Ramakrishnan R, Nirmalan Praveen K, Krishnadas R, Thulasiraj R D, Tielsch James M, Katz Joanne, Friedman David S, Robin Alan L
Aravind Eye Care System, Madurai, Tamil Nadu, India.
Ophthalmology. 2003 Aug;110(8):1484-90. doi: 10.1016/S0161-6420(03)00564-5.
To determine the prevalence of glaucoma and risk factors for primary open-angle glaucoma in a rural population of southern India.
A population-based cross-sectional study.
A total of 5150 subjects aged 40 years and older from 50 clusters representative of three southern districts of Tamil Nadu in southern India.
All participants had a comprehensive eye examination at the base hospital, including visual acuity using logarithm of the minimum angle of resolution illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated central 24-2 full-threshold perimetry.
Definite primary open-angle glaucoma (POAG) was defined as angles open on gonioscopy and glaucomatous optic disc changes with matching visual field defects, whereas ocular hypertension was defined as intraocular pressure (IOP) greater than 21 mmHg without glaucomatous optic disc damage and visual field defects in the presence of an open angle. Manifest primary angle-closure glaucoma (PACG) was defined as glaucomatous optic disc damage or glaucomatous visual field defects with the anterior chamber angle partly or totally closed, appositional angle closure or synechiae in the angle, and absence of signs of secondary angle closure. Secondary glaucoma was defined as glaucomatous optic nerve damage and/or visual field abnormalities suggestive of glaucoma with ocular disorders that contribute to a secondary elevation in IOP.
The prevalence (95% confidence interval) of any glaucoma was 2.6% (2.2, 3.0), of POAG it was 1.7% (1.3, 2.1), and if PACG it was 0.5% (0.3, 0.7), and secondary glaucoma excluding pseudoexfoliation was 0.3% (0.2,0.5). On multivariate analysis, increasing age, male gender, myopia greater than 1 diopter, and pseudoexfoliation were significantly associated with POAG. After best correction, 18 persons (20.9%) with POAG were blind in either eye because of glaucoma, including 6 who were bilaterally blind and an additional 12 persons with unilateral blindness because of glaucomatous optic neuropathy in that eye. Of those identified with POAG, 93.0% had not been previously diagnosed with POAG.
The prevalence of glaucoma in this population is not lower than that reported for white populations elsewhere. A large proportion of those with POAG had not been previously diagnosed. One fifth of those with POAG had blindness in one or both eyes from glaucoma. Early detection of glaucoma in this population will reduce the burden of blindness in India.
确定印度南部农村人口中青光眼的患病率及原发性开角型青光眼的危险因素。
基于人群的横断面研究。
来自印度南部泰米尔纳德邦三个南部地区50个群组的5150名40岁及以上的受试者。
所有参与者在基层医院接受了全面的眼科检查，包括使用对数最小分辨角文盲E视力表检查视力和验光、裂隙灯生物显微镜检查、前房角镜检查、压平眼压测量、散瞳眼底检查以及自动中心24-2全阈值视野检查。
明确的原发性开角型青光眼（POAG）定义为前房角镜检查显示房角开放且伴有青光眼性视盘改变及相应的视野缺损；高眼压症定义为眼压（IOP）大于21 mmHg，无青光眼性视盘损害且在房角开放的情况下无视野缺损。显性原发性闭角型青光眼（PACG）定义为青光眼性视盘损害或青光眼性视野缺损，同时前房角部分或完全关闭、房角贴附性关闭或房角粘连，且无继发性房角关闭的体征。继发性青光眼定义为青光眼性视神经损害和/或提示青光眼的视野异常，伴有导致眼压继发性升高的眼部疾病。
任何类型青光眼的患病率（95%置信区间）为2.6%（2.2，3.0），POAG为1.7%（1.3，2.1），PACG为0.5%（0.3，0.7），不包括假性剥脱综合征的继发性青光眼为0.3%（0.2，0.5）。多因素分析显示，年龄增加、男性、近视度数大于1屈光度以及假性剥脱与POAG显著相关。最佳矫正后，18例（20.9%）POAG患者因青光眼单眼或双眼失明，其中6例双眼失明，另有12例因患眼青光眼性视神经病变单眼失明。在确诊为POAG的患者中，93.0%此前未被诊断为POAG。
该人群中青光眼的患病率不低于其他地区白人人群的报告患病率。很大一部分POAG患者此前未被诊断。五分之一的POAG患者因青光眼单眼或双眼失明。在该人群中早期发现青光眼将减轻印度的失明负担。
