In the JournalsPerspective

Primary angle-closure glaucoma increasingly widespread in European-derived populations

In European-derived populations, primary angle-closure glaucoma is increasingly prevalent, according to a study.

The literature review examined more than 40 years of population studies on primary angle-closure glaucoma (PACG) to assess disease prevalence.

“PACG is more common than previously thought, and all primary glaucoma cases should be considered to be PACG until the anterior chamber angle is shown to be open on gonioscopy,” the study authors said.

A 0.4% PACG prevalence was found for the European-derived population 40 years of age or older.

Inclusion criteria were Caucasian or predominantly Caucasian population and a random sampling of participants with structural and/or functional evidence of glaucomatous optic neuropathy as defined by the International Society for Geographical and Epidemiological Ophthalmology.

“Our analysis suggests that PACG is between almost two and four times more common than previous estimates, and there are 1.6 million people in Europe, 581,000 people in the USA and 130,000 people in the U.K. with PACG today,” the authors said.

PACG may be expected to increase by 19% in the U.K., 9% in Europe and 18% in the U.S. within the next decade and by 51% in the U.K., 30% in Europe and 67% in the U.S. by 2050, according to the study.

In European-derived populations, primary angle-closure glaucoma is increasingly prevalent, according to a study.

The literature review examined more than 40 years of population studies on primary angle-closure glaucoma (PACG) to assess disease prevalence.

“PACG is more common than previously thought, and all primary glaucoma cases should be considered to be PACG until the anterior chamber angle is shown to be open on gonioscopy,” the study authors said.

A 0.4% PACG prevalence was found for the European-derived population 40 years of age or older.

Inclusion criteria were Caucasian or predominantly Caucasian population and a random sampling of participants with structural and/or functional evidence of glaucomatous optic neuropathy as defined by the International Society for Geographical and Epidemiological Ophthalmology.

“Our analysis suggests that PACG is between almost two and four times more common than previous estimates, and there are 1.6 million people in Europe, 581,000 people in the USA and 130,000 people in the U.K. with PACG today,” the authors said.

PACG may be expected to increase by 19% in the U.K., 9% in Europe and 18% in the U.S. within the next decade and by 51% in the U.K., 30% in Europe and 67% in the U.S. by 2050, according to the study.

    Perspective

    Day and colleagues have carried out a systematic review of previous population studies to determine the prevalence of primary angle-closure glaucoma (PACG) in European-derived populations (ie, Europe, the U.S. and Australia). The estimated prevalence is 0.4% in those older than 40 years, rising to almost 1% in those older than 70 years. This is much higher than previous estimates, and case numbers are likely to continue increasing given our aging populations.

    PACG causes more severe visual loss than open-angle glaucoma, but damage may be halted effectively by peripheral iridotomy and lens extraction. Many cases of PACG may initially be missed without careful assessment of the angle. The main message of this study is, therefore, that all primary glaucoma cases should be considered to be PACG until ruled out by gonioscopy. We should also distinguish PAC from PACG through optic disc and visual field assessment.

    • Tiarnan Keenan, BM BCh, MRCOphth
    • Manchester Royal Eye Hospital and University of Manchester

    Disclosures: Keenan has no relevant financial disclosures.