknowledgments

The authors thank Harry Quigley (Proyecto Eye Study), David Friedman (Salisbury Eye Evaluation Study), Radoslaw Kaczmarek (The Wroclaw Epidemiological Study), Hua Zhong and Yuansheng Yuan (The Yunnan Minority Eye Study), Robert Casson (Kandy Eye Study), Fotis Topouzis (The Thessaloniki Eye Study), Paul Mitchell (Blue Mountains Eye Study), and Lisandro Sakata (Projecto Glaucoma) for providing raw data for age- and gender-specific POAG prevalence rates from their respective studies.

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    Supplemental material is available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s):

    T.Y.W.: Member of the board of and a Consultant–Abbott, Novartis, Pfizer, Allergan, Bayer.

    H.A.Q.: Consultant to and has received payment for lectures, including service on speakers bureaus–Zeiss; Expert testimony–Allergan; Receives book royalties; Stock/stock options–Graybug.

    T.A.: Member of the board–Alcon, Allergan, MSD, Bausch & Lomb; Consultant–Alcon, Allergan, MSD, Bausch & Lomb, Quark; Grants pending–Alcon, Carl Zeiss Meditec, Allegan, Santen, Ellex, Ocular Therapeutics, Aquesys; Payment for lectures, including service on speakers bureaus–Alcon, Allergan, Santen, Carl Zeiss Meditec, Ellex, Pfizer.

    C-Y.C.: Support–National Medical Research Council, Singapore (CSA/033/2012). The funding organization had no role in the design or conduct of this research.

    Y-C.T. and X.L. contributed equally to the manuscript.

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