Open-Angle Glaucoma Affects 4.8% of Chinese Americans Over 50

Longer axial length, older age, family history and diabetes were independent risk factors for open-angle glaucoma in this study. These findings underscore the need for tailored screening strategies in high-risk populations, especially those with high myopia. Click image to enlarge. Chinese Americans have been among the fastest growing minority population in the United States over the past decade. This population carries a high prevalence of myopia, putting them at risk for related diseases such as retinal detachment, cataract and open angle glaucoma (OAG). Several epidemiological studies have specifically examined OAG in urban and rural Asia-based populations of Chinese descent, but nothing comparable has been performed for Chinese descendants living in the US. A new study, published in American Journal of Ophthalmology, found the overall prevalence of OAG among this population to be 4.8%, higher than in those of European descent and Asia-based Chinese descendants.This population-based trial, dubbed the Chinese American Eye Study (CHES), included Chinese Americans aged 50 years and older, who resided in 10 census tracts of Monterey Park, CA. A total of 4,582 (79.2%) of 5,782 eligible adults underwent an interview and comprehensive eye exam between 2010 and 2013. Overall and sex-and age-stratified glaucoma prevalence estimates were calculated as the ratio of subjects with OAG to total study subjects in each category. Multivariable logistic regression identified independent risk factors associated with open-angle glaucoma. For comparison with other studies, researchers obtained age- and sex-specific prevalence data from published reports and performed direct age standardization using the age and sex distribution of the Asian population in the 2010 US Census.The final analysis included 4,310 participants with complete data. The mean age of participants was 61.4 years and 36.7% were men. The findings were as follows:The overall prevalence of OAG was 4.8% in Chinese Americans ages 50 years and older. Age-specific prevalence ranged from 2.8% among those aged 50 to 59 years to 14.8% among those aged 80 years and older. The overall prevalence of OAG was lower among women (3.85%), than among men([6.4%). The lower prevalence among women was seen mostly in younger participants. Among those aged 80 years and older, the prevalence among women and men was 16.7% and 12.7% respectively.The prevalence of ocular hypertension was 2.1% for ages 50 to 59; 3.1% for ages 60 to 69; 2% for ages 70 to 79; and 1.7% for ages 80 and over. Women and men had similar rates of ocular hypertension (2.20% vs. 2.21%).Participants with OAG had a mean IOP of 17.0mm Hg with 13.5% having an IOP >21mm Hg. Compared to those without open-angle glaucoma, participants with the condition had significantly longer axial length (24.58mm vs. 23.83mm), more negative mean deviation (-8.16 vs. -2.35 dB), greater pattern standard deviation (6.44 vs. 2.81 dB) and larger cup-disc ratios (0.7 vs. 0.4).The study authors say a notable finding was that 68.5% of CHES participants with OAG had previously undiagnosed disease. Independent risk factors for OAG, controlling for sex, included older age, higher IOP, longer axial length, family history of glaucoma and diabetes.In the discussion of their paper in AJO, the researchers say, “This high proportion of undiagnosed glaucoma highlights the importance of improving screening strategies.” They say this is consistent with other Asia-based studies done in Japan, Singapore and China, but contrasts with non-Asian populations in US Caucasians, Iceland and Italy. “Mounting evidence suggests that vascular health, oxidative stress and endothelial dysfunction interact with IOP and contribute to glaucoma pathogenesis,” the authors wrote.Central corneal thickness (CCT) was not an independent risk factor in this study. The authors say this contrasts with other populations demonstrating that CCT posed a risk among Black and Hispanic populations, as well as Chinese, Japanese and Koreans, compared to Southeast Asians, Filipinos and Pacific Islanders. “This highlights differences within Asian populations; therefore, our Chinese-American findings may not generalize to other Asian groups,” wrote the authors.Other limitations include participants who were more likely female, more educated and less likely to smoke than non-participants. “Second, the definition of glaucoma lacks a universal ‘gold standard’ and varies between experts, representing a common source of debate,” the authors wrote. “Third, longitudinal data are needed to validate identified risk factors and their relative contributions to OAG development in Chinese Americans.”This study suggests some clinical takeaways, they concluded. “The high prevalence of undiagnosed normal tension glaucoma emphasizes the need for improved screening strategies beyond IOP measurement alone,” the authors wrote. “Targeting high-risk populations including family members of glaucoma patients and individuals with high myopia may enhance screening efficiency. The strong association between longer axial length and glaucoma risk suggests that myopia prevention strategies in childhood warrant investigation as potential glaucoma prevention approaches.”Click here for the journal source. Richter, Grace M. et al. Prevalence and risk factors of open angle glaucoma in an adult Chinese American population: The Chinese American Eye Study. American Journal of Ophthalmology. August 10, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.