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    Why primary angle-closure glaucoma is declining in Scotland


    What factors could explain these trends? During this period, the mid-year estimates of the Scottish population increased by 4.6% The Scottish population under 50 years of age remained stable during this period while the population 50 years and older rose from 1.7 million to 2.1 million.

    From the work of others, Gillan and colleagues said cataract surgery is being performed more frequently and at a younger age in the United Kingdom.

    The beginning of the study period paralleled the kickoff of the U.K. Department of Health “Action on Cataracts” project. This initiative is designed to improve access to care for patients in need of cataract surgery, and to reduce variations in waiting times for cataract surgery.

    The increased efficiency of the patient pathway succeeded in “massively increasing surgical throughput,” Gillan and colleagues wrote.

    However, increasing rates of cataract surgery may not provide the only explanation for the decline in APACG, they wrote.

    Work done by the International Society for Geographical and Epidemiological Ophthalmology has tightened the definition and classification of APACG. The European Glaucoma Society and the American Academy of Ophthalmology have endorsed this narrower definition. As a result, clinicians may be using the diagnosis less often, creating the perception of a decline in cases.

    As for the peripheral iridotomy rates, increasing cataract rates could explain the decline in the first decade of the study period.

    The authors attributed the subsequent increase to the introduction of the new General Ophthalmic Services contract in Scotland in 2006, providing free eye care services by optometrists.

    Mandatory examinations

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