Global, regional, and national burden of glaucoma, 1990-2023: a systematic analysis of the Global Burden of Disease Study 2023.

OBJECTIVE

This study aims to characterize the spatiotemporal trends in the global glaucoma burden from 1990 to 2023 and project future trends to 2050, informing tailored prevention and control strategies across countries.

METHODS

Age-standardized disability-adjusted life-year (AS-DALY) rates for glaucoma were extracted from the Global Burden of Disease Study 2023 database for 204 countries and territories. Temporal trends from 1990 to 2023 were quantified using the estimated annual percentage change (EAPC), and joinpoint regression was applied to identify significant changes in trend, with average annual percentage change (AAPC) used to summarize overall long-term patterns. Future burden from 2024 to 2050 was projected using an exponential smoothing state-space (ETS/EMS) model. Associations between burden and socio-demographic development were assessed using both Pearson and Spearman correlations with the Socio-demographic Index (SDI). An age-period-cohort framework was further used to evaluate age, period, and cohort effects on glaucoma burden.

RESULTS

In 2023, the global glaucoma AS-DALY rate was 7.46 per 100,000, reflecting a 39% decline (- 4.74 units) since 1990, despite a 52% rise in absolute DALYs due to population aging. Males exhibited a steeper decline (EAPC - 1.58%) than females (- 1.25%). High- and middle-SDI countries neared the minimum burden by 2000 and 2010, respectively, while low-SDI countries showed persistent high rates with partial rebounds. The period 2000-2015 accounted for 41% of the total reduction. Forecasts suggest a mean annual AS-DALY decline of 1.2% from 2023 to 2050, yielding a 27.8% reduction without rebound.

CONCLUSIONS

Glaucoma exhibits a trajectory of rising cases but declining rates, with significant SDI-related disparities. Low-SDI countries require AI-enabled mass screening and access to generic medications, middle-SDI countries need risk-stratified management and laser trabeculoplasty, and high-SDI countries should focus on normal-tension glaucoma in the elderly.