Article

Survival time among patients with glaucomatous visual field defects

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Abstract

During our studies on glaucoma we have made an important and surprising observation. We think it is urgent to report that we have found the survival time of glaucoma patients seems to be substantially shortened. To the best of our knowledge this has not been previously reported.

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... It has been suggested that in untreated glaucoma, blindness will occur in an average of 14.4 years with intraocular pressures (IOPs) between 21 and 25 mmHg, and 6.5 years for pressures between 25 and 30 mmHg. 1 Even on treatment, an estimated 9% of the patients will become bilaterally blind after 20 years of treatment. 2 Some studies have considered glaucoma and its relationship to shortened survival, [3][4][5][6][7] Others have considered the effects of systemic disease on glaucomatous progression. 8,9 These studies, however, do not consider poor life expectancy as a factor in glaucomatous progression. ...
... Of the studies that have examined glaucoma and its relationship to shortened survival, 3-7 the majority showed some association. 3,[5][6][7] One study 5 showed the lowest survival rate to be among males using acetazolamide. In our study, of the 23 pairs of patients who could be considered for visual field progression, the male/female mix in each group was identical (Table 5). ...
Article
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To investigate the disease progression and final visual outcome of glaucoma patients with poor life expectancy, compared to matched patients with a longer life expectancy. Visual fields at diagnosis and at the last ophthalmic appointment before death were analysed for glaucoma patients referred between 1991 and 1995, and deceased before the end of 2001. These patients were matched to the patients living beyond 2001. Functional vision was also assessed, and classified as better than the NHS partial sighted criteria. A total of 61 deceased patients were identified, resulting in 40 matched pairs. In all, 6.5% of the patients with poor life expectancy progressed from functional vision to beyond partial sighted criteria, and none of the matched patients progressed to this extent. At final assessment an association between poor life expectancy and progression beyond functional vision was found existing (P = 0.02), with a lesser association at diagnosis (P = 0.06). Visual field scores of the matched pairs who had test results available for both initial and final assessment (n = 23 pairs) showed no statistically significant difference between the two groups at diagnosis (P = 0.52); However, a significant difference at final the assessment did exist (P = 0.042). No difference between the initial (off medication) intraocular pressures (IOPs) was found (P = 0.82). At the final assessment a significant difference existed (P = 0.025), with the surviving group having a higher final mean pressure (15.9 mmHg, SD 2.8, vs 18.3 mmHg, SD 4.9). Patients with poor life expectancy progressed more than the matched surviving patients, when measured from an initially similar position, despite better IOP control.
... Some studies have shown reduced survival rates for patients with open-angle glaucoma (Belloc 1963; Thorburn & Lindblom 1983;Hiller et al. 1999;Lee et al. 2003). Findings of pseudoexfoliation deposits in extra-ocular locations have led to the suggestion that exfoliation syndrome or exfoliative glaucoma might be part of a systemic process (Streeten et al. 1992) that may lead to increased mortality. ...
... Belloc (1963) reported reduced life expectancy for males and females who were legally classified as blind because of glaucoma at the age of 40 years, while only the males showed the same tendency at the age of 65 years. Thorburn & Lindblom (1983) found the survival time of patients with open-angle glaucoma and visual field defects to be substantially shortened. High intraocular pressure or the presence of glaucoma was found to be a marker for decreased life expectancy in the Framingham Eye Study cohort (Hiller et al. 1999). ...
Article
To compare the survival rates of patients with exfoliative glaucoma (XFG) and those with primary open-angle glaucoma (POAG), and to establish whether the use of acetazolamide has any influence on survival. The survival data, including date and cause of death, for 1147 patients with XFG or POAG who were ultimately hospitalized at the Eye Department, National Hospital, Oslo, between 1961 and 1970, were analysed retrospectively. The Cox proportional hazard model was used in the survival analyses. No statistically significant differences in survival were found between patients with XFG and those with POAG (p = 0.85). As expected, female gender and younger age at diagnosis were associated with longer survival periods. Surprisingly, we found that patients with more recent birth dates had relatively lower survival rates than patients with earlier birth dates; when this was included in the analyses, the use of acetazolamide was found to be associated with reduced survival (n = 492, p = 0.02).
