-
Ophthalmology Nov 2014Glaucoma is the leading cause of global irreversible blindness. Present estimates of global glaucoma prevalence are not up-to-date and focused mainly on European... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Adult; Aged; Aged, 80 and over; Blindness; Female; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Global Health; Humans; Male; Middle Aged; Prevalence
PubMed: 24974815
DOI: 10.1016/j.ophtha.2014.05.013 -
The British Journal of Ophthalmology Sep 2012To estimate the prevalence of primary angle closure glaucoma (PACG) in European derived populations. (Review)
Review
AIM
To estimate the prevalence of primary angle closure glaucoma (PACG) in European derived populations.
METHOD
Systematic review and modelling of PACG prevalence data from population studies. PACG was defined according to the ISGEO definition requiring structural and/or functional evidence of glaucomatous optic neuropathy. Prevalence estimates were applied to the 2010 United Nations projected population figures to estimate case numbers.
RESULTS
The prevalence of PACG in those 40 years or more is 0.4% (95% CI 0.3% to 0.5%). Age-specific prevalence values are 0.02% (CI 0.00 to 0.08) for those 40-49 years, 0.60% (0.27 to 1.00) for those 50-59 years, 0.20% (0.06 to 0.42) for those 60-69 years and 0.94% (0.63 to 1.35) for those 70 years and older. Three-quarters of all cases occur in female subjects (3.25 female to 1 male; CI 1.76 to 5.94).
CONCLUSION
This analysis provides a current evidence-based estimate of PACG prevalence in European derived populations and suggests there are 130,000 people in the UK, 1.60 million people in Europe and 581,000 people in the USA with PACG today. Accounting for ageing population structures, cases are predicted to increase by 19% in the UK, 9% in Europe and 18% in the USA within the next decade. 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.
Topics: Glaucoma, Angle-Closure; Global Health; Humans; Prevalence; White People
PubMed: 22653314
DOI: 10.1136/bjophthalmol-2011-301189 -
The Cochrane Database of Systematic... Feb 2012Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with... (Review)
Review
BACKGROUND
Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.
OBJECTIVES
To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles (PACs), PAC and PACG.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012.
SELECTION CRITERIA
We included only randomised controlled trials (RCTs) in this review. Patients with narrow angles, PAC or PACG were eligible. We excluded studies that included only patients with acute presentations, using laser peripheral iridoplasty to break acute crisis.
DATA COLLECTION AND ANALYSIS
No analysis was carried out as only one trial was included in the review.
MAIN RESULTS
We included one RCT with 158 participants. The trial reported laser peripheral iridoplasty as an adjunct to laser peripheral iridotomy compared to iridotomy alone. The authors report no superiority in using iridoplasty as an adjunct to iridotomy for IOP, number of medications or need for surgery.
AUTHORS' CONCLUSIONS
There is currently no strong evidence for laser peripheral iridoplasty's use in treating angle-closure.
Topics: Glaucoma, Angle-Closure; Humans; Iris; Laser Therapy; Randomized Controlled Trials as Topic
PubMed: 22336823
DOI: 10.1002/14651858.CD006746.pub3 -
Clinical Ophthalmology (Auckland, N.Z.) 2012Topiramate (TPM) is a sulfa-derivative monosaccharide that is used mainly for treating epilepsy and preventing migraine. Within the gamut of side effects attributable to...
BACKGROUND AND PURPOSE
Topiramate (TPM) is a sulfa-derivative monosaccharide that is used mainly for treating epilepsy and preventing migraine. Within the gamut of side effects attributable to this drug, ophthalmologic manifestations are of crucial importance. In this study, for the first time, the aim was to provide a systematic literature review regarding this issue.
METHODS
For the time period 1996-2011, a PubMed search was made for the studies concerning the adverse/beneficial effects of TPM on vision. Overall, 404 citations out of a total of 2756 TPM-related studies were examined for relevance.
