Abstract
Purpose
To determine the prevalence of glaucoma according to the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) classification in an adult German cohort.
Methods
The Gutenberg Health Study is a population-based, prospective cohort study in the Rhine-Main Region in mid-western Germany with a total of 15,010 participants. In this study, the first 5000 subjects with an age range between 35 and 74 years were included. Optic disk pictures were obtained by a non-mydriatic fundus camera (Visucam™) and analyzed using the Visupac™ software. Glaucoma prevalence was determined in two steps. First, the ISGEO classification was applied using “hypernormal subjects” (normal visual field) as reference. In the second analysis, we additionally considered the disk area (DA) in relation to the vertical cup-to-disk ratio by quantile regression. All results are given as weighted numbers for the population of Mainz/Bingen.
Results
The prevalence of definite glaucoma in our sample was 1.44% (n = 72). The prevalence adjusted for disk area was 1.34% (n = 67). The prevalence gradually increased in both models with each decade of age (from 0.9 to 2.4%, respectively). In both models, none of the glaucoma cases had a small optic disk (< 1.6 mm2). Glaucoma prevalence in medium optic disks was 1.0% (without DA adjustment) vs. 1.6% (with DA adjustment) and in large optic disks 5.6 vs. 2.5%.
Conclusions
The prevalence of definite glaucoma was similar to other European population-based cohorts, with slightly higher prevalence in younger subjects. Our analysis highlighted the influence of optic disk size in determining the diagnosis of glaucoma based on cup-to-disk ratio in epidemiological studies.
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Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121(11):2081–2090. https://doi.org/10.1016/j.ophtha.2014.05.013
Kapetanakis VV, Chan MP, Foster PJ, Cook DG, Owen CG, Rudnicka AR (2016) Global variations and time trends in the prevalence of primary open angle glaucoma (POAG): a systematic review and meta-analysis. Br J Ophthalmol 100(1):86–93. https://doi.org/10.1136/bjophthalmol-2015-307223
Wolfs RC, Borger PH, Ramrattan RS, Klaver CC, Hulsman CA, Hofman A, Vingerling JR, Hitchings RA, de Jong PT (2000) Changing views on open-angle glaucoma: definitions and prevalences--the Rotterdam study. Invest Ophthalmol Vis Sci 41(11):3309–3321
Foster PJ, Buhrmann R, Quigley HA, Johnson GJ (2002) The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 86(2):238–242
Swanson MW (2011) The 97.5th and 99.5th percentile of vertical cup disc ratio in the United States. Optomet Vision Sci : Off Publ Am Acad Optomet 88(1):86–92. https://doi.org/10.1097/OPX.0b013e3181fc3638
Jonas JB, Gusek GC, Naumann GO (1988) Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci 29(7):1151–1158
Crowston JG, Hopley CR, Healey PR, Lee A, Mitchell P, Blue Mountains Eye S (2004) The effect of optic disc diameter on vertical cup to disc ratio percentiles in a population based cohort: the Blue Mountains eye study. Br J Ophthalmol 88(6):766–770
Hohn R, Kottler U, Peto T, Blettner M, Munzel T, Blankenberg S, Lackner KJ, Beutel M, Wild PS, Pfeiffer N (2015) The ophthalmic branch of the Gutenberg health study: study design, cohort profile and self-reported diseases. PLoS One 10(3):e0120476. https://doi.org/10.1371/journal.pone.0120476
Terry AL, Paulose-Ram R, Tilert TJ, Johnson CA, Zhang X, Lee PP, Saaddine JB (2010) The methodology of visual field testing with frequency doubling technology in the National Health and nutrition examination survey, 2005-2006. Ophthalmic Epidemiol 17(6):411–421. https://doi.org/10.3109/09286586.2010.528575
Littmann H (1982) Determination of the real size of an object on the fundus of the living eye. Klinische Monatsblatter fur Augenheilkunde 180(4):286–289. https://doi.org/10.1055/s-2008-1055068
European Glaucoma Society (2014) Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 1: Patient examination
Gupta P, Zhao D, Guallar E, Ko F, Boland MV, Friedman DS (2016) Prevalence of Glaucoma in the United States: the 2005-2008 National Health and nutrition examination survey. Invest Ophthalmol Vis Sci 57(6):2905–2913. https://doi.org/10.1167/iovs.15-18469
Zhang X, Cotch MF, Ryskulova A, Primo SA, Nair P, Chou CF, Geiss LS, Barker LE, Elliott AF, Crews JE, Saaddine JB (2012) Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. Am J Ophthalmol 154(6 Suppl):S53–S62 e51. https://doi.org/10.1016/j.ajo.2011.08.045
Topouzis F, Wilson MR, Harris A, Anastasopoulos E, Yu F, Mavroudis L, Pappas T, Koskosas A, Coleman AL (2007) Prevalence of open-angle glaucoma in Greece: the Thessaloniki eye study. Am J Ophthalmol 144(4):511–519. https://doi.org/10.1016/j.ajo.2007.06.029
