Prevalence of Glaucoma in Europe and Projections to 2050

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PURPOSE: To provide updated glaucoma prevalence estimates and to quantify the current and future burden of disease in Europe. DESIGN: Two-stage, individual participant data meta-analysis. PARTICIPANTS: We included 55 415 adults ≥40 years of age (mean age, 65.6 years; 53.9% women) from 14 population-based studies (1991-2020) with case ascertainment based on direct ophthalmic examination. METHODS: Within each study, age- and sex-stratified glaucoma prevalence was calculated, before pooling results using random-effects meta-analysis and performing age standardization. Meta-regression and subgroup analyses were used to assess for temporal trends and to investigate heterogeneity across clinically relevant subgroups. Estimates were applied to European population projections to predict the number of individuals with glaucoma. MAIN OUTCOME MEASURES: Age-standardized prevalence (European Standard Population, 2013) of total and previously undiagnosed glaucoma for individuals ≥40 years of age and annual projected number of glaucoma cases (UN World Population Prospects, 2022) in Europe to 2050. RESULTS: Overall, 2021 participants (3.65%) received a diagnosis of glaucoma with an age-standardized European prevalence of 2.99% (95% confidence interval [CI], 2.86%-3.12%). Older age (odds ratio [OR], 1.32 per 5-year increase; 95% CI, 1.29-1.36; P < 0.001) and male sex (OR, 1.18; 95% CI, 1.08-1.30; P < 0.001) were associated with higher prevalence. Despite regional and diagnostic differences in prevalence estimates, no temporal trend was identified. More than half (56.4%) of cases were undiagnosed previously, with a higher proportion of undetected disease in younger participants, including >80% in those <55 years of age. We estimate a current burden of 12.3 million individuals with glaucoma in Europe, including 6.9 million individuals with undiagnosed disease. This burden is projected to grow by >1 million people by 2050 because of changing population age structure, with a preponderance of primary open-angle glaucoma. CONCLUSIONS: The current and future burden of glaucoma in Europe may be substantially higher than previously estimated, with a considerable proportion of disease in the general population remaining undetected. This may have broader implications for other age-related conditions in which the number of affected individuals is based solely on published aggregate-level data. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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