Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota

doi:10.1016/j.ophtha.2013.09.003

Ophthalmology

Volume 121, Issue 1, January 2014, Pages 134-141

Presented in part at: the Annual Meeting of the American Glaucoma Society, March 4–7, 2010, Naples, Florida.

https://doi.org/10.1016/j.ophtha.2013.09.003 Get rights and content

Objective

To determine the longitudinal trends in the probability of blindness due to open-angle glaucoma (OAG) in Olmsted County, Minnesota, from 1965 to 2009.

Design

Retrospective, population-based cohort study.

Participants

All residents of Olmsted County, Minnesota (aged ≥40 years) who were diagnosed with OAG between January 1, 1965, and December 31, 2000.

Methods

All available medical records of every incident case of OAG were reviewed until December 31, 2009, to identify progression to blindness, defined as visual acuity ≤20/200 or visual field constriction to ≤20°. Kaplan–Meier analysis was used to estimate the cumulative probability of glaucoma-related blindness. Population incidence of blindness within 10 years of diagnosis was calculated using US Census data. Rates for subjects diagnosed in the period 1965–1980 were compared with rates for subjects diagnosed in the period 1981–2000 using log-rank tests and Poisson regression models.

Main Outcome Measures

Cumulative probability of OAG-related blindness and population incidence of blindness within 10 years of diagnosis.

Results

Probability of glaucoma-related blindness in at least 1 eye at 20 years decreased from 25.8% (95% confidence interval [CI], 18.5–32.5) for subjects diagnosed in 1965–1980 to 13.5% (95% CI, 8.8–17.9) for subjects diagnosed in 1981–2000 (P = 0.01). The population incidence of blindness within 10 years of the diagnosis decreased from 8.7 per 100 000 (95% CI, 5.9–11.5) for subjects diagnosed in 1965–1980 to 5.5 per 100 000 (95% CI, 3.9–7.2) for subjects diagnosed in 1981–2000 (P = 0.02). Higher age at diagnosis was associated with increased risk of progression to blindness (P < 0.001).

Conclusions

The 20-year probability and the population incidence of blindness due to OAG in at least 1 eye have decreased over a 45-year period from 1965 to 2009. However, a significant proportion of patients still progress to blindness despite recent diagnostic and therapeutic advancements.

Section snippets

Data Collection

This is a population-based study of all residents of Olmsted County, Minnesota, who were newly diagnosed with OAG between 1965 and 2000. As a result of a unique resource known as the Rochester Epidemiology Project (REP), Olmsted County is one of the few places in the world where longitudinal population-based studies are conducted. The REP13, 14, 15 is a surveillance and medical records linkage system established to study the occurrence and natural history of disease among the residents of

Results

A total of 563 new cases of OAG were diagnosed during the period from 1981 to 2000. There were 235 male and 328 female subjects, with a mean age of 65.2±15.3 years (mean ± standard deviation [SD]). The follow-up time extended to the end of 2009 and ranged from less than 1 month to 28.2 years with a mean follow-up time of 11.2±6.7 years. Table 1 summarizes the characteristics of incident cases from this period, as well as the previously collected study data set for the period 1965–1980.16, 17

Discussion

The REP tracks the entire population of Olmsted County over multiple decades and is particularly well suited for assessing longitudinal trends in OAG-related blindness rates. In contrast, prospective population-based eye studies are primarily designed to assess prevalence instead of incidence and are unable to assess long-term trends in a relatively rare condition such as OAG-related blindness. Even if serial ophthalmic examinations could be performed for the study populations, these studies

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: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Funding: Mayo Foundation for Medical Education and Research, a Research to Prevent Blindness Special Scholar Award (A.J.S.), an unrestricted departmental grant from Research to Prevent Blindness, and the Rochester Epidemiology Project (REP) (Grant Number R01 AG034676 from the National Institute on Aging). The sponsors or funding organizations had no role in the design or conduct of this research.

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Original articleLong-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Data Collection

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthalmology

Rheum Dis Clin North Am

Mayo Clin Proc

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

The number of people with glaucoma worldwide in 2010 and 2020

Br J Ophthalmol

Causes and prevalence of visual impairment among adults in the United States

Arch Ophthalmol

Original article
Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota