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The Eye Diseases Prevalence Research Group* Objective: To estimate the prevalence and distribution of open-angle glaucoma (OAG) in the United States by age, race/ethnicity, and gender.Methods: Summary prevalence estimates of OAG were prepared separately for black, Hispanic, and white subjects in 5-year age intervals starting at 40 years. The estimated rates were based on a meta-analysis of recent population-based studies in the United States, Australia, and Europe. These rates were applied to 2000 US census data and to projected US population figures for 2020 to estimate the number of the US population with OAG. Results:The overall prevalence of OAG in the US population 40 years and older is estimated to be 1.86% (95% confidence interval, 1.75%-1.96%), with 1.57 million white and 398000 black persons affected. After applying race-, age-, and gender-specific rates to the US population as determined in the 2000 US census, we estimated that OAG affects 2.22 million US citizens. Owing to the rapidly aging population, the number with OAG will increase by 50% to 3.36 million in 2020. Black subjects had almost 3 times the age-adjusted prevalence of glaucoma than white subjects.Conclusions: Open-angle glaucoma affects more than 2 million individuals in the United States. Owing to the rapid aging of the US population, this number will increase to more than 3 million by 2020.

The Eye Diseases Prevalence Research Group* Objective: To determine the prevalence of diabetic retinopathy among adults 40 years and older in the United States. Methods: Pooled analysis of data from 8 populationbased eye surveys was used to estimate the prevalence, among persons with diabetes mellitus (DM), of retinopathy and of vision-threatening retinopathy-defined as proliferative or severe nonproliferative retinopathy and/or macular edema. Within strata of age, race/ethnicity, and gender, US prevalence rates were estimated by multiplying these values by the prevalence of DM reported in the 1999 National Health Interview Survey and the 2000 US Census population. Results: Among an estimated 10.2 million US adults 40 years and older known to have DM, the estimated crude prevalence rates for retinopathy and vision-threatening retinopathy were 40.3% and 8.2%, respectively. The estimated US general population prevalence rates for retinopathy and vision-threatening retinopathy were 3.4% (4.1 million persons) and 0.75% (899000 persons). Future projections suggest that diabetic retinopathy will increase as a public health problem, both with aging of the US population and increasing age-specific prevalence of DM over time. Conclusion: Approximately 4.1 million US adults 40 years and older have diabetic retinopathy; 1 of every 12 persons with DM in this age group has advanced, visionthreatening retinopathy.

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This case-control study evaluated risk factors for open-angle glaucoma (OAG) and high intraocular pressure (IOP), including systemic hypertension and its treatment, other systemic factors, familial, and demographic variables. The three study groups were based on masked ophthalmologic gradings of visual fields and fundus photographs, as well as tonometry. The OAG group (n = 122) had OAG field defects, IOP > 21 mmHG, and cup-disc ratios > or = 0.5 and/or evidence of glaucoma disc damage. The ocular hypertensives (n = 108) had no field defects, IOP > 21 mmHg and normal discs. The controls (n = 190) had no field defects, IOP < 21 mmHg and normal discs. The data collection protocol included a standardized interview and measurements. Medical history was confirmed by contacting the primary care physicians (89% response from physicians). Study groups were compared by polychotomous logistic regression analyses. Men were more likely to have OAG and less likely to have ocular hypertension. Systemic hypertension was more frequent in ocular hypertensives (Odds Ratio = 2.36); high diastolic pressure was associated with OAG and ocular hypertension (OR = 2.13 and 2.21, respectively). Treatment for systemic hypertension was unrelated to OAG risk. Low perfusion pressures (blood pressure-IOP differences) were strongly associated with OAG and ocular hypertension, a finding that could be due to the high IOP in these groups. A family history of glaucoma was more frequent in OAG (OR = 3.08) and ocular hypertension (OR = 2.38) than in controls. Alcohol consumption was related to ocular hypertension (OR = 2.32). No other associations were significant. The results confirm an association of blood pressure with intraocular pressure. Since the OAG and ocular hypertensive groups had similar blood pressure results, an independent effect of blood pressure on OAG was not substantiated.

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This study investigated the self-reported family history of open-angle glaucoma (OAG) among 4,314 black participants in the Barbados Eye Study (BES), which was based on a random sample of Barbados-born citizens between 40 and 84 years of age. Data collection included Humphrey perimetry, fundus photography, various ophthalmic and other measurements and a comprehensive interview, including family history. Results showed that participants with OAG and previous OAG treatment reported more family history; maternal history was reported twice as often as paternal history. In persons without previous OAG treatment, those with newly diagnosed OAG reported more sibling history (Odds Ratio = 4.5). The Statistical Analysis for Genetic Epidemiology (S.A.G.E.) system was used to test the transmission models for OAG in a subset of 1,048 families (5,806 individuals) with the most complete self-reported family information. The S.A.G.E. results are consistent with the existence of a major dominant allele for OAG. These results should be viewed as promising, but preliminary, since they are based on self-reported data. More definitive information is currently being collected by the Barbados Family Study of Open-angle Glaucoma.

This study highlights the high incidence of obesity/overweight in this cohort and suggests that the future public health burden of excess weight and its associated comorbidities may be elevated in this population of African origin. The development of strategies and interventions for the prevention and treatment of obesity/overweight are therefore of primary and immediate importance.