title: The Maccabi Glaucoma Study: prevalence and incidence of glaucoma in a large israeli health maintenance organization.
abstract: OBJECTIVE
  To investigate the prevalence and incidence of glaucoma in a large health maintenance organization (HMO) in Israel.
  
  
  METHODS
  A population-based retrospective cohort study, conducted using electronic medical database.
  
  
  METHODS
  Collected data included personal and medical characteristics.
  
  
  METHODS
  Maccabi Healthcare Services, the second-largest HMO in Israel, insuring 2 million members and serving 25% of the population with a nationwide distribution.
  
  
  METHODS
  Maccabi members from January 2003 to December 2010.
  
  
  METHODS
  Prevalence and incidence of glaucoma according to the International Classification of Diseases, 9th revision, Clinical Modification diagnostic codes.
  
  
  RESULTS
  A total of 15,708 prevalent glaucoma patients were identified among active members of Maccabi in December 2010. A total of 15,332 (97.6%) were 40 years or older, with a point prevalence of 2.2%. Prevalence of glaucoma was strongly associated with age, ranging from 0.28% at age 40-50 to 9.2% among elderly aged 80 or above. The 5 most prevalent diagnoses were open-angle glaucoma (1.61%), exfoliation glaucoma (0.20%), unspecified glaucoma (0.17%), angle closure (0.11%), and normal tension glaucoma (0.06%). We identified 6674 incident glaucoma patients diagnosed between 2003 and 2010. The observed incidence density rate among 40+-year-old members was 1.84 (1.79-1.88) new cases per 1000 person-years. Median age at diagnosis was 64 years old. The risk of glaucoma was similar between sexes up to age 70 years, and was significantly (P<.01) higher in men in older ages.
  
  
  CONCLUSIONS
  Glaucoma affects nearly 10% of the elderly population in Maccabi, with the highest risk of diagnosis at age 70-74. Since glaucoma leads to irreversible vision loss, the present estimates of morbidity should be of significant concern.
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel. Electronic address: halevko@hotmail.com.
authors.forename: Hani
authors.initials: H
authors.lastname: Levkovitch-Verbin
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Goldshtein
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Zigman
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Varda
authors.initials: V
authors.lastname: Shalev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000453:epidemiology*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies