To determine the distribution of intraocular pressure (IOP) as measured by a noncontact tonometer (NCT) and risk factors responsible for ocular hypertension in elderly Chinese people. Design: Population-based study of randomly sampled Chinese people 65 years and older in Shihpai, Taipei, Taiwan. Main Outcome Measures: Participants completed an interview and underwent a physical examination and a standardized ophthalmic examination, including IOP measurement with the NCT. People with a history of glaucoma were excluded. Risk factors were assessed using multivariate regression analysis. Results: Of 1361 study participants examined, 1292 (95.4%) had no history of glaucoma and were therefore included in the study. Their mean±SD IOP was 12.9±3.1 mm Hg. The IOP decreased significantly (PϽ.001) with age, changing from 13.3±3.0 mm Hg in participants aged 65 to 69 years to 11.6±2.8 mm Hg in those 80 years and older. Women had significantly higher IOP than men (PϽ.001). In the multivariate regression analysis, decreasing age, female sex, increasing systolic blood pressure, a history of diabetes, and alcohol drinking were significantly associated with increasing IOP. Conclusions: The distribution of IOP in elderly Chinese people is similar to that found in other East Asian people, with a negative age-IOP relationship. The mean IOP values in this elderly Chinese population were lower than in white people but higher than in Japanese people in similarly aged groups. Establishing the epidemiologic characteristics of IOP with the NCT is important for the mass screening of ocular hypertension.

In patients with PACG, the long-term IOP-lowering effect and surgical complications of combined trabeculectomy and cataract extraction are comparable with those of trabeculectomy alone. However, the combined surgery incurred fewer subsequent surgical interventions.

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PurposeTo understand the impact of socioeconomic status (SES) on the diagnosis of primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in Taiwan.MethodsSubjects with glaucoma were identified from the National Health Insurance Research Database of year 2006, which included one million randomly selected insurants. Individuals who had ≥4 ambulatory visits within one year which had the diagnosis code of POAG (ICD-9-CM 365.11 or 365.12) or PACG (365.23) and concurrent prescription of anti-glaucoma medication or surgery were selected. Individual SES was represented by monthly income calculated from the insurance premium. Neighborhood SES was defined based on neighborhood household income averages. Urbanization level of habitation was categorized into 3 levels. The odds ratio of having POAG or PACG in subjects with different SES was evaluated by using multiple logistic regression analysis.ResultsIn total, 752 and 561 subjects with POAG and PACG, respectively, who were treated on a regular basis, were identified. The diagnosis of glaucoma was affected by age, gender, frequency of healthcare utilization, individual SES, and urbanization level of habitation. With the adjustment of age, gender, healthcare utilization, neighborhood SES and level of urbanization, subjects with lower income were more likely to be diagnosed as PACG, but less likely as POAG.ConclusionsSubjects with more frequent healthcare utilization were more likely to be diagnosed with glaucoma. Subjects with low SES were more susceptible to PACG, but subjects with high SES were more likely to be diagnosed as POAG. This information is useful for the design and target participant setting in glaucoma education and screening campaign to maximize the efficacy of limited resources in preventing glaucoma blindness.

PurposeTo investigate the association between retinitis pigmentosa (RP) and acute angle closure during a 15-year follow-up period.MethodsUsing the Taiwan Longitudinal Health Insurance Database 2000, we identified 382 RP patients based on the diagnostic code of RP (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 362.74) made during 1996–2010, excluding subjects under age of 20 years at diagnosis or subjects undergoing lens extraction before the index date. The control group included 3820 randomly selected non-RP subjects matched with the RP patients in age, gender and the index date of diagnosis. The incidence of acute angle closure during the study period was observed based on an ICD-9-CM code of 365.22. Cochran-Mantel-Haenszel test was used to determine the odds ratio (OR) of having acute angle closure in RP patients.ResultsThe mean age at the diagnosis of RP was 51.1years (standard deviation [SD] 16.7). Acute angle closure occurred in 5 RP patients (1.3%) and in 15 controls (0.4%). The mean age with the acute angle closure was 53.3 years (SD 8.0) in RP patients and 64.6 years (SD 8.4) in controls (P = 0.015). After adjusting for age, gender and comorbid disorders, RP patients had 3.64-fold (95% confidence interval [CI], 1.29–10.25, P<0.001) greater odds of having acute angle closure. After stratification for gender and age, the risk of acute angle closure in RP was higher in patients under age of 60 years (adjusted OR 11.84; 95% CI, 2.84–49.48) and male patients (adjusted OR 19.36; 95% CI, 3.43–109.40)(both P = 0.001).ConclusionsRP patients had increased risk of acute angle closure than controls. Contrary to the fact that angle closure disease is more prevalent in elderly females in general population, acute angle closure attack occurred earlier in life and the risk was higher in males among RP patients.