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.