... The results of our study are supported by many previous ndings [6,7,[16][17][18][19][20][21]. The National Health Interview Survey (NHIS) [21] reported that the probability of death from any cause occurring over a median of seven years of follow-up was higher (HR: 1.35, 95% CI: 1.19-1.53) ...
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Objective: To investigate the association between glaucoma and mortality in the older population. Design: Population-based, prospective cohort study. Participants: Participants aged 45 years or older at baseline (47.9% male) were enrolled in 2011 for the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality of the participants was observed during seven years of follow-up. Methods: The baseline data were collected in the 2011 CHARLS, and participants were followed up for seven years (until 2018). The risk of all-cause mortality was examined using Cox proportional hazards regression with age as the time scale, adjusting for significant risk factors and comorbid conditions. Main outcome measures: Mortality, resulting from all causes. Results: Among the 14,803 participants included, the risk of all-cause death was significantly higher among people with glaucoma than among those without glaucoma, after adjustment for other confounders (hazard ratio [HR]: 2.159, 95% confidence interval [CI]: 1.549-3.008). In a subgroup analysis based on the mean age of death, among those who were 75 years and older (n = 563), the risk of all-cause death was significantly higher in patients with glaucoma than in those without glaucoma (HR: 1.907, 95% CI: 1.249-2.911). Conclusions: Participants with glaucoma were at an increased risk for all-cause mortality, especially those participants aged 75 years and above. Our findings revealed possible underlying mechanisms creating the association between glaucoma and all-cause mortality, and they highlighted the importance of glaucoma management to prevent premature death in middle-aged and older adults.
... Influences on survival of glaucoma patients include a possible impact of the glaucoma itself, as well as adverse treatment effects, for instance eye drops (Epstein & Kaufman 1965, Ballin et al. 1966, Kerr et al. 1982, Diggony & Franks 1996 and acetazolamide (Nilsson & Sandholm 1985), and association with other diseases which may increase the mortality (Waldmann et al. 1996). Belloc (1963), Thorburn & Lindblom (1983), and Bengtsson (1984) have previously commented on survival among glaucoma patients. Blika and coworkers studied 5-year survival of 737 glaucoma patients from a geographical region in middle Norway in an unpublished paper from 1993 (personal communication). ...
Article
To investigate the survival of patients with capsular or simple glaucoma compared with that of the common population, with particular attention to the impact of sex and use of acetazolamide (Diamox). The 30 year survival of 1147 patients with capsular or simple glaucoma who were finally hospitalized at the Eye Department, Rikshospitalet, Oslo, from 1961 to 1970, are analysed, using log rank tests. The time varying impacts of sex and acetazolamide on survival are also studied using a regression model. There was a significant increased mortality for patients with acetazolamide, and for men also those not using it. The observed mortality for men was initially lower than the average Norwegian population, but later the mortality increased more rapidly in the glaucoma group. This may be explained by a selection of the healthiest patients to Rikshospitalet, and actually indicates that the excess mortality is even higher than calculated here. The analysis of data indicated increased mortality for glaucoma patients when the disease had lasted for some time. This was especially pronounced for men using acetazolamide. A similar study from a period when acetazolamide was not in common use and an analysis of causes of death is also asked for.
... Several studies have indicated decreased life expectancy for patients with open-angle glaucoma (Belloc 1963; Thorburn & Lindblom 1983;Egge & Zahl 1999;Hiller et al. 1999;Lee et al. 2003). Pseudoexfoliation used to be considered a condition of purely ophthalmological interest. ...
