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Roger C. W. Wolfs, Petra H. Borger, Raan S. Ramrattan, Caroline C. W. Klaver, Caroline A. A. Hulsman, Albert Hofman, Johannes R. Vingerling, Roger A. Hitchings, Paulus T. V. M. de Jong; Changing Views on Open-Angle Glaucoma: Definitions and Prevalences—The Rotterdam Study. Invest. Ophthalmol. Vis. Sci. 2000;41(11):3309-3321.
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purpose. To create a quantitative basis for diagnostic criteria for
open-angle glaucoma (OAG), to propose an epidemiologic definition for
OAG based on these, and to determine the prevalence of OAG in a general
methods. Of the 7983 subjects 55 years of age or older participating in
the population-based Rotterdam Study, 6756 subjects participated in the
ophthalmic part of this study (6281 subjects living independently and
475 in nursing homes). The criteria for the diagnosis of OAG were based
on ophthalmoscopic and semiautomated Imagenet estimations of the optic
disc such as vertical cup-to-disc ratio (VCDR), minimal width of neural
rim, or asymmetry in VCDR between both eyes, and visual field testing
with kinetic Goldmann perimetry. All criteria for the diagnosis of OAG
were assessed in a masked way independently of each other.
results. Mean VCDR on ophthalmoscopy was 0.3 and with Imagenet
0.49, and the 97.5th percentile for both was 0.7. The prevalence of
glaucomatous visual field defects was 1.5%. Overall prevalence of
definite OAG in the independently living subjects was 0.8% (95%
confidence interval [CI] 0.6, 1.0; 50 cases). Prevalence of OAG in
men was double that in women (odds ratio 2.1; 95% CI 1.2, 3.6).
Different commonly used criteria for diagnosis of OAG resulted in
prevalence figures ranging from 0.1% to 1.2%.
conclusions. The overall prevalence of OAG in the present study was
comparable to most population-based studies. However, prevalence
figures differed by a factor of 12 when their criteria for OAG were
applied to this population. A definition for definite OAG is
proposed: a glaucomatous optic neuropathy in eyes with open angles in
the absence of history or signs of secondary glaucoma characterized by
glaucomatous changes based on the 97.5 percentile for this population
together with glaucomatous visual field loss. In the absence of the
latter or of a visual field test, it is proposed to speak of probable
OAG based on the 99.5th or possible OAG based on the 97.5th percentiles
of glaucomatous disc changes for a population under
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