Risk factors for previously undiagnosed primary open-angle glaucoma: The EPIC-Norfolk Eye Study

Michelle P.Y. Chan*, Anthony P. Khawaja, David C. Broadway, Jennifer Yip, Robert Luben, Shabina Hayat, Tunde Peto, Kay Tee Khaw, Paul J. Foster

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and aim: Undiagnosed glaucoma is an invisible but important public health issue. At least half of glaucoma cases are estimated to be undiagnosed in western populations. The aim of this study is to examine risk factors for previously undiagnosed primary open-angle glaucoma (POAG). Design: Cross-sectional study within the European Prospective Investigation of Cancer-Norfolk Eye Study, a large-scale cohort study in the UK. Participants: 314 study participants with POAG in either eye. Methods: Logistic regression was used to examine associations with previously undiagnosed POAG compared with previously diagnosed POAG. The factors examined included sociodemographic, ocular, physical and economic factors that could be barriers to eye care access. Results: 217 participants had previously diagnosed POAG and 107 participants were newly diagnosed with POAG during the study. After adjusting for covariables, the factors significantly associated with previously undiagnosed POAG were: A lower pretreatment intraocular pressure (IOP) (OR 0.71/mm Hg, 95% CI 0.63 to 0.80, p<0.0001), and to have reported no problems with their eyesight (OR 0.03, 95% CI 0.01 to 0.10, p<0.0001). Conclusions: The risk factors for previously undiagnosed POAG identified in this study highlight the over-reliance on IOP level in glaucoma screening and the risk of missing glaucoma among lower IOP cases. It also suggests a role in improving glaucoma awareness in the community.

Original languageEnglish
JournalBritish Journal of Ophthalmology
Publication statusAccepted/In press - 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.


  • epidemiology
  • glaucoma


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