{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:33:52Z","timestamp":1792805632638,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To analyze the risk factors associated with previously undiagnosed primary glaucoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study was conducted among residents aged 50\u202fyears and older in primary health care centers in Yinzhou District, China, from November 26, 2020, to December 3, 2021. Participants underwent various screening procedures. Patients with suspected glaucoma and other ocular abnormalities were referred to Yinzhou People\u2019s Hospital for further examination, diagnosis and treatment. We integrated ophthalmic screening data with the Yinzhou Regional Health Information Platform (YRHIP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 344 patients aged 50\u202fyears or older were diagnosed with primary glaucoma, including 142 (41.3%) previously undiagnosed patients. Among the 191 patients with primary angle-closure diseases and the 153 patients with primary open-angle glaucoma, 87 (45.5%) and 55 (35.9%), respectively, were previously undiagnosed. According to the multivariable models, the factors significantly associated with decreased odds of having previously undiagnosed glaucoma at the time of screening were older age (all\n                      <jats:italic>p<\/jats:italic>\n                      values &amp;lt;0.01), worse visual acuity (PVA) (OR 0.37, 95% CI 0.18\u20130.76), a greater vertical cup-to-disc ratio (VCDR) (OR 0