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Editors Selection IGR 26-1

Epidemiology: 12 million Europeans with glaucoma — and half don't know it

Comment by Nicholas Tan & Ching-Yu Cheng on:

127149 Prevalence of Glaucoma in Europe and Projections to 2050: Findings from the European Eye Epidemiology Consortium, Stuart KV; de Vries VA; de Vries VA; de Vries VA; de Vries VA; Schuster AK et al., Ophthalmology, 2025; 132: 1114-1124

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Stuart and colleagues have provided an updated prevalence estimate and future projections of European glaucoma burden, based on pooled individual participant data of 55,415 adults aged ≥40 years from 14 population-based studies (1991–2020). They report an age-standardized European glaucoma prevalence of 2.99% and show that 56.4% of glaucoma in the community was previously undiagnosed. Applying finely stratified age- and sex-specific estimates to United Nations population projections , they further estimate 12.3 million people living with glaucoma in Europe in 2024, including 6.9 million undiagnosed cases, with the total projected to rise to ~13.5 million by 2050 as Europe ages. Two strengths of this study are especially worth highlighting. First, individual participant data enables finer 5 year age-band estimation and direct standardization to European age structure (exactly what burden modelling is most sensitive to). Second, they included a demographic subset of very old adults (up to >85 and even >100 years in some cohorts) whereas many prior projections effectively truncated populations (e.g., at 80 years); this matters because glaucoma is disproportionately concentrated in the oldest age groups. Their mention of Europe’s burden being “substantially higher than previously estimated” is therefore less a contradiction of older prevalence work than a correction of what earlier frameworks could count. Tham et al.1 estimated Europe’s glaucoma prevalence at ~2.93% (95% CrI: 1.85-4.40%) in adults aged 40–80, a figure notably close to Stuart et al.’s 2.99% (95% CI: 2.86-3.12%) result. Yet the earlier projected European case counts, including primary open angle glaucoma and primary angle closure glaucoma, were significantly lower at 7.12 million in 2020 and 7.85 million in 2040. This divergence arises in the translation of prevalence into number of people. Stuart et al.’s inclusion of adults >80 years-old, an age group omitted in previous projections, accounts for ~4 million additional cases. Additionally, updated European population age structures increase absolute case counts despite similar underlying age-specific prevalences. This paper also demonstrates how prevalence estimates are sensitive to how disease is defined and detected. Studies using ISGEO criteria reported lower prevalence compared to those based on clinical diagnosis, and the diagnostic approach was associated with prevalence in meta-regression. The implication is prevalence is partly a function of definition. Finally, the most policy-relevant result is the size and age-pattern of undiagnosed disease: >80% undiagnosed in those <55 years, and an overall more than half (56%) undetected, despite glaucoma long being known to be the leading cause of irreversible blindness. This finding should re-energize debates about revisiting screening for glaucoma, potentially assisted by newer advances such as AI, telemedicine, portable devices, and genetically informed risk-stratified case-finding.

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