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Observational Study
. 2017 Sep 13:358:j3889.
doi: 10.1136/bmj.j3889.

Glaucoma and intraocular pressure in EPIC-Norfolk Eye Study: cross sectional study

Michelle P Y Chan  1 , David C Broadway  2 , Anthony P Khawaja  3 , Jennifer L Y Yip  3 , David F Garway-Heath  4   5 , Jennifer M Burr  6 , Robert Luben  3 , Shabina Hayat  3 , Nichola Dalzell  3 , Kay-Tee Khaw  3 , Paul J Foster  4   5
Affiliations
Observational Study

Glaucoma and intraocular pressure in EPIC-Norfolk Eye Study: cross sectional study

Michelle P Y Chan et al. BMJ. .

Abstract

Objectives To report the distribution of intraocular pressure (IOP) by age and sex and the prevalence of glaucoma.Design Community based cross sectional observational study.Setting EPIC-Norfolk cohort in Norwich and the surrounding rural and urban areas.Participants 8623 participants aged 48-92 recruited from the community who underwent ocular examination to identify glaucoma.Main outcome measures Prevalence and characteristics of glaucoma, distribution of IOP, and the sensitivity and specificity of IOP for case finding for glaucoma.Results The mean IOP in 8401 participants was 16.3 mm Hg (95% confidence interval 16.2 mm Hg to 16.3 mm Hg; SD 3.6 mm Hg). In 363 participants (4%), glaucoma was present in either eye; 314 (87%) had primary open angle glaucoma. In the remaining participants, glaucoma was suspected in 607 (7%), and 863 (10.0%) had ocular hypertension. Two thirds (242) of those with glaucoma had previously already received the diagnosis. In 76% of patients with newly diagnosed primary open angle glaucoma (83/107), the mean IOP was under the threshold for ocular hypertension (21 mm Hg). No one IOP threshold provided adequately high sensitivity and specificity for diagnosis of glaucoma.Conclusions In this British community, cases of glaucoma, suspected glaucoma, and ocular hypertension represent a large number of potential referrals to the hospital eye service. The use of IOP for detection of those with glaucoma is inaccurate and probably not viable.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and report: DFG has received personal fees from Aerie, Alimera, Allergan, Quark, Quethera, Santen, Santhera, Sensimed, grants and personal fees from Alcon, Pfizer, and grants from NIHR i4i programme outside the submitted work, and has a patent contact lens tonometer pending; PJF reports an unrestricted grant from Alcon (US) and grants and personal fees from Allergan (UK) and Zeiss (EU); no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of participants through EPIC-Norfolk study
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Fig 2 Age and sex distribution of EPIC-Norfolk 3HC cohort compared with population of Norfolk and UK (2014 mid-year population estimates15)
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Fig 3 Distribution of IOP in EPIC-Norfolk population (n=8401). Distribution approximates Gaussian distribution but has exaggerated central peak and modest right skew
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Fig 4 Intraocular pressure for all eyes and eyes with glaucoma in EPIC-Norfolk cohort
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Fig 5 Sensitivity and specificity for detection of all cause glaucoma in EPIC-Norfolk cohort
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization. Fact Sheet No. 282. Visual impairment and blindness June 2012. http://www.who.int/mediacentre/factsheets/fs282/en.
    1. Bunce C, Xing W, Wormald R. Causes of blind and partial sight certifications in England and Wales: April 2007-March 2008. Eye (Lond) 2010;24:1692-9. 10.1038/eye.2010.122 pmid:20847749. - DOI - PubMed
    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. 10.1136/bjo.86.2.238 pmid:11815354. - DOI - PMC - PubMed
    1. Health and Social Care Information Centre. Hospital outpatient acitivity-2014-15:primary diagnosis Dec 2015. http://digital.nhs.uk/article/2021/Website-Search?productid=19879&q=outp... - top.
    1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014;121:2081-90. 10.1016/j.ophtha.2014.05.013 pmid:24974815. - DOI - PubMed

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