RESULTS
A total of 74 relevant studies were reviewed, 65 of which comprise small observational studies describing the ophthalmic side effects of TPM in 84 patients. Of these patients, 66 were affected by ciliochoroidal effusion syndrome as the cardinal ocular side effect of TPM (17 cases of myopic shift and 49 cases of angle closure glaucoma). A comprehensive statistical analysis is provided on these 66 subjects. Other rare side effects of TPM on the vision were also reviewed, including massive choroidal effusion, ocular inflammatory reactions, visual field defects, probable effects on retina, cornea, and sclera, and neuroophthalmologic complications. In addition, a framework is provided to classify these results.
DISCUSSION
Due to the expanding spectrum of indications for the administration of TPM, neurologists and psychiatrists should be aware of its diverse ocular side effects. In conclusion, ocular complications following this drug should be taken seriously and be subjected to ophthalmic counseling.
PubMed: 22275816
DOI: 10.2147/OPTH.S27695 -
Journal of Glaucoma 2013To estimate the prevalence of primary glaucoma in mainland China and to quantify its association with age, sex, and region. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To estimate the prevalence of primary glaucoma in mainland China and to quantify its association with age, sex, and region.
METHODS
Population-based studies that reported the prevalence of primary open-angle glaucoma (POAG) or/and primary angle-closure glaucoma (PACG) among adult populations in mainland China were identified through systematic searches. Fourteen articles providing 12 population-based studies were included. The overall pooled prevalence estimates were calculated using a random-effects model. A logistic metaregression was used to model the associations between the odds ratio (OR) and 95% confidence interval of primary glaucoma and age, sex, and region.
RESULTS
The overall pooled prevalence of POAG was 0.7% (95% confidence interval, 0.4-1.2), and PACG was found in 1.4% (1.0%, 1.7%). The OR per decade increase in age was 1.68 (1.12, 2.52) for POAG, and 2.11 (1.72, 2.60) for PACG. The OR of POAG prevalence was 0.65 (0.26, 1.62) between men and women. Chinese women were 1.75 (1.20, 2.56) times more likely than men to have PACG. The OR between western China and east China were 0.37 (0.10, 1.35) for POAG, and 1.06 (0.63, 1.76) for PACG. The OR between urban China and rural China were 3.92 (1.55, 9.92) for POAG, and 1.07 (0.55, 2.10) for PACG.
CONCLUSIONS
The prevalence of PACG was approximately double that of POAG in adult Chinese. The rate of change of PACG prevalence with age increased more rapidly than that of POAG. The prevalence of POAG in urban was higher than that in rural. PACG was more common in women than in men.
Topics: Age Distribution; China; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Odds Ratio; Prevalence; Rural Population; Sex Distribution; Urban Population
PubMed: 22134352
DOI: 10.1097/IJG.0b013e31824083ca -
BMJ Clinical Evidence Jun 2011Glaucoma is characterised by progressive optic neuropathy and peripheral visual field loss. It affects 1% to 2% of white people aged over 40 years and accounts for 8% of... (Review)
Review
INTRODUCTION
Glaucoma is characterised by progressive optic neuropathy and peripheral visual field loss. It affects 1% to 2% of white people aged over 40 years and accounts for 8% of new blind registrations in the UK. The main risk factor for glaucoma is raised intraocular pressure, but 40% of people with glaucoma have normal intraocular pressure and only 10% of people with raised intraocular pressure are at risk of optic-nerve damage. Glaucoma is more prevalent, presents earlier, and is more difficult to control in black people than in white populations.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for established primary open-angle glaucoma, ocular hypertension, or both? What are the effects of lowering intraocular pressure in people with normal-tension glaucoma? What are the effects of treatment for acute angle-closure glaucoma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: laser trabeculoplasty (alone or plus topical medical treatment), topical medical treatments, and surgical trabeculectomy.
Topics: Glaucoma; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension
PubMed: 21658300
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2008Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with... (Review)
Review
BACKGROUND
Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.
OBJECTIVES
To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles, PAC and PACG.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library), MEDLINE, EMBASE and LILACS (Latin American and Caribbean Literature on Health Sciences). The databases were last searched on 11 February 2008.
SELECTION CRITERIA
Only randomised controlled trials (RCTs) were eligible for inclusion in this review. Patients with narrow angles, PAC or PACG were eligible. Studies that included only patients with acute presentations, using laser peripheral iridoplasty to break acute crisis were excluded.
