Prevalence and associated factors of glaucoma in the Russian Ural Eye and Medical Study

Abstract

To assess the prevalence and associated factors of glaucoma in a Russian population. The population-based Ural Eye and Medical Study included 5899 (mean age 59.0 ± 10.7 years; range 40–94 years). Glaucomatous optic neuropathy was diagnosed using International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Among 5545 participants with assessable optic disc photographs, 246 individuals [4.4%; 95% confidence interval (CI) 3.9, 5.0] had glaucoma, with open-angle glaucoma (OAG) in 177 individuals (3.2%; 95% CI 2.7, 3.7) and angle-closure glaucoma (ACG) in 69 individuals (1.2; 95% CI 1.0, 1.5), with IOP > 21 mmHg in 79 (32.1%) patients, and with 80 (32.5%) patients on glaucoma therapy. Glaucoma prevalence increased from 3/485 (0.6%; 95% CI 0.0, 1.3) in the age group of 40–45 years to 33/165 (20.0%; 95% CI 13.8, 26.2) in the group aged 80 + years. Higher OAG prevalence correlated with older age [odds ratio (OR) 1.07; 95% CI 1.04, 1.09; P < 0.001], longer axial length (OR 1.36; 95% CI 1.17, 1.58; P < 0.001), higher intraocular pressure (IOP) (OR 1.18; 95% CI 1.13, 1.23; P < 0.001), higher stage of lens pseudoexfoliation (OR 1.26; 95% CI 1.08, 1.47; P = 0.004) and lower diastolic blood pressure (OR 0.98; 95% CI 0.96, 0.99; P = 0.035). Higher ACG prevalence correlated with older age (OR 1.07; 95% CI 1.03, 1.11; P < 0.001), narrower anterior chamber angle (OR 0.81; 95% CI 0.77, 0.86; P < 0.001), and higher IOP (OR 1.30; 95% CI 1.23, 1.38; P < 0.001). Glaucoma caused moderate to severe vision impairment (MSVI) in 9 (4.9%; 95% CI 1.8, 8.1) out of 184 individuals with MSVI (OAG, n = 7; ACG, n = 2), and blindness in one (9.1%) of 11 blind individuals. In this population from Russia, two thirds of glaucoma patients were not on therapy, and in two thirds of the glaucoma patients IOP was ≤ 21 mmHg. Otherwise, glaucoma prevalence, OAG-to-ACG ratio, and glaucoma associations did not differ markedly from Caucasian and East Asian populations.

Alcohol, Intraocular Pressure, and Open-Angle Glaucoma

“…Five studies reported multiple alcohol exposure levels, and a single pooled effect estimate across all levels was calculated for use in meta-analysis. 26 , 28 – 30 , 67 Overall, 10 studies reported no association between any alcohol use and OAG, 16 , 23 – 31 with only one large cohort study of Black women reporting a harmful association. 67 Although there was a suggestion of a dose–response effect in those studies reporting ordinal alcohol exposure levels, 26 , 28 , 30 , 67 no study-specific test for trend reached statistical significance.…”

“…One further cross-sectional study 50 was included in the IOP analysis but excluded from the OAG analysis, because a second study from the same population 29 provided prospective data with greater adjustment for confounding variables. A further 5 articles 23 , 24 , 27 , 31 , 51 were identified from a reference list search of all included studies and previous reviews for a total of 34 articles included in the systematic review. This included 8 studies with IOP as the outcome, 24 with OAG as the outcome, and 2 with both IOP and OAG as outcomes.…”

“…The characteristics of the 11 studies (2 cross-sectional, 23 , 24 5 case-control, 16 , 25 – 28 4 cohort 29 – 31 , 67 ), comprising 173 058 participants, included in the meta-analysis of alcohol use and OAG are presented in Table 4 . Seven reported associations with prevalent OAG, 16 , 23 – 28 and 4 reported associations with incident OAG. 29 – 31 , 67 Primary open-angle glaucoma was the outcome variable in 7 of the studies.…”

“… 21 , 22 There is also evidence to suggest that any association with IOP may be mediated by both sex and glaucoma status. 18 , 20 Additionally, most observational studies exploring the association between alcohol use and glaucoma have yielded nonsignificant results, with both cross-sectional 16 , 23 – 28 and longitudinal studies 29 – 31 failing to demonstrate a consistent association.…”

Association between Ocular Parameters and Intraocular Pressure Elevation during Femtosecond Laser-Assisted Cataract Surgery in Open-Angle Glaucoma and Nonglaucoma Individuals

“…No patients with OAG revealed an AL longer than 26 mm in our study population, but the results of that research may imply that IOP elevation may easily occur in patients with OAG and short AL. Since OAG tends to develop in patients with longer AL according to a population-based study [23], individuals with OAG and short AL might have certain factors that predispose them to IOP elevation and glaucoma progression. Further study is needed to confirm this hypothesis.…”