title: Burden of undetected and untreated glaucoma in the United States.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: General Preventive Medicine Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Shaikh
authors.affiliation: Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.affiliation: Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California. Electronic address: colemana@ucla.edu.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Coleman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D015995:Prevalence; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology