Glaucoma and intraocular pressure in EPIC-Norfolk Eye Study: cross sectional study.

Objectives  To report the distribution of intraocular pressure (IOP) by age and sex and the prevalence of glaucoma. Design  Community based cross sectional observational study. Setting  EPIC-Norfolk cohort in Norwich and the surrounding rural and urban areas. Participants  8623 participants aged 48-92 recruited from the community who underwent ocular examination to identify glaucoma. Main outcome measures  Prevalence and characteristics of glaucoma, distribution of IOP, and the sensitivity and specificity of IOP for case finding for glaucoma. Results  The mean IOP in 8401 participants was 16.3 mm Hg (95% confidence interval 16.2 mm Hg to 16.3 mm Hg; SD 3.6 mm Hg). In 363 participants (4%), glaucoma was present in either eye; 314 (87%) had primary open angle glaucoma. In the remaining participants, glaucoma was suspected in 607 (7%), and 863 (10.0%) had ocular hypertension. Two thirds (242) of those with glaucoma had previously already received the diagnosis. In 76% of patients with newly diagnosed primary open angle glaucoma (83/107), the mean IOP was under the threshold for ocular hypertension (21 mm Hg). No one IOP threshold provided adequately high sensitivity and specificity for diagnosis of glaucoma. Conclusions  In this British community, cases of glaucoma, suspected glaucoma, and ocular hypertension represent a large number of potential referrals to the hospital eye service. The use of IOP for detection of those with glaucoma is inaccurate and probably not viable.