Article
To investigate whether type of glaucoma or use of acetazolamide are associated with main cause of death and comorbidity. The survival data, including date and cause of death, for 1147 patients with capsular or simple glaucoma who were ultimately hospitalized at the Eye Department, National Hospital, Oslo, between 1961 and 1970, were analysed. Binary logistic regression was carried out to investigate the patterns of death causes and comorbidity in subgroup analyses. Patients with exfoliative glaucoma (XFG) and those with primary open-angle glaucoma (POAG) showed no significant differences in rates of death caused by acute cerebrovascular diseases, cardiac diseases and cancer. Interestingly, we found that chronic cerebral diseases such as senile dementia, cerebral atrophy and chronic cerebral ischaemia (n = 81) were more common in patients with XFG than in those with POAG (p = 0.01) and in the group of acetazolamide users (p = 0.03). Patients with XFG had a higher probability of developing an acute cerebrovascular disease than patients with POAG (n = 228, p = 0.03). In this retrospective study, we found that comorbidity with acute cerebrovascular disease and chronic cerebral diseases (senile dementia, cerebral atrophy and chronic cerebral ischaemia) were more common in patients with XFG than in patients with POAG. Prospective data are needed in order to conclude upon the associations found in this study.
Article
To compare mortality rates in glaucoma patients and matched controls from a large population screening as well as glaucoma patients diagnosed through routine clinical examination (self-selected patients). A population-based screening of 32,918 elderly citizens of Malmö was conducted between 1992 and 1997. Individuals with newly detected, previously untreated open-angle glaucoma were identified. Two controls of the same age and gender were chosen among the screening negative participants for each patient. From the same birth cohorts, glaucoma patients seen in routine clinical practice (self-selected patients) were identified through retrospective examination of patient records from the Eye Department at Malmö University Hospital. The number and time of deaths for each group were determined based on centrally administered registers. Mean follow-up time was 7.75 years. Five-year mortality did not differ significantly between the groups, and was 9.2% among glaucoma patients from the screening (n=402), and 11.9% among the controls (n=804; p=0.7406). Self-selected glaucoma patients had a 5-year mortality of 8.5% (n=354), not significantly different from the screening-detected glaucoma patients (p=0.1361). Among glaucoma patients, neither IOP (p=0.1781) nor pseudoexfoliation (p=0.8882) was related to significantly increased mortality. The results of this study strongly suggest that the life expectancy of glaucoma patients does not differ from the population at large.
Article
To study mortality in subjects with age-related maculopathy (ARM), cataract, or open-angle glaucoma (OAG) in comparison with those without these disorders. Population-based prospective cohort study. Subjects (n = 6339) aged 55 years and older from the population-based Rotterdam Study for whom complete information on eye disease status was present. Vital status continuously monitored from 1990 until January 1, 2000. The diagnosis of ARM was made according to the International Classification System. Cataract, determined on biomicroscopy, was defined as any sign of nuclear or (sub)cortical cataract, or both, in at least one eye with a visual acuity of 20/40 or less. Aphakia and pseudophakia in at least one eye were classified as operated cataract. Definite OAG was defined as a glaucomatous optic neuropathy combined with a glaucomatous visual field defect. Diagnoses were assessed at baseline. Mortality hazard ratios were computed using Cox proportional hazard regression analysis, adjusted for appropriate confounders (age, gender, smoking status, body mass index, cholesterol level, atherosclerosis, hypertension, history of cardiovascular disease, and diabetes mellitus). The adjusted mortality hazard ratio for subjects with AMD (n = 104) was 0.94 (95% confidence interval [CI], 0.52-1.68), with biomicroscopic cataract (n = 951) was 0.94 (95% CI, 0.74-1.21), with surgical cataract (n = 298) was 1.20 (95% CI, 0.86-1.68), and with definite OAG (n = 44) was 0.39 (95% CI, 0.10-1.55). Both ARM and cataract are predictors of shorter survival because they have risk factors that also affect mortality. When adjusted for these factors, ARM, cataract, and OAG were themselves not significantly associated with mortality.
