July 2019

GLAUCOMA

Presentation Spotlight
Blindness from glaucoma rising in Europe


by Stefanie Petrou Binder, MD EyeWorld Contributing Writer


From 1990 to 2015 prevalence of blindness, moderate and severe vision impairment for all ages decreased from 0.26% to 0.15%
Source: Ingrida Januleviciene, MD

 

Glaucoma is the third most common cause of blindness in Europe, following cataract and AMD. Data from the World Health Organization (WHO) show that by 2020, the rate of glaucoma-related blindness in Europe will rise to 13.9%, exceeding the worldwide rate of 8.43%. Ingrida Januleviciene, MD, discussed relevant studies and statistics associated with glaucoma blindness at the 36th Congress of the European Society of Cataract and Refractive Surgeons
“The percentage of glaucoma blindness in Europe is high and expected to rise further by 2020,” Dr. Januleviciene said. “Life-long glaucoma requires attention. People are living longer, the population is expanding, and this leads to an increasing number of individuals who are at risk of visual impairment.”
WHO statistics reveal that 90% of blindness is found in the developing world, of which 75% is either treatable or preventable. “The question is, how can we explain the other 10%, specifically blindness in Europe? Restoration of sight is one of the most cost-effective interventions in healthcare, and the successful implementation of Vision 2020 programs can result in potential saving of $102 billion in lost productivity by the year 2020,” she said.
While glaucoma-related blindness is treatable and preventable, its high rate in Europe has been attributed to largely subjective factors, such as noncompliance, late presentation, greater severity of the disease at the time of diagnosis, and a general lack of knowledge among patients. These factors result in lost productivity and increased disability, with patients unable to read, drive, or move around on their own.
There are different definitions of blindness. Studies on the subject have defined blindness as a simple loss of visual acuity, a visual field constriction of less than 20 degrees of fixation, visual acuity of 20/200 or worse, or a mean deviation of –22 dB, Dr. Januleviciene said.
Glaucoma prevalence rises rapidly once patients reach their 70s. According to a meta- analysis, the global prevalence of glaucoma for persons aged 40–80 years is 3.54%. In 2014, this represented 64.4 million people worldwide, estimated to be 76 million by 2020 and 111.8 million by 2040.1 Binocular glaucoma blindness was noted in 6.7 million individuals in 2000, 8.5 million in 2010, and is estimated to reach more than 11 million by 2020.2
The implementation of modern imaging technologies is vital for glaucoma screening, treatment, and targeted public health strategies to decrease the blinding effects of glaucoma. While the blinding rate can reach 30% in parts of the developing world, some data suggest it to be 1.3% in the white population of the U.S. A European blinding rate is harder to assess, as according to Dr. Januleviciene, each country’s varying economic development plays a determining role. One study observed twice the incidence of blindness in eastern and central Europe compared to western Europe.3
“The current world blindness rate of 8.66% is expected to be lower by the year 2020, estimated at 8.43%. Central and eastern Europe, however, will likely still see an increase in the blindness rate, with only western Europe expected to see a decrease. With all of our technology and so many educated doctors, we should not be seeing increasing blindness from glaucoma in Europe,” Dr. Januleviciene said.
Several studies documented the prevalence and risk of blindness from glaucoma. A retrospective chart review from 2006–2010 in Malmö, Sweden found that out of 592 persons with glaucoma, 42.2% had at least one blind eye and 16.4% were bilaterally blind. The median time with glaucoma diagnosis was 12 years, the median age when developing bilateral blindness was 86 years, and the median duration of bilateral blindness was 2 years.4 Another retrospective evaluation of 106 patients between 1991 and 2002 found that the risk of going blind from glaucoma in both eyes was 6%. Blindness from glaucoma was associated with advanced stage of glaucoma at diagnosis, fluctuation of IOP during treatment, presence of exfoliation syndrome, and poor patient compliance.5
Risk factors for glaucoma-related blindness were documented by various studies and include: noncompliance with the treatment regimen, late presentation (the major cause of blindness in 29–41% of patients registered as blind from glaucoma), greater severity of disease at the time of diagnosis despite beginning treatment, and a general lack of knowledge about glaucoma, Dr. Januleviciene said.
“The main reason why people are becoming blind has to do with our aging and expanding population, which is understandable, but noncompliance and a lack of knowledge is not acceptable. The fact that patients wait until they lose the vision in one eye before they come for a check-up of the other eye can also be explained by the patients’ lack of knowledge to some extent,” Dr. Januleviciene said.
Although we fear blindness and associate glaucoma with blindness, relatively few individuals understand what glaucoma is, the risk factors, how it is detected, and how it can be treated. An investigation carried out in Germany including 2,742 glaucoma patients revealed that 75% had a passive knowledge of the term but only 8% could correctly identify a basic glaucoma definition. The investigators found that general knowledge among patients was poor.6

About the doctor

Ingrida Januleviciene, MD, PhD
Professor of ophthalmology
Eye Clinic of Lithuanian
University of Health Sciences
Kaunas, Lithuania

Contact information

Januleviciene
: ingrida.januleviciene@lsmuni.lt

References

1. Tham YC, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–90.
2. Quigley HA, Broman AT. Number of people with glaucoma worldwide in 2010 and in 2020. Br J Opthalmol. 2006;90:262–7.
3. Bourne RRA, et al. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe in 2015: magnitude, temporal trends and projections. Br J Ophthalmol. 2018;102:575–585.
4. Peters D, et al. Lifetime risk of blindness in open-angle glaucoma. Am J Ophthalmol. 2013;156:724–30.
5. Forsman E, et al. Lifetime visual disability in open-angle glaucoma and ocular hypertension. J Glaucoma. 2007;16:313–9.
6. Pfeiffer N, et al. Knowledge about glaucoma in the unselected population: A German survey. J Glaucoma. 2002;11:458–63.

Financial interests

Januleviciene: None

Blindness from glaucoma rising in Europe Blindness from glaucoma rising in Europe
Ophthalmology News - EyeWorld Magazine
283 110
220 84
,
2019-07-01T08:30:28Z
True, 7