Оценочные показатели количества слепых или слабовидящих людей вследствие глаукомы на Южном Урале

    Relevance

    Glaucoma is the third leading cause of vision loss after cataracts and refractive errors, and its prevalence is increasing around the world. In 2013, the number of people aged 40–80 years with glaucoma was 64.0 million; by 2020, this number increased by 18.0% to 76.0 million. According to Yih-Chung Tham et al., the number of people with glaucoma is expected to almost double by 2040 reaching 118.8 million [1–5].

    Primary open-angle glaucoma (POAG) is the most common type of the disease worldwide, with such risk factors as age, elevated intraocular pressure (IOP), positive family history, Sub-Saharan African ethnicity and high myopia [1, 4, 6]. Primary angle closure glaucoma (PACG) is the second most common form of the disease and is particularly prevalent in East Asians. PACG accounts for almost half of all cases of glaucoma-related blindness worldwide, despite being less common than POAG [7, 8].

    Purpose

    To analyze the prevalence of blindness and visual impairment caused by glaucoma.

    Material and methods

    In 2015–2017 a cross-sectional, clinical and populationbased Ural Eye and Medical Study (UEMS), was conducted at Ufa Eye Research Institute to assess the prevalence of eye diseases among the population aged 40 years or older in the region of Southern Urals. The study had the following inclusion criteria: voluntary choice to participate in the study, age 40 years or older; permanent residence in the study area.

    The study followed the basic principles of the Helsinki Declaration and Good Clinical Practice (GCP) guidelines.

    Written informed voluntary consent was obtained from all participants.

    The UEMS was carried out in three stages. In the first stage a questionnaire was administered to the study participants. It included questions about the demographic and social status of the respondents, their working and living conditions, as well as questions about their health status. The first and second stages of the study included 293 criteria. In the third phase, an ophthalmological examination was carried out, which included 355 assessment criteria. The eye examination included general and specific methods such as: visometry, refractometry, tonometry (Tonometer Kowa KT-800, Kowa Company Ltd., Hamamatsu City, Japan), biomicroscopy, corneal topography (Pentacam HR, Typ70900, OCULUS, Optikgeräte GmbH Co., Wetzlar, Germany), automated perimetry(PTS 1000 Perimeter, Optopol Technology Co., Zawercie, Poland), fundus photography (VISUCAM 500, Carl Zeiss Meditec AG, Jena, Germany), optical coherence tomography (OCT) (RS-3000, NIDEK co., Ltd., Aichi Japan).

    Glaucoma was diagnosed based on tonometry results, automated perimetry values, ophthalmoscopy findings and OCT images. The anterior chamber angle was assessed using Pentacam images of the anterior segment. Visual acuity in the better or single eye was considered.

    The level of visual impairment was determined using the World Health Organization classification (for ease of further data analysis, respondents with moderate and severe visual impairment were combined):

    – mild visual impairment: visual acuity between 6/12 and 6/18 (between 0.5 and 0.3);

    – moderate and severe visual impairment: visual acuity less than 6/18 and greater than or equal to 3/60 (less than 0.3 and greater than or equal to 0.05);

    – blindness: visual acuity less than 3/60 (less than 0.05) [8]. Statistical data processing was carried out using the IBM SPSS Statistics 23.0 software package (USA). A p-value of less than 0.05 was used to determine statistically significance.

    The confidence interval (CI) was calculated using the Wilson method with continuity correction.

    Results and discussion

    A total of 5899 participants were included in the Ural Eye and Medical Study. 5893 subjects with a mean age of 59,0±10,7 years (median 58 years; range 40–94 years) were enrolled in the study of the prevalence of visual acuity loss or blindness and the causes of these conditions. Out of this participants, 184 patients (3.1%; 95% CI%: 2.7–3.6) had mild visual impairment, 182 patients (3.1%; 95% CI%: 2.7–3.5) had moderate to severe visual impairment, and 11 individuals (0.19%; 95% CI%: 0.10–0.34) were defined as blind.

    246 individuals were found to have glaucoma (4.4%; 95% CI%: 3.9–5.0); POAG was detected in 177 patients (3.2%; 95% CI%: 2.7–3.7) and PACG – in 69 patients (1.2%; 95% CI%: 1.0– 1.5).

    The proportion of people with moderate to severe visual impairment due to glaucoma in the study population was 4.9% (n=9; 95% CI%: 1.8–8.1), including POAG in 7 people and PACG in 2 people. Glaucoma-induced blindness was observed in 1 (9.1%) of the 11 blind respondents.

    According to the Vision Loss Expert Group of the Global Burden of Disease Study, globally 3,61 million people (95% CI%: 2,81–4,42) were blind and nearly 4,14 million people (95% CI%: 3,24–5,18) were moderate to severe visually impaired due to glaucoma. In 2020, glaucoma was the cause of blindness in 8,39% (95% CI%: 6,54–10,29) of cases worldwide. Regionally, the highest proportions of blindness due to glaucoma were found in high-income countries (26.12% [95% CI%: 20.72– 32.09]), North Africa and the Middle East (14.98% [95% CI%: 11.47–18.72]), and Central and Eastern Europe and Central Asia (12.59% [95% CI%: 9.80–15.49]). The regions with the lowest proportion of glaucoma-induced blindness were South Asia (4.85% [95% CI%: 3.69–6.10]) and South-East Asia, East Asia and Oceania (5.02% [95% CI%: 3.83– 6.37]). The proportion of blind people in Latin America and the Caribbean was (9.15% [95% CI%: 7.01–11.25]) and in Sub-Saharan Africa (10.05% [95% CI%: 7.86–12.37]).