Article
To examine whether high intraocular pressure (greater than or equal to 25 mm Hg) or a history of treatment for glaucoma is associated with decreased survival and, if so, how such ocular markers might be explained. Eye examinations, including applanation tonometry, were conducted on members of the Framingham Eye Study cohort from February 1, 1973, to February 1, 1975. Participants who reported a history of treatment for glaucoma were identified. Survival data, including information on the date of death, were available from the time of the Eye Study through March 31, 1990. Of the 1,764 persons under the age of 70 years at the baseline eye examination, 1,421 persons had low intraocular pressure (< or =20 mm Hg), 264 persons had medium intraocular pressure levels (20 to 24 mm Hg), and 79 persons had high intraocular pressure (> or =25 mm Hg) or history of glaucoma treatment. During the follow-up period, 29%, 30%, and 47% died in the groups with low, medium, and high intraocular pressure (or history of glaucoma treatment), respectively. In an age-and-sex adjusted Cox proportional hazards analysis, the death rate ratio for the group with medium intraocular pressure relative to the group with low intraocular pressure was 1.04. The corresponding death rate ratio for the group with high intraocular pressure was 1.56 with a 95% confidence interval of 1.11 to 2.19 (P < .001). After adjustment for age, sex, hypertension, diabetes, cigarette smoking, and body mass index, a positive relationship remained, but at a borderline level of significance (P = .075). High intraocular pressure or the presence of glaucoma is a marker for decreased life expectancy in the Framingham Eye Study cohort. The relationship is present even after adjustment for risk factors known to be associated with higher mortality such as age, sex, hypertension, diabetes, cigarette smoking, and body mass index. Special attention to the general health status of patients with high intraocular pressure or glaucoma seems warranted.
Article
Prevalence data for primary open angle glaucoma (POAG), taken from eight population surveys, was smoothed by curve-fitting to derive composite estimates with respect to quinqennial age groups from 40-44 to 85-89 years. These were applied to national population figures to provide a distribution of cases with respect to age. Estimated prevalence for age 40-89 years in mainly white Caucasian people was 1.2%, rising from 0.2% for those in their 40s to 4.3% for those in their 80s. Of the total cases, 7% were less than 55 years old, 44% were aged 55-74 years, and 49% were older. 'Implied incidence' was estimated from the prevalence results, being 0.11% per year in people aged 55 to 74 years. The analysis applied to relatively narrow definitions of POAG. If 'probable' cases and also 'ocular hypertensives requiring treatment' (of relevance for glaucoma screening) were included, the prevalence would be almost twice as high. Also, a larger proportion of potential cases for a screen would be less than 55 years old, partly because the average age of incident (i.e., newly developed) cases is less than that of prevalent (i.e., all existing) cases.
Article
Purpose: To determine the burden of undetected and untreated glaucoma in the noninstitutionalized population over the age of 40 years in the United States of America (US). Design: Cross-sectional study. Methods: setting: US civilian, noninstitutionalized population from the 2005-2006 and 2007-2008 administrations of the National Health and Nutrition Examination Survey that were 40 years old or older with completed retinal photographs, completed interview question regarding prior diagnosis of glaucoma, and a negative response to questions regarding comorbidities. main outcome measures: Prevalence of self-reported glaucoma history; signs of glaucoma damage seen in retinal photographs and perimetry; prevalence of undiagnosed glaucoma; and comparison of demographic factors using odds ratios to identify populations with highest burden of previously undiagnosed glaucoma. Results: The study population included 3850 participants who met the inclusion criteria. The 99.5th percentile of the vertical cup-to-disc ratio was 0.67 and the 99.5th percentile of the vertical cup-to-disc ratio asymmetry between eyes was 0.26. Prevalence of undiagnosed glaucoma was 2.9%, increasing with age to 6.6% of the population over 70 years old. Among those with glaucoma, 78% were previously undiagnosed and untreated. Blacks have roughly 4.4 times (95% confidence interval [CI]: 2.9-6.7; P < .0001) and Hispanics have roughly 2.5 times (95%CI: 1.5-4.3; P = .0012) greater odds of having undiagnosed and untreated glaucoma than non-Hispanic whites. Conclusions: Approximately 2.4 million persons in the US have undetected and untreated glaucoma. Overall, prevalence of both diagnosed and undiagnosed glaucoma is much higher in minorities and the elderly. Among those with definite glaucoma, individuals younger than 60 years of age have a greater proportion of undetected disease.
