Rural Glaucoma in China: Present Status and Future Directions

Abstract

BACKGROUND: Glaucoma is the commonest cause of irreversible blindness worldwide. Factors associated with the development of glaucoma have been examined in several studies, but not in the Chinese rural population. The China Rural Glaucoma Cohort Study (China-RG Study) was conducted to investigate the present status of glaucoma in China. METHODS: The China-RG Study is a population-based study (June–October 2018) that included 22 rural areas from ten provinces in China and enrolled 52,041 individuals (age >6 years). Participants completed a comprehensive eye examination, including visual acuity, intraocular pressure (IOP), slit-lamp microscopy, direct ophthalmoscopy, and further investigations. Associations of demographics and medical factors with glaucoma were assessed using multiple logistic regression models. Disability (YLD) and quality-adjusted life-years (QALYs) were used to express adverse health outcomes of glaucoma; cost-effectiveness analysis was conducted to evaluate the superiority of glaucoma-screening program. FINDINGS: Overall prevalence of glaucoma was 1.6% (95% CI 1.52–1.77%); 58.2%, and 19.8% had primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG), respectively. Increasing age, history of cerebral infarction, marital status, location, and family history of glaucoma were significant risk factors for both PACG and POAG. Cost–benefit analysis indicated savings of approximately 286,56.57 million yuan in direct medical expenses nationwide by adopting the proposed screening mode. INTERPRETATION: Glaucoma should be included in chronic disease-management programs in China for long-term care and continuous management of high-risk cases. The scope and inclusions of basic public health services should be expanded, especially to include ophthalmic diseases. FUNDING STATEMENT: This research was supported by the National Natural Science Foundation of China (grant no. 81830026) and the Natural Science Foundation of Tianjin (grant no. 18ZXDBSY00030) DECLARATION OF INTERESTS: The authors declare there are no competing interests. ETHICS APPROVAL STATEMENT: Ethics approval for study conduct was obtained from the institutional ethics committee of Tianjin Medical University General Hospital; all participants provided written informed consent prior to study participation.