Global incidence and risk factors for glaucoma: A systematic review and meta-analysis of prospective studies

Abstract

Background: This study aims to estimate global incidence and assess risk factors for glaucoma subtypes.

Methods: The literature search was performed in three English (PubMed, Embase, MEDLINE) and three Chinese (China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database) databases to identify prospective studies on glaucoma incidence between 1 January 1990 and 29 November 2022. We used a multilevel mixed-effects meta-regression to estimate the age- and sex-specific incidence rate of primary open-angle glaucoma (POAG). The global and regional incidence rate of POAG in 2022 were respectively estimated. The annual cumulative incidence (ACI) of POAG and primary angle-closure glaucoma (PACG), and risk factors for POAG were pooled using a random-effects meta-analysis, respectively. The heterogeneity of the included articles was tested using the Q statistic and measured by I² index. Publication bias was detected by funnel plots, Egger's regression test, and Begg's rank correlation test.

Results: A total of 9050 articles were identified in literature search, and 50 articles provided incidence data of glaucoma subtypes. In 2022, the global incidence rate of POAG was 23.46 (95% confidence interval (CI) = 15.68-32.91) per 10 000 person-years among 40-79 years. An increase from 5.51 (95% CI = 1.63-11.12) per 10 000 person-years in 40-44 years to 64.36 (95% CI = 49.82-80.70) per 10 000 person-years in 75-79 years was noted between the year 1990 and 2019. Across sociodemographic index (SDI) and World Health Organization (WHO) regions, the incidence rate was the highest in low SDI region and Africa, respectively. The pooled ACI of POAG was 0.21% (95% CI = 0.13%-0.30%). Six risk factors for POAG were identified, including intraocular pressure (IOP) treatment (meta-odds ratio (OR) = 3.69; 95% CI = 2.64-5.15), a family history of glaucoma (meta-OR = 2.49; 95% CI = 1.92-3.24), myopia (meta-OR = 2.08; 95% CI = 1.59-2.70), elevated IOP (meta-OR = 1.13; 95% CI = 1.11-1.15), advanced age (meta-OR = 1.07; 95% CI = 1.05-1.08), male (female: meta-OR = 0.76; 95% CI = 0.66-0.88). The pooled ACI of PACG was 0.05% (95% CI = 0.00%-0.16%).

Conclusions: Significant disparities existed in incidence rates for glaucoma across geographic regions and age groups. Further research is needed to understand which risk factors drive glaucoma incidence in different socioeconomic strata for tailored health policy on preventing glaucoma.

Registration: This study is registered with PROSPERO (number CRD42023434203).

Figure 1

Flowchart of systematic review and meta-analysis. Four articles provided incidence data for both primary open-angle glaucoma and primary angle-closure glaucoma.

Figure 2

Location of included articles reporting the incidence or risk factors for glaucoma subtypes. H-SDI – high social demographic index countries, LM-SDI – low- and middle-sociodemographic index countries.

Figure 3

Incidence rate of primary open-angle glaucoma in different World Health Organization regions and social demographic index groups, by age and sex group. SDI – sociodemographic index, WHO – World Health Organization.

Figure 4

The pooled annual cumulative incidence of primary open-angle glaucoma and primary angle-closure glaucoma. Articles by Teo ZL et al. had different inclusion and exclusion criteria. ACI – annual cumulative incidence, CI – confidence interval.

Figure 5

Synthesised effect size of risk factors for primary open-angle glaucoma investigated in at least three articles using multivariable regression. IOP – intraocular pressure, OR – odds ratio, RF – risk factor.