Etninen tausta glaukooman riskitekijänä

Anja Tuulonen

Näytön aste: C

Tumma etninen tausta lisää riskiä sairastua glaukoomaan.

Systemaattinen katsaus 1

The systematic review «Burr JM, Mowatt G, Hernández R ym. The clinical ef...»1 aimed to identify the magnitude of risk of OAG attributable to age, ethnicity, family history, myopia and diabetes. Population-based cohort and cross-sectional studies, investigating the risk of developing OAG were included, as well as meta-analyses and systematic reviews of observational population-based studies. Studies reporting populations in UK, Europe, North America, Canada or Australia were included. Hospital or clinic-based settings were excluded. The review was restricted to English language publications. The methodological quality of the included studies was assessed.

4 383 reports were identified from the search for studies on epidemiology, risk and disease progression, of which 285 were selected for full assessment for this review. 92 reports describing 27 studies met the inclusion criteria for the review.

The overall quality of each study was summarised as (A) no major flaws or (B) possible important flaws. Studies were included when they rated ‘A’ in all fields. Exceptions were made to include ‘B’ studies when no better evidence was available. In most studies (81 %), participants were sampled adequately and selected from a relevant population. Suboptimal approaches to diagnose OAG (e.g. high IOP, absence of a visual test, baring of the blind spot, case records, unstandardised criteria) were used in five studies (19 %).

Crude and adjusted relative risks (or odds ratios depending on study design) of OAG for the risk factors under investigation were abstracted. Where two or more studies contributed data, a random effects meta-analysis was undertaken. If both an unadjusted and adjusted ratio were reported in a study, an age- and gender-adjusted odds ratio was used in the meta-analysis. A relative risk was generated when an adjusted odds ratio was not reported and raw data were available.

The relationship between ethnicity and OAG was evaluated in only one study. This study provided a direct comparison of prevalence between black and white ethnicity. Age-specific prevalence rates for OAG among African-Americans ranged from 1.23 % (95 % CI 0.23 to 2.24) in those aged 40–49 years to 9.15 % (95 % CI 5.83 to 12.48) in those aged 70–79 years. The relative risk of OAG among the Baltimore over-40 years black population compared with whites is estimated to be 3.80 (95 % CI 2.56 to 5.64). The onset of disease appears to be earlier for blacks as the number of cases identified for those aged between 40 and 59 was considerably higher than that observed in whites (2.3 % and 0.25 %, respectively).

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Systemaattinen katsaus 2

Structured Medline (January 1950-January 2013) search and a hand search of references and citations of retrieved articles yielding 57 articles from 41 studies were included in the systematic review «Hollands H, Johnson D, Hollands S ym. Do findings ...»2.

The summary prevalence of glaucoma in the highest-quality studies was 2.6 % (95 % CI, 2.1 %-3.1 %). Among risk factors evaluated that black race increases the risk of glaucoma (OR, 2.9; 95 % CI, 1.4-5.9).

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Systemaattinen katsaus 3

The objective of the analysis of this systematic review «Health Quality Ontario. Routine eye examinations f...»3 was to determine the strength of association between age, gender, ethnicity, family history of disease and refractive error and the risk of developing glaucoma. The medical advisory secretariat conducted a computerized search of literature in English-language articles, published from January 2000 to March 2006. In addition, a search was conducted for published guidelines, health technology assessments, and policy decisions. Bibliographies of references of relevant papers were searched for additional references.

Studies including participants ≥ 20 years old, population-based prospective cohort studies, population-based cross-sectional studies when prospective cohort studies were unavailable or insufficient and studies determining and reporting the strength of association or risk- specific prevalence or incidence rates were included in the review. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to summarize the overall quality of the body of evidence.

A total of 498 citations for the period January 2000 through February 2006 were retrieved and an additional 313 were identified when the search was expanded to include articles published between 1990 and 1999. An additional 6 articles were obtained from bibliographies of relevant articles. Of these, 36 articles were retrieved for further evaluation. Upon review, 1 meta-analysis and 15 population-based epidemiological studies were accepted for this review

Only 1 cross-sectional study compared the prevalence rates of POAG between black and white participants. These data suggest that prevalent glaucoma is statistically significantly greater in a black population 50 years of age and older compared with a white population of similar age. There is an overall 4-fold increase in prevalent POAG in a black population compared with a white population. This increase may be due to a confounding variable not accounted for in the analysis. The quality of the evidence is low.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: kohtalainen


Racial differences in CCT have been reported in several population studies, with individuals of African ancestry having thinner corneas, on average, than Caucasians, Hispanics or Asians [see «Sarveiskalvon paksuuden merkitys silmänpaineesta riippumattomana riskitekijänä on epävarma.»D], «Burr JM, Botello-Pinzon P, Takwoingi Y ym. Surveil...»4. It has been suggested that black race may not be an independent risk factor because black patients tend to have higher IOP, thinner corneas and higher C/D ratios than other patients with OHT and are therefore generally at a higher risk than white patients. In the OHTS and OHTS-EGPS, when either VCD ratio or CCT was included in the multivariate model, race was no longer statistically significant.


  1. Burr JM, Mowatt G, Hernández R ym. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess 2007;11:iii-iv, ix-x, 1-190 «PMID: 17927922»PubMed
  2. Hollands H, Johnson D, Hollands S ym. Do findings on routine examination identify patients at risk for primary open-angle glaucoma? The rational clinical examination systematic review. JAMA 2013;309:2035-42 «PMID: 23677315»PubMed
  3. Health Quality Ontario. Routine eye examinations for persons 20-64 years of age: an evidence-based analysis. Ont Health Technol Assess Ser 2006;6:1-81 «PMID: 23074485»PubMed
  4. Burr JM, Botello-Pinzon P, Takwoingi Y ym. Surveillance for ocular hypertension: an evidence synthesis and economic evaluation. Health Technol Assess 2012;16:1-271, iii-iv «PMID: 22687263»PubMed