Assessing Risks of Glaucoma

Abstract: Glaucoma is a potentially blinding disease where the affected individual often firstnotices symptoms when the disease has reached a late stage. If glaucoma is detectedearly e.g., at screening, the risk for visual impairment can be reduced. There are manyfactors that affect a patient´s risk of developing glaucoma or visual impairment due toglaucoma. In the four studies of this thesis, the general aim was to evaluate such factors, focussing mainly on age, intraocular pressure and severity at detection, to provide more information on the need for improved case detection.The objectives of Study I and IV were to report the prevalence and severity ofundetected glaucoma in different age groups when detected at screening. Study I wasbased on data originally collected in a large population screening for individuals 57-77 years old performed in 1992-1997. In Study IV, 322 elderly subjects 77-89 years old were screened for glaucoma in 2019-2021. We found that the prevalence of undetected glaucoma increased with age but disease severity was similar at 60-77 years of age with about 30% of glaucomatous eyes with advanced disease or worse, but mostly early in elderly patients 77-89 years old.Using the large screening material from 1992-1997 that included 32,918 subjects, wecreated a regression model for the prediction of undetected glaucoma based on thecombined effect of age and intraocular pressure (Study II). Glaucoma increasedexponentially with age and intraocular pressure.Study III aimed to find the lifetime risk of glaucoma visual impairment in individualsfollowed-up for raised intraocular pressure since the 1980s. We found that only 9% ofsubjects developed bilateral visual impairment and 3% bilateral blindness resultingfrom glaucoma.The results are of value when estimating the need for improved glaucoma detection and when considering the management of patients with raised intraocular pressure.