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Meta-Analysis
. 2022 Nov;36(11):2099-2105.
doi: 10.1038/s41433-021-01802-9. Epub 2021 Oct 13.

Blindness in glaucoma: primary open-angle glaucoma versus primary angle-closure glaucoma-a meta-analysis

Ronnie George  1 , Smita Panda  2 , Lingam Vijaya  2
Affiliations
Meta-Analysis

Blindness in glaucoma: primary open-angle glaucoma versus primary angle-closure glaucoma-a meta-analysis

Ronnie George et al. Eye (Lond). 2022 Nov.

Abstract

Aim: To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that reported blindness rates for both PACG and POAG.

Method: A systematic search was performed in PubMed for articles published in English between 2000 and 2020 reporting the prevalence of POAG as well as PACG among various ethnic populations. A study was included if it was (1) population-based (2) had published prevalence and blindness rates for both PACG and POAG in the same cohort. (3) Glaucoma was defined as per the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) criteria. The proportion of blindness for both POAG and PACG for each study and the cumulative proportion taking all the studies were calculated.

Results: We included 23 studies with 78,434 participants. POAG was diagnosed in 1702 persons with 151 (8.9%) blind. There were 724 cases of PACG with 196 (27.0%) blind. The risk ratio of blindness in PACG to POAG varied from 0.73 to 10.6 among the studies. The cumulative risk ratio was 2.39 (95% confidence interval (CI); 1.99, 2.87). Risk ratios for studies including visual field restriction while defining blindness were similar to studies that did not (1.92 vs 2.64, P = 0.11). Risk ratios were also similar for studies that used greater than 2 instead of 3 or more quadrants of iridotrabecular contact to define angle closure (2.79 vs 2.25).

Conclusion: Primary angle-closure disease is more likely to be associated with blindness.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow diagram.
Description of the search methodolgy.
Fig. 2
Fig. 2. The forest plot shows the risk ratio of blindness in primary angle-closure glaucoma compared to primary open-angle glaucoma in each study.
The risk ratio ranged from 0.73 to 10.6 with a cumulative risk ratio of 2.39 (95% CI; 1.99, 2.87). The studies did not show heterogeneity (I2 = 0%).
Fig. 3
Fig. 3. Comparison of the risk ratio of blindness in primary angle-closure glaucoma compared to primary open-angle glaucoma among studies in rural, urban and mixed populations.
The risk ratio for PACG was comparable among rural, urban and mixed populations.
Fig. 4
Fig. 4. Comparison of risk ratios for blindness between PACG and POAG based on inclusion or exclusion of visual field restriction in the definition of blindness.
Inclusion or exclusion of visual field restriction did not impact risk ratio.
See this image and copyright information in PMC

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