Article
Elderly ophthalmic out-patients that had visited an eye-clinic were searched in a population register 7 years later. Observed numbers of survivors were compared with those expected according to appropriate life tables. Most observed numbers of survivors came close to the expected ones. Patients, aged more than 80 years when visiting the eye-clinic, had, however, a consistently increased survival rate. Glaucoma patients, less than 80 years old, had a slightly (not significantly) lower survival rate than expected.
Article
In this population-based screening study, dealing with 1941 persons above 64 years of age from three different municipalities, the overall open-angle glaucoma prevalence was found to be 8.3%. The prevalence in the separate areas (7.0%, 8.6%, and 9.5%) were not statistically different. Roughly 30% of the population with pseudo-exfoliation syndrome had glaucoma, and 4.2% had ocular hypertension, whereas the corresponding figures for those without pseudo-exfoliation were 4% and 0.8%, respectively. The high glaucoma rates are partly due to the high pseudo-exfoliation prevalence in the area. The prevalence of the capsular glaucoma increased towards a maximum between 75 and 79 years of age, whereafter the curve declined. This may indicate reduced survival time of glaucomatous patients.
Article
Recent studies have reported a connection between glaucoma and decreased survival. To evaluate the underlying causes of glaucoma-related mortality, we searched vital records data for deaths citing glaucoma and reviewed the demographic variables and comorbidities contained on these records. Deaths including glaucoma, as either an underlying cause or a contributing cause of death, were selected from US multiple-cause-of-death data for the years 1990 to 2003 and combined with population data from the US Census Bureau to calculate mortality rates. Logistic regression was used to determine whether reporting of accidents and/or selected systemic disorders are associated with glaucoma on the death certificate. Fifteen thousand two hundred twenty-eight glaucoma-related deaths (0.05%) were identified during the years under study. Black males had the highest glaucoma-related mortality rate with 9.4 deaths per 1,000,000 persons annually, whereas Hispanic females had the lowest mortality rate at 1.8 deaths per 1,000,000. After adjusting for age, sex, and race/ethnicity, positive associations were found between glaucoma and hypertension [Odds ratio (OR): 4.89; 95% confidence interval (CI)=4.73-5.05], diabetes (OR: 2.60; 95% CI=2.50-2.71), asthma (OR: 3.14; 95% CI=2.72-3.62), and accidents of all types (OR: 1.45; 95% CI=1.35-1.55). Glaucoma is an important contributor to mortality for certain individuals. The disparities in mortality rates observed among race/ethnic strata may be attributed to differences in access to care as well as true differences in disease incidence and/or severity among racial groups. Despite limitations with the data, our findings suggest associations between glaucoma and a number of comorbid conditions. These associations should be explored in future studies and serve to guide strategies for disease management and prevention.
Article
To conduct a meta-analysis to estimate the relationship between primary open-angle glaucoma (POAG) and mortality. A systematic search of the PubMed, Embase, and Web of Science databases yielded 9 cohort studies with relative risk (RR) estimates for all-cause mortality. The studies were critically reviewed by an expert in the field. The data were extracted and analyzed in a pooled analysis by the random-effects model. Meta-regression to assess for heterogeneity by several covariates and subgroup analysis on cardiovascular mortality were performed. A significant risk was not detected in the final pooled analysis (RR, 1.13; 95% confidence interval [CI], 0.97-1.31) for all-cause mortality. A meta-regression across mean follow-up time, age, and sex was not significant. A meta-regression across diabetes status in 3 of the 9 studies did not demonstrate significant results (P = .94). Subgroup analysis on cardiovascular mortality from 4 of the 9 studies was marginally significant (RR, 1.20; 95% CI, 1.00-1.43; P = .05), but insignificant after removal of a study in which POAG was ascertained by self and proxy report (RR, 1.12; 95% CI, 0.87-1.46). This meta-analysis does not demonstrate an association between POAG and all-cause or cardiovascular mortality.
