The number of people over 40 in the UK living with glaucoma—the leading cause of irreversible blindness worldwide—is already higher than expected and is projected to surge to more than 1.6 million by 2060, finds research published online in the British Journal of Ophthalmology.
This is equivalent to a rise of 60% on 2025 figures, and outpaces the projected 28% population increase in the over 40s over the same period, say the researchers.
This trend will be driven by an increasingly ageing population and growth in the proportion of higher risk ethnically diverse groups, prompting the need for an expansion in eye health services to meet demand, they emphasise.
Previous estimates suggest that around 700,000 people are living with glaucoma in the UK, but this figure probably doesn't accurately reflect population demographics, say the researchers.
This is especially important because glaucoma isn't symptomatic until its later stages, they point out. And late diagnosis is a major risk factor for sight loss, with over 40% of patients in the UK experiencing preventable vision impairment due to treatment delays.
To generate revised current estimates and future projections that better capture the UK's evolving demography, the researchers drew on the most recent population census data (2021-22) and published clinical prevalence estimates of glaucoma for their analysis.
They focused on people aged at least 40, as glaucoma is rare below this age, and grouped them by 5-year age bands, sex, and 4 broad ethnic categories: European; African; Asian; and mixed/other.
The numbers of those aged 40 and older added up to just over 34 million people, most of whom (30,215,460, around 89%) lived in England and Wales; nearly 3 million lived in Scotland (around 9%), and just under 1 million in Northern Ireland.
The age distribution typified an ageing population of an industrialised nation, with the over 65s making up over a third (37%) of UK adults aged 40+. Women accounted for just over half (52%) of this age group, and ethnic composition was predominantly European (88.5%), followed by Asian (6%), African (3%), and mixed/other (2.5%).
Of the 34 million people aged at least 40, 1,019,629 (3%) currently have glaucoma, the researchers estimate. And estimates stratified by age indicate an increase from around 10,000 (0.25%) of those aged 40–44 to nearly 173,000 (11%) of those aged 85+.
Prevalence was slightly higher in men (just over 3%) than it was in women (just under 3%), with this sex difference more pronounced in older age groups.
African ethnic groups had the highest overall prevalence (4%) and Asian populations the lowest (just under 2.5%).
Among people of European ancestry, the largest number of cases occurred in the oldest age group (85+), reflecting a relatively older population distribution, with 39% of Europeans aged 65 or older.
Prevalence among African ethnic groups peaked in 55–59 year olds, reflecting a younger demographic distribution, with only about 16% aged 65+. Asian and mixed/other groups also had younger age structures, with 20% and 17%, respectively, aged 65+.
Although non-European groups represent only 6% of the UK population aged 65 and older, they account for an estimated 8% of current glaucoma cases, the estimates indicate.
Based on the available data, the number of people with glaucoma is projected to rise to 1.61 million by 2060, say the researchers. This corresponds to a 60% rise in cases on 2025 figures, despite only a 28% increase in the over 40s during the same period.
This trend will be driven by an ageing population, especially those aged 75+, and the growth in the proportion of higher risk ethnically diverse groups, suggest the researchers.
"These demographic shifts are anticipated to amplify the burden of glaucoma on the healthcare system over the forthcoming decades, underscoring the need for targeted public health strategies and long-term healthcare planning to address the growing demand," they explain.
"The projected increase in numbers of those affected by glaucoma will place considerable strain on ophthalmic services, necessitating expansion in specialist care, diagnostic capacity or innovative transformation of long-term management services," they point out.
"Furthermore, the higher prevalence among the growing non-European populations highlights the need to develop refined and targeted awareness campaigns and early detection strategies," they add.
In a linked editorial, Dr Alexander Schuster of the University of Mainz, Germany, and Dr Cedric Schweitzer of the Bordeaux Population Health Research Center, France, echo these sentiments.
"This increase underlines a critical need for strategies that go beyond treatment options, focusing on evidence-based healthcare planning, including structured case detection, resource allocation for disease surveillance, and treatment to prevent visual impairment and blindness at older age," they write.
They cite Swedish data showing that population-based screening of 67 year olds might halve the number of those losing their sight to glaucoma over the next 20 years, and additional research proving the capability of AI to boost diagnostic accuracy.
"Such strategies, which may further incorporate genetic risk and behaviour characteristics, will help lower the risk of visual impairment due to glaucoma, while the number of affected individuals in the UK will increase dramatically," they continue.
"It is now time to take action by scientifically developing and evaluating these strategies," they conclude.
