Geographic Disparities in Access to Glaucoma Surgery: Lessons from a Nationwide Registry Study

Background: Glaucoma is a progressive, age-related optic neuropathy and a leading cause of irreversible blindness worldwide. Ensuring timely diagnosis and equitable access to surgical care is therefore essential to prevent avoidable vision loss. Methods: Nationwide registry-based data on hospital-based glaucoma diagnoses and surgical procedures over an 11-year period were analyzed and stratified by treatment region and area of residence. Population data were age-stratified to allow calculation of standardized diagnosis and surgery rates per 10,000 population aged ≥ 60 years. Regional comparisons were performed, and demographic projections for populations aged ≥ 60 years were generated using an exponential smoothing state space model. Results: Geographic variation in glaucoma care was observed, despite broadly similar demographic profiles across regions. Surgery-to-diagnosis ratios among individuals aged ≥ 60 years differed markedly between regions. Relevant for future healthcare planning, age forecasting suggests an increase in people aged ≥ 60 years over the coming years. Conclusions: Geographic disparities in glaucoma surgical care may persist even in well-resourced healthcare systems. Centralization of surgical services may contribute to differences, although explanations such as variation in referral patterns and clinical decision-making cannot be excluded. These findings highlight a broader, internationally relevant challenge: aligning glaucoma care delivery with shifting demographic needs.