Screening reveals hidden glaucoma epidemic among elderly Swedes
A new Swedish study found that glaucoma goes undetected in a significant portion of people aged 77-89, threatening vision loss in an aging population. The finding has major implications for healthcare systems planning eye care services and for insurers calculating age-related disease burden.
Originaltitel: Prevalence and severity of undetected open-angle glaucoma in persons 77-89 years old.
Nästan 6 procent av malmöbor mellan 77 och 89 år har tidigare opåvisad öppen vinkelglaukom — en prevalens som kräver omprövning av screeningstrategier för äldre befolkningen. Forskargruppen vid Lunds universitet screenade 602 personer med tonometri, perimetri enligt FDT-metoden och fundisfotografi. Positiva fall bekräftades genom Full-threshold perimetri. Av de 35 diagnosticerade patienterna hade 74 procent ensidig sjukdom, två tredjedelar mild och en femtedel måttlig sjukdom. Ingen patient hade slutstadium-glaukom. Medianintraokular tryck låg på 16 mmHg. För regionvård och inköp innebär resultaten behov av utökad screening och tidigare detektion av glaukom hos äldre. Många patienter identifieras i tidiga stadier, vilket möjliggör preventiv behandling och sparar sjukvårdsresurser genom att undvika blindhet. Studien stöder införandet av systematisk glaukomscreening i geriatrisk primärvård.
PURPOSE: To determine the prevalence and severity of previously undetected open-angle glaucoma in individuals 77-89 years of age in Malmö, Sweden. DESIGN: Cross-sectional study SUBJECTS: All residents of Malmö, Sweden, aged 77-89 years were eligible for participation, except individuals with a prior glaucoma diagnosis at Skåne University Hospital. A total of 1957 individuals were invited, of whom 602 (30.8%) attended the screening. METHODS: The screening procedure included intraocular pressure measurement using an Icare tonometer, visual field screening using the Frequency Doubling Technology (FDT) perimeter, and fundus photography. Subjects with positive screening results were offered a post-screening visit with a full ophthalmological examination, including threshold perimetry using the SITA Standard 24-2 program of the Humphrey Field Analyzer. The severity of disease was evaluated based on the perimetric mean deviation (MD) index. MAIN OUTCOME MEASURES: Prevalence of previously undetected open-angle glaucoma in individuals 77-89 years old (%) and the magnitude of visual field defects expressed as proportions (%) of patients in 5 different disease severity stages. RESULTS: The prevalence of previously undetected open-angle glaucoma was 5.98% (95% CI: 4.2%-8.2%), n= 35 patients. The condition was unilateral in 74% of patients. The severity of disease was early in 66% and moderate in 20%, while 14% of patients had advanced or severe disease. No patient had developed end-stage disease. The median intraocular pressure in glaucoma patients was 16 mmHg (IQR: 14-19 mmHg). CONCLUSIONS: The prevalence of previously undetected open-angle glaucoma was high in this age category, 5.98%, but most patients had early or moderate disease, and no patient had end-stage disease.