Article
To evaluate the relationship between glaucoma medication use and death. This study uses longitudinal data from 2003 to 2007 on persons 40 years and older with glaucoma or suspected glaucoma enrolled in a large managed care network. Cox regression analysis was performed to estimate the hazard of death associated with the use of various glaucoma medication classes and combinations thereof. Multivariable models were adjusted for demographic characteristics and comorbid medical conditions. Of 21 506 participants with glaucoma or suspected glaucoma, 237 (1.1%) died during the study period. The use of any class of glaucoma medication was associated with a 74% reduced hazard of death (adjusted hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.16-0.40) compared with no glaucoma medication use. This association was observed for use of a single agent alone, such as a topical beta-antagonist (0.44; 0.24-0.83) or a prostaglandin analogue (0.31; 0.18-0.54), and for use of different combinations of drug classes. After adjustment for potential confounding variables, the use of glaucoma medications was associated with a reduced likelihood of death in this large sample of US adults with glaucoma. Future investigations should explore this association further because these findings may have important clinical implications.
Article
The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.
Article
To evaluate the association between open-angle glaucoma (termed glaucoma) and 9-year mortality in an older population-based cohort. Population-based cohort. Three thousand six hundred fifty-four persons aged 49 to 97 years (82.4% of the eligible population), residents of the Blue Mountains, west of Sydney, Australia. At baseline (1992-1994), glaucoma was diagnosed from congruous typical glaucomatous visual field changes (full-threshold fields) and optic disc cupping (stereo-optic disc photography). Demographic information from baseline participants was matched with the Australian National Death Index data (December 2001) to obtain the number and causes of deaths. Cox proportional hazards regression analysis, controlling for age, male gender, diabetes, hypertension, heart disease, stroke, use of oral beta-blockers, current smoking history, alcohol use, myopia, and nuclear cataract were performed to assess hazard ratios for cardiovascular mortality. Adjustments for all-cause mortality also included history of cancer. Cardiovascular and all-cause mortality. At baseline, glaucoma was diagnosed in 108 participants (3.0%). Of 873 deaths (23.9%) before January, 2002, 312 people (8.5%) died of cardiovascular events. The age-standardized all-cause mortality was 24.3% in persons with and 23.8% in those without glaucoma, whereas cardiovascular mortality was 14.6% in persons with and 8.4% in those without glaucoma. After multivariate adjustment, those with glaucoma had a nonsignificant increased risk of cardiovascular death (relative risk [RR], 1.46; 95% confidence interval [CI], 0.95-2.23). Increased cardiovascular mortality was observed mainly in glaucoma patients aged <75 years (RR, 2.78; 95% CI, 1.20-6.47). Further stratified analyses showed that cardiovascular mortality was higher among those with previously diagnosed glaucoma (RR, 1.85; 95% CI, 1.12-3.04), particularly in those also treated with topical timolol (RR, 2.14; 95% CI, 1.18-3.89). Findings from the Blue Mountains Eye Study demonstrate an increased cardiovascular mortality in persons with previously diagnosed glaucoma. There was a suggestion of higher cardiovascular mortality in glaucoma patients using topical timolol that merits further study.
Article
The present study was based on already existing clinical data concerning 599 persons born before 1907, examined during a general ophthalmic survey 1969-72 and still remaining in the same district in July 1980. At the survey 1969-72, 19 out of 1057 persons had manifest glaucoma, 14 were already treated for ocular hypertension, 54 had an IOP greater than 20.5 mmHg and 970 were considered normal. Immediately after the survey, 17 patients were treated for manifest glaucoma and 19 for ocular hypertension. During the following 9 years treated persons were lost to a greater extent (64%) than untreated persons (43%). In July 1980 only 6 persons treated for manifest glaucoma since the survey remained, and 3 of them were socially blind. One out of 7 treated and 2 out of 28 untreated persons with ocular hypertension at the survey had developed visual field defects 9 years later. Manifest glaucomas, often advanced cases, were also detected in 9 persons considered normal at the survey. 5 out of 12 persons with manifest glaucoma detected after the survey had an IOP less than 20.5 mmHg at detection. The visual capacity of persons still remaining in the district 1980 was largely independent of all efforts to prevent blindness from glaucoma in the present population.