Commentary: Glaucoma in patients aged less than 40 years: A growing concern

Glaucoma, an age-related progressive optic neuropathy, is the second most common cause of global irreversible blindness worldwide.[1,2,3] By virtue of irreversibility, it understandably assumes high social importance, with its ever-increasing prevalence and the colossal projected estimates of the visual burden it may impose on the health system in the next two decades.[3]

Early diagnosis is always considered key in preventing blindness and for effective glaucoma treatment, with special focus on the elderly who need assistance and care.[1,3] The economic cost from glaucomatous visual impairment directly influences the daily functional quality of the individual and therefore is a challenge to eye health services if the disease is known to be asymptomatic.[1,3,4] While the effect of reduced threatened productivity is easily understood with a chronic blinding disease in the elderly population, such estimates in the younger population would have varied proportions and aftermaths. Therefore, knowing the clinical profile of glaucoma in younger patients or its value on resource allocation and societal burdens cannot be underestimated.[5] This study, while adding new information on the profile of glaucoma in patients aged < 40 years, also draws a parallel from previous studies that reported a male preponderance of the disease. However, this could also reflect the low socioeconomic strata of patients that precludes access to tertiary level care in that population or region. Yet, these regional population-specific peculiarities of glaucoma in any setup is a valuable tool for clinical stratification and for formulating recommendations to policymakers. One such focus would be to increase the access of women in low access areas to tertiary eye care; it can be enhanced with telemedicine or by enabling referral/travel to higher centers.[6]

This study concurs with previous literature on profiles of glaucoma seen at tertiary care centers with patients aged <40 years being diagnosed as juvenile open-angle glaucoma (JOAG).[7] The total combined percentage of childhood, JOAG, and secondary glaucoma in such studies range from 9%–11%, which is close to what this study reports. Secondary glaucoma understandably would be the most common form of glaucoma in this age group. It may also have been possible that primary glaucoma or angle-closure disease seen in this cohort may have been patients with plateau iris which needs further investigations. While secondary glaucoma may have been the predominant emergencies served during COVID, this study also reflects the possibility that these may reflect the differences in profiles of patients seeking care at a tertiary eye care versus private clinics or rural areas. Nevertheless, this study reports important highlights and reflects the visual burden of glaucoma in the younger population too. This is an important guide for decision-making and formulating outreach services for the underprivileged and policymakers alike.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.