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

Area of Science:

• Ophthalmology
• Public Health
• Epidemiology

Background:

• Primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) are leading causes of irreversible blindness globally.
• Understanding the comparative risk of blindness between these two glaucoma types is crucial for effective public health strategies and resource allocation.

Purpose of the Study:

• To estimate and compare the risk of blindness in patients with primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG).
• To synthesize evidence from population-based studies reporting blindness rates for both PACG and POAG.

Main Methods:

• Systematic literature search of PubMed for English articles (2000-2020) reporting prevalence and blindness rates for both PACG and POAG in the same cohort.
• Inclusion criteria: population-based studies, ISGEO criteria for glaucoma definition, published prevalence and blindness data for both conditions.
• Calculation of cumulative proportion and risk ratios for blindness in PACG compared to POAG.

Main Results:

• Analysis of 23 studies involving 78,434 participants.
• Blindness rates: 8.9% for POAG (151/1702) and 27.0% for PACG (196/724).
• The cumulative risk ratio for blindness in PACG versus POAG was 2.39 (95% CI: 1.99–2.87), indicating a substantially higher risk.

Conclusions:

• Primary angle-closure disease is significantly more likely to be associated with blindness than primary open-angle glaucoma.
• Findings underscore the importance of early detection and management of PACG to prevent vision loss.
• Public health initiatives should consider the differential impact of these glaucoma subtypes on blindness prevalence.