More than half of patients with glaucoma seem to be undiagnosed.
Systematic review 1
The systematic review «Burr JM, Mowatt G, Hernández R ym. The clinical ef...»1 identified 4 383 reports 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 date of last searches was December 2005.
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, unstandardised criteria) were used in five studies (19%). IOP status was obtained from a secure record (examination or examination records) in most studies.
The pooled prevalence rate from 19 studies was estimated to be 2.1% [95% confidence interval (CI) 1.7 to 2.5]. For previously undetected OAG, the pooled prevalence rate was 1.4% (95% CI 1.0 to 1.9), that is 67%.
Systematic review 2
The objective of the analysis 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 «Medical Advisory Secretariat.. Routine eye examina...»2.
POAG is undiagnosed in up to 50% of the population. The quality of the evidence is moderate.