DATA COLLECTION AND ANALYSIS
No analysis was carried out due to lack of trials.
MAIN RESULTS
There were no RCTs assessing laser peripheral iridoplasty in the non-acute setting of angle-closure.
AUTHORS' CONCLUSIONS
There is currently no strong evidence for laser peripheral iridoplasty's use in treating angle-closure.
Topics: Glaucoma, Angle-Closure; Humans; Iris; Laser Therapy
PubMed: 18646165
DOI: 10.1002/14651858.CD006746.pub2 -
The Cochrane Database of Systematic... Jul 2006Angle-closure glaucoma is characterized by obstruction to the outflow of aqueous humor and consequent rise in intraocular pressure. The obstruction may result from an... (Review)
Review
BACKGROUND
Angle-closure glaucoma is characterized by obstruction to the outflow of aqueous humor and consequent rise in intraocular pressure. The obstruction may result from an anatomical predisposition of the eye or may be due to pathophysiologic processes in any part of the eye. The former is considered the primary form and the latter a secondary form of angle closure. Relative pupillary block obstructing free flow of aqueous from the posterior chamber of the eye to the anterior chamber is considered to be the most common mechanism of angle closure. Crowding of the angle is another mechanism, which often coexists with pupillary block. This can result from an anterior placement of the lens due to an increase in the thickness of the lens (as occurs with aging), anterior displacement by a posterior force (for example choroidal effusion), or laxity of the zonules.
OBJECTIVES
The objective of this review was to assess the effectiveness of lens extraction for chronic primary angle-closure glaucoma compared with other interventions for the condition in people without past history of acute-angle closure attacks.
SEARCH STRATEGY
We searched CENTRAL (2005, Issue 3), MEDLINE (1950 to April 2006), EMBASE (1980 to April 2006), and LILACS (to August 2005). We searched the reference lists of included studies and used the Science Citation Index database.
SELECTION CRITERIA
In the absence of any randomized trials we included non-randomized studies comparing lens extraction with other treatment modalities for chronic primary angle-closure glaucoma including, but not limited to, laser iridotomy, medications, and laser iridoplasty. We excluded studies with a case-series design.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted data on methodological quality of the included studies, outcomes for the review, and study characteristics including participant characteristics, interventions, and sources of funding. Differences were resolved through discussion.
MAIN RESULTS
We found no randomized trials evaluating the effects of lens extraction as a treatment for chronic primary angle-closure glaucoma. Two non-randomized comparative studies included in the review have several methodological flaws including selection bias. While these studies and other non-comparative studies provide information on biological plausibility and treatment effect they do not provide proof of effectiveness. Also, they do not address the question of how primary lens extraction compares with other treatments for chronic primary angle-closure glaucoma.
AUTHORS' CONCLUSIONS
There is no evidence from good quality randomized trials or non-randomized studies of the effectiveness of lens extraction for chronic primary angle-closure glaucoma.
Topics: Chronic Disease; Glaucoma, Angle-Closure; Humans; Lens, Crystalline
PubMed: 16856103
DOI: 10.1002/14651858.CD005555.pub2 -
Der Nervenarzt Jan 2002Official drug information materials mention angle-closure glaucoma as an absolute or relative contraindication for benzodiazepines, albeit with some unexplained... (Comparative Study)
Comparative Study Review
Official drug information materials mention angle-closure glaucoma as an absolute or relative contraindication for benzodiazepines, albeit with some unexplained variability. A systematic review of the literature reveals that this contraindication seems to be based on only one published case while 22 other investigations, some of them controlled, tend to favor that benzodiazepines reduce intraocular pressure. The common 1990-2001 database of the Drug Commission of the German Medical Profession and the Federal Institute for Drugs and Medical Devices contained one spontaneous report of glaucoma related to a benzodiazepine-like hypnotic.
Topics: Anti-Anxiety Agents; Benzodiazepines; Clinical Trials as Topic; Contraindications; Germany; Glaucoma, Angle-Closure; Humans; Hypnotics and Sedatives; Intraocular Pressure
PubMed: 11975064
DOI: 10.1007/s115-002-8146-8