Thapa SS, Paudyal I, Khanal S, Twyana SN, Paudyal G, Gurung R, Ruit S, van Rens GH (2012) A population-based survey of the prevalence and types of glaucoma in Nepal: the Bhaktapur Glaucoma study. Ophthalmology 119(4):759–764. https://doi.org/10.1016/j.ophtha.2011.10.021
He M, Foster PJ, Ge J, Huang W, Zheng Y, Friedman DS, Lee PS, Khaw PT (2006) Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou. Invest Ophthalmol Vis Sci 47(7):2782–2788. https://doi.org/10.1167/iovs.06-0051
Mitchell P, Smith W, Attebo K, Healey PR (1996) Prevalence of open-angle glaucoma in Australia. The Blue Mountains eye study. Ophthalmology 103(10):1661–1669
Bonomi L, Marchini G, Marraffa M, Bernardi P, De Franco I, Perfetti S, Varotto A, Tenna V (1998) Prevalence of glaucoma and intraocular pressure distribution in a defined population. The Egna-Neumarkt study. Ophthalmology 105(2):209–215
Kyari F, Entekume G, Rabiu M, Spry P, Wormald R, Nolan W, Murthy GV, Gilbert CE, Nigeria National B, Visual Impairment Study G (2015) A population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and visual impairment survey. BMC Ophthalmol 15:176. https://doi.org/10.1186/s12886-015-0160-6
Dielemans I, Vingerling JR, Wolfs RC, Hofman A, Grobbee DE, de Jong PT (1994) The prevalence of primary open-angle glaucoma in a population-based study in the Netherlands. The Rotterdam study. Ophthalmology 101(11):1851–1855
Iwase A, Suzuki Y, Araie M, Yamamoto T, Abe H, Shirato S, Kuwayama Y, Mishima HK, Shimizu H, Tomita G, Inoue Y, Kitazawa Y, Tajimi Study Group JGS (2004) The prevalence of primary open-angle glaucoma in Japanese: the Tajimi study. Ophthalmology 111(9):1641–1648. https://doi.org/10.1016/j.ophtha.2004.03.029
Hoffmann EM, Zangwill LM, Crowston JG, Weinreb RN (2007) Optic disk size and glaucoma. Surv Ophthalmol 52(1):32–49. https://doi.org/10.1016/j.survophthal.2006.10.002
van Romunde SH, Thepass G, Lemij HG (2013) Is hyperopia an important risk factor for PACG in the Dutch population?-a case control study. J Ophthalmol 2013:630481. https://doi.org/10.1155/2013/630481
Matsumoto C, Takada S, Okuyama S, Arimura E, Hashimoto S, Shimomura Y (2006) Automated flicker perimetry in glaucoma using Octopus 311: a comparative study with the Humphrey matrix. Acta Ophthalmol Scand 84(2):210–215. https://doi.org/10.1111/j.1600-0420.2005.00588.x
Acknowledgements
We thank all study participants for their willingness to provide data for this research project and we are indebted to all coworkers for their enthusiastic commitment.
Funding
The Gutenberg Health Study is funded through the government of Rhineland Palatinate (“Stiftung Rheinland-Pfalz für Innovation”, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim, PHILIPS Medical Systems and Novartis Pharma, including an unrestricted grant for the Gutenberg Health Study. PSW is funded by the Federal Ministry of Education and Research (BMBF 01EO1003). Funders were involved in the development of the study design as scientific consultants. However, they played no role in data collection, analysis, decision to publish, or preparation of the manuscript.
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The study protocol and study documents were approved by the local ethics committee of the Medical Chamber of Rhineland-Palatinate, Germany (reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015). According to the tenets of the Declaration of Helsinki, written informed consent was obtained from all participants prior to their entry into the study.
Conflict of interest
Dr. Pfeiffer received honoraria for lectures or consulting from Thea, Isarna, Novartis, Alcon, Medscape, Boehringer Ingelheim, Ivantis. Dr. Schuster received financial support for other projects by Heidelberg Engineering and Bayer Healthcare. Dr. Wild has received research funding from Boehringer Ingelheim, PHILIPS Medical Systems, Sanofi-Aventis, Bayer Vital, Daiichi Sankyo Europe and receiced honoraria for lectures or consulting from Boehringer Ingelheim, Bayer HealthCare, Bayer Vital, Public Health–Heinrich-Heine-University Düsseldorf, Astra Zeneca and Sanofi-Aventis. All other authors declare that they have no conflict of interest.
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Höhn, R., Nickels, S., Schuster, A.K. et al. Prevalence of glaucoma in Germany: results from the Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol 256, 1695–1702 (2018). https://doi.org/10.1007/s00417-018-4011-z
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DOI: https://doi.org/10.1007/s00417-018-4011-z