Incidence and Prevalence of Uveitic Glaucoma Declined Since 2013

Decreasing incidence and prevalence of uveitic glaucoma may be attributed to more cautious usage of corticosteroids and increased steroid-sparing immunomodulatory treatments, as well as earlier and more aggressive treatment of ocular hypertension in uveitis patients, study suggests. Photo: Joseph Sowka, OD. Click image to enlarge. Several studies have been conducted exploring the incidence and prevalence of uveitis, and others investigated the rates of glaucoma in uveitis populations, but few have put the two together. In a recent study, researchers assessed the cumulative and yearly prevalence and incidence of uveitic glaucoma in the TriNetX database between 2013 and 2022. They found that the incidence and prevalence rates of uveitic glaucoma have been decreasing since 2013, and patients with both anterior and intermediate uveitis had the highest relative rates of glaucoma, as well as the highest rates of ocular hypertension and corticosteroid response. The findings were reported in American Journal of Ophthalmology.A total of 30,681 patients with uveitis and glaucoma, ocular hypertension or corticosteroid response diagnosed on the same day or after the onset of uveitis were identified.Patients with both anterior and intermediate uveitis had the highest rates of uveitic glaucoma, followed by anterior, panuveitis, endophthalmitis, intermediate and posterior. Anterior and intermediate uveitis patients also had the highest rates of ocular hypertension and corticosteroid response.The average age of the cohort at presentation was 67 years, 55% were female and 50.7% were Caucasian. Among the uveitis population, 15.5% of patients developed glaucoma in the 10-year time period. The cumulative incidence of uveitic glaucoma was five per 100,000 and the cumulative prevalence was 27 per 100,000 between 2013 and 2022.“Although the number of prevalent and incident cases of uveitic glaucoma increase per year, the annual total population within the database increases at a more rapid pace, resulting in decreasing incidence and prevalence rates,” the authors wrote in their American Journal of Ophthalmology paper.The slight increase in incidence from 2021 onward may reflect the post-pandemic influx of patients returning for care. This coincides with a slight decrease in prevalence from 2019 onward which may reflect pandemic losses of patients and decreased ophthalmic care during the pandemic.Previous studies have shown that damage from anterior uveitis, including posterior synechiae, inflammatory debris accumulation and alteration in protein content in the aqueous humor can cause morphological changes in the angle, lending these patients more prone to developing glaucoma. In this study, patients with anterior and intermediate uveitis may have had higher rates of glaucoma and ocular hypertension due to more severe inflammatory reactions than patients with a sole diagnosis of anterior uveitis.“Interestingly, patients with a diagnosis of both anterior and intermediate uveitis also had the highest rates of corticosteroid response. This may be due to patients with these diagnoses often requiring more potent and/or long-term intraocular corticosteroids to control their ocular inflammation than anterior uveitis patients,” the authors explained in their article.The authors noted that sarcoidosis was found to be a leading disease associated with uveitic glaucoma. This didn’t surprise them, as they pointed out that prior studies reported 34% of sarcoidosis-associated uveitis develop glaucoma, most likely due to inflammatory debris and sarcoid nodules obstructing the trabecular meshwork that can cause rises in intraocular pressure.Click here for the journal source. Marshall RF, Lee D, Thorne JE, et al. Incidence and prevalence of glaucoma, corticosteroid response and ocular. Hypertension in uveitis and its anatomical subtypes. Amer J Ophthalmol. May 29, 2025. [Epub ahead of print.]