    Glaucoma caused 1.41% (95% CI%: 1.10–1.75) of all cases of moderate to severe visual impairment worldwide. Latin America and the Caribbean (2.04% [95% CI%: 1.60–2.55]), high-income countries (1.92% [95% CI%: 1.51–2.46]) and sub-Saharan Africa (1.92% [95% CI%: 1.51–2.42]) were the regions with the highest proportion of glaucoma among all people with moderate and significant visual impairment due to glaucoma [1].

    The population-based Ural Eye and Medical Study (UEMS) showed that the number of people living in the Southern Ural region with glaucoma-related moderate to severe visual impairment was higher than in the other world regions (Fig.). The prevalence of blindness due to glaucoma in the Southern Urals is close to that in Latin America and the Caribbean, higher than in the countries of South, SouthEast, East Asia and Oceania, but lower than in high-income countries, North Africa and the Middle East.

    Several factors may contribute to these differences, including delayed diagnosis, limited access to specialized ophthalmic care, variability in patient adherence to treatment, and possible regional genetic predispositions. Addressing these gaps through targeted screening programs, earlier initiation of therapy, and patient education could help reduce the burden of preventable vision loss in the Southern Urals.

    Conclusion

    The prevalence of moderate to severe visual impairment due to glaucoma was 4.9%, which is relatively higher than in the other world regions. The prevalence of blindness due to glaucoma in the population of the Southern Urals was 9.1%, which is comparable to the global average. These results emphasize the importance of region-specific glaucoma prevention and early detection programs.

    Information about the authors

    Leisan I. Gilemzianova – Head of the Laboratory of Experimental Research, Ufa Eye Research Institute, Bashkir Medical University of the Ministry of Health of Russia, gileisan@gmail.com, https://orcid.org/0000-0002-0583-013X

    Jost B. Jonas – professor, Rothschild Foundation Hospital, Institute of Myopia, Paris, France, jost.jonas@medma.uni-heidelberg.de, https://orcid.org/0000-0003-2972-5227

    Bourne Rupert – professor, Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, England, eyesecretary. cpm@gmail.com, https://orcid.org/0000-0002-8169-1645

    Songhomitra Panda-Jonas – doctor, Privatpraxis Prof Jonas und Dr. Panda-Jonas, Heidelberg, Germany, drsjonas@gmail.com, https://orcid.org/000-00300709-863X

    Информация об авторах

    Гилемзянова Лейсан Ильшатовна – зав. лабораторией экспериментальных исследований Уфимскогго НИИ глазных болезней ФГБОУ ВО БГМУ Минздрава России, gileisan@gmail.com, https://orcid.org/0000-0002-0583-013X

    Йонас Йост Бруно – профессор, Госпиталь Фонда Ротшильда, Институт близорукости, Париж, Франция, jost.jonas@medma.uniheidelberg.de, https://orcid.org/0000-0003-2972-5227

    Борн Руперт – профессор Института исследования зрения и глазных болезней, Университет Англия Раскин, Кембридж, Англия, eyesecretary.cpm@gmail.com, https://orcid.org/0000-0002-8169-1645

    Сонгромитра Панда-Йонас – доктор Частной клиники профессора Йонаса и Доктора Панда-Йонас, Гейдельберг, Германия, drsjonas@ gmail.com, https://orcid.org/000-00300709-863X

    Author’s contribution:

    Gilemzianova G.I. – writing original draft, review & editing.

    Jonas J.B. – writing, review & editing, methodology, formal analysis, data curation.

    Bourne R. – writing, review & editing, conceptualization.

    Panda-Jonas S. – writing, review & editing, methodology.

    Вклад авторов:

    Гилемзянова Л.И. – написание оригинального текста, рецензирование и редактирование.

    Йонас Й.Б. – написание, рецензирование и редактирование, методология, формальный анализ, обработка данных.

    Борн Р. – написание, рецензирование и редактирование, концепция и дизайн исследования.

    Панда-Йонас С. – написание, рецензирование и редактирование, методология.

    Financial transparency: Authors have no financial interest in the submitted materials or methods.

    Финансирование: Авторы не получали конкретный грант на это исследование от какого-либо финансирующего агентства в государственном, коммерческом и некоммерческом секторах.

    Conflict of interest: There is no conflict of interest.

    Конфликт интересов: Отсутствует.

    Поступила: 15.07.2025

    Переработана: 29.07.2025

    Принята к печати: 04.08.2025

    Originally received: 15.07.2025

    Final revision: 29.07.2025

    Accepted: 04.08.2025