Professional Documents
Culture Documents
discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/225295240
CITATIONS
READS
51
329
2 AUTHORS, INCLUDING:
Paul Foster
University College London
224 PUBLICATIONS 8,870 CITATIONS
SEE PROFILE
Definition of glaucoma
A definition of glaucoma for use in epidemiologic studies was agreed on in 1998, and that definition is still in
use.1 Glaucoma is defined as an optic neuropathy that is
characterized by specific structural findings in the optic
disc and specific functional deficits detected by automated
visual field testing. Raised intraocular pressure (IOP) is still
recognized as an important risk factor, but it is not a defining characteristic of the disease.
Glaucomatous optic neuropathy results from loss of neural
tissue and from posterior bowing of the lamina cribrosa. The
vertical cup-disc ratio (VCDR) can be used as an index of
neuroretinal rim loss, and the 97.5th percentile of the VCDRs
of the normal population could be considered the upper limit
of normal. From the available evidence, a VCDR of 0.7 is the
97.5th percentile cut-off in all ethnic groups studied.2 If the
VCDR is used alone, 2.5% of the normal population would
be defined as having glaucoma. To make this more robust, if
visual field testing is not possible and the VCDR is used alone,
the 99.5th percentile is used as the cutoff. A VCDR of 0.8 is
used as the cutoff for the 99.5th percentile.
A field abnormality is considered if, on a Zeiss-Humphrey
field analyzer plot using a threshold program with a 24-2 test
pattern, there is an abnormal glaucoma hemifield test or a
reproducible cluster of 3 nonedge points abnormal at the 5%
level and of typical glaucomatous distribution.
Prevalence of glaucoma
223
Evidence
VCDR or VCDR asymmetry 97.5th percentile of the normal
population plus visual field defect compatible with glaucoma
Severely damaged disc (VCDR 99.5th percentile of the normal
population) plus no reliable visual field obtainable
No view of optic disc plus IOP 99.5th percentile of the normal
population or evidence of previous filtering surgery
1
2
3
Age
Refractive error
Central corneal
thickness
Optic disc diameter
Intraocular pressure
Blood pressure
Diabetes mellitus
Cardiovascular
disease
Physical activity
IOP, intraocular pressure.
Indian
European origin
American Hispanic
Year of
Publication
Location
PACG (%)
POAG (%)
Secondary Glaucoma
Reference
0.59
0.1
3.1
2.7
1.4
8.8
4.74
7.1
1.5
0.15
1.7
0.35
A few
1.42
Not stated
0.81
4
5
6
7
8
9
10
1.26
0.24
1.00
Nil
Not stated
Not stated
0.48
Not stated
0.3
0.57
0.21
0.11
0.26
Not stated
0.34
4.97
0.68
Not stated
0.41
Nil
0.15
0.29
0.3
0.2
0.02
11
12
13
14
15
16
17
18
19,20
19,20
21
22
23
24
8
25
26
27
28
29
30
31
32
2000
2002
1969
1989
1991
1994
1993
Kongwa, Tanzania
Hlabisa, South Africa
Jamaica
St Lucia
Baltimore, U.S.
Barbados
Mamre, South Africa
40
40
35-74
30
40
40-84
40
1973
1987
1988
1989
1991
1996
1996
2000
1999
Umanaq, Greenland
Alaska
Alaska
Beijing, China
Japan
Taiwan
Hovsgol, Mongolia
Singapore
Hyderabad, India
1966
1980
1981
1991
1991
1992
1994
1994
1996
1997
1998
1998
2001
Ferndale, Wales
Framingham, U.S.
Dalby, Sweden
Middle Norway
Baltimore, U.S.
Beaver Dam, U.S.
Roscommon, Ireland
Rotterdam, Netherlands
Blue Mountains, Australia
Ponza, Italy
Egna-Neumarkt, Italy
Melbourne, Australia
Tucson, U.S.
40
40
40
40
40
40
40
40-79
30
40
40-74
52-85
55-69
65
40
43-84
50
55
49
40
40
40
40
224
Age Range
Nil
Nil
0.67
Not stated
2.3
4.8
2.65
3.8
1.4
0.34
3.0
1.4
1.14
0.71
1.08
0.09
Not stated
Nil
Not stated
0.31
0.04
0.09
Nil
0.27
0.97
0.6
0.1
0.1
Nil
0.03
2.62
Not stated
0.5
1.79
1.62
2.56
0.43
1.9
0.86
3.37
1.29
2.1
1.88
1.1
3.0
2.51
2.0
1.7
1.97
Race
Age
Sex
Family history
There is increased
There is increased
There is increased
history.
There is increased
Refractive error
REFERENCES
1. Foster PJ, Buhrmann R, Quigley HA, Johnson GJ The definition and
classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002;
86:238-42.
2. Wolfs RC, Borger PH, Ramrattan RS, et al. Changing views on openangle glaucoma: Definitions and prevalences; The Rotterdam Study.
Invest Ophthalmol Vis Sci.. 2000;41:3309-21.
3. Foster P, Quigley H. Glaucoma. In Johnson G, Minassian D, Weale R,
West S, eds. The epidemiology of eye disease, 3rd ed. London: Imperial
College Press, 2012, pp. 225.
4. Buhrmann RR, Quigley HA, Barron Y, et al. Prevalence of glaucoma in
a rural East African population. Invest Ophthalmol Vis Sci. 2000;41:40-8.
5. Rotchford AP, Johnson GJ. Glaucoma in Zulus: A population-based
cross-sectional survey in a rural district in South Africa. Arch Ophthalmol. 2002;120:471-8.
6. Wallace J, Lovell HG. Glaucoma and intraocular pressure in Jamaica.
Am J Ophthalmol. 1969:67:93-100.
7. Mason RP, Kosoko O, Wilson MR, et al. National survey of the prevalence and risk factors of glaucoma in St Lucia, West Indies: Prevalence
findings. Ophthalmology. 1989;96:1363-8.
CAN J OPHTHALMOLVOL. 47, NO. 3, JUNE 2012
225
226