ABSTRACT.Purpose: To study differences between glaucoma patients identified through a population screening and glaucoma patients diagnosed in routine clinical practice (self-selected patients). Methods: A total of 402 individuals with newly detected open-angle glaucoma were identified through a large population screening programme that ran from October 1992 to January 1997. The screening programme was attended by a total of 32 918 citizens of Malmö, Sweden, aged between 57 and 79 years. Citizens who had visited the Eye Department of Malmö University Hospital in the year before the screening of their birth cohort were not invited to participate (n Ω 4117). Among the latter, we identified 354 patients with open-angle glaucoma through a retrospective examination of patient records. Results: At detection, 52.9% of the glaucoma patients identified through screening had normal tension glaucoma (NTG), defined as intraocular pressure (IOP) ∞ 21 mmHg in both eyes, compared to 13.5% of the self-selected patients (p ∞ 0.0001). Mean IOP at the time of diagnosis was 22.9 mmHg in the screened group and 32.5 mmHg in the self-selected group. Pseudoexfoliation was present in 16.4% of the screened group and 44.0% of the self-selected group (p ∞ 0.01). Bilateral disease was present in 40.1% of the screened group and 34.6% of the self-selected group (p Ω 0.1160). Median MD (mean deviation from the age-corrected normal visual field) in the worse eye was ª8.0 dB in the screened group and ª16.2 dB in the self-selected group (p ∞ 0.0001). Visual acuity was lower in the self-selected group, which was also on average slightly more myopic. Of the patients detected through screening, 62% had seen an ophthalmologist previously, 17% within the preceding 2-year period. Conclusions: Normal tension glaucoma was four times as common in patients identified through population screening as in self-selected patients, suggesting that patients with NTG are easily overlooked in clinical practice. Even though the patients detected through population screening had lower mean IOP, lower prevalence of pseudoexfoliation, better visual fields and a lower incidence of bilateral disease than self-selected patients, many still had considerable damage. Special efforts, such as glaucoma screening, are needed if manifest glaucoma, and especially NTG, is to be detected at an earlier stage than it currently is.
ABSTRACT.Purpose: To study the association between refractive error, glaucoma damage and IOP in a large population. Methods: We examined 32,918 citizens of the city of Malmö, Sweden, 57-79 years of age, searching for individuals with undetected glaucoma. Refraction was measured with autorefractors. Glaucoma damage was defined as reproducible visual field defects with the Humphrey Full Threshold 24-2 program. Results: Glaucoma prevalence was clearly associated with refractive state, increasing gradually with increasing myopia. This was seen both in males and females and persisted over the full age range. Glaucoma was significantly more common in myopic than in hyperopic eyes with low IOP readings (pΩ0.024). The overrepresentation of glaucoma in myopic eyes declined with increasing IOP and no relationship was observed in eyes with IOP Ø31 mmHg. Conclusion:In this large population, the prevalence of glaucoma increased with increasing myopia. The association between myopia and glaucoma was strong at lower IOP levels, and weakened gradually with increasing IOP. Our findings indicate that myopia is an important risk factor for glaucoma and particularly for normal tension glaucoma.
The results of this study strongly suggest that the life expectancy of glaucoma patients does not differ from the population at large.
ABSTRACT.Purpose: Cross-sectional studies have consistently shown younger people to be less hyperopic than older people, but it is not known if this reflects a myopic shift from one generation to the next or a true age-related shift. Methods: We used data from three population surveys to study cohort phenomena and true age-related changes in refraction of elderly people in southern Sweden. Differences concerning the use of cycloplegics made us restrict comparisons between refractions in separate studies to persons aged 65 to74 years, in whom our measurements were considered unlikely to have been affected by accommodation. Results: An apparent increase in mean spherical equivalent as rapid as 0.6 D in 10 years was observed in our latest (and largest) cross-sectional survey. The myopic shift, from one generation to the next, was limited to 0.25 D in 25 years. This discrepancy was explained by a true age-related hyperopic shift between 55 and 70, which was confirmed in a longitudinal study of over 1000 persons followed for more than 8 years. Conclusion: A true age-related hyperopic shift between 55 and 70 does indeed exist, and should not be disregarded by anyone who is prescribing spectacles or performing surgery for refractive errors. In the long run, however, a persisting secular trend towards myopia could prove even more important.
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