Undiagnosed glaucoma and its risk factors in the Yinzhou community-based glaucoma screening program

To analyze the risk factors associated with previously undiagnosed primary glaucoma.

This cross-sectional study was conducted among residents aged 50 years and older in primary health care centers in Yinzhou District, China, from November 26, 2020, to December 3, 2021. Participants underwent various screening procedures. Patients with suspected glaucoma and other ocular abnormalities were referred to Yinzhou People's Hospital for further examination, diagnosis and treatment. We integrated ophthalmic screening data with the Yinzhou Regional Health Information Platform (YRHIP).

A total of 344 patients aged 50 years or older were diagnosed with primary glaucoma, including 142 (41.3%) previously undiagnosed patients. Among the 191 patients with primary angle-closure diseases and the 153 patients with primary open-angle glaucoma, 87 (45.5%) and 55 (35.9%), respectively, were previously undiagnosed. According to the multivariable models, the factors significantly associated with decreased odds of having previously undiagnosed glaucoma at the time of screening were older age (all p values <0.01), worse visual acuity (PVA) (OR 0.37, 95% CI 0.18-0.76), a greater vertical cup-to-disc ratio (VCDR) (OR 0.12, 95% CI 0.02-0.99), and high-tension glaucoma (HTG) (OR 0.02, 95% CI 0.00-0.09). Compared with patients who had undergone their last visit for eye care within 1 year, patients who had last seen an eye care provider >2 years prior to the time of screening were more likely to be undiagnosed at the time of screening (all p values <0.05).

Younger age, longer duration since the last eye care visit, better PVA, smaller VCDR, and normal-tension glaucoma (NTG) were all significantly associated with an increased likelihood of previously undiagnosed primary glaucoma.