Primary Angle Closure Glaucoma in East Asia: Educational Attainment as a Protective Factor

Abstract

Purpose: To examine the relationship between education, other risk factors and incident primary angle closure glaucoma (PACG).

Method: Glaucoma was excluded in a group of 4597 Mongolian volunteers in 1999. After 6 years, 1892 traced participants had full ophthalmic examination, dilated disc photographs and agreed to complete a questionnaire on socio-economic status. PACG was diagnosed using both structural and functional evidence from objective grading of paired disc photographs, follow up visual fields and clinical examination. Ophthalmic examination included van Herick grading, Goldmann intraocular pressure (IOP), gonioscopy, lens opacity grading and dilated disc examination. Central anterior chamber depth, lens thickness and axial length were recorded using ultrasound A scan mounted on a slitlamp. Education level was assessed using national census categories.

Results: PACG was diagnosed in 29 participants (6 year incidence = 1.53%, 95% confidence interval (CI) = 1.03–2.19%). In univariate analysis, risk factors for incident PACG included presence of refractive error, narrow van Herick grading of ≤15%, narrower average Shaffer grading, higher IOP, larger cup disc ratio and lower levels of education. In multivariate analysis, adjusted for age, sex, Shaffer grading, refractive error and IOP, those with no formal education were approximately 7 times more likely to develop PACG compared to those with >8 years of formal schooling (OR = 7.27, 95% CI = 2.73–19.38).

Conclusions: People with lower levels of education have a higher risk of incident PACG, independent of age, sex, IOP and axial length.

Keywords::

• Glaucoma (angle closure)
• Socioeconomic status
• Risk factors

ACKNOWLEDGMENTS

Financial Support: The Wellcome Trust, British Council for Prevention of Blindness (London), Christian Blind Mission (CBM) (Bensheim), The National Lotteries Fund through Fight for Sight (London). The Yag laser used in this study was donated by the Velux Foundation, Copenhagen. The authors acknowledge a proportion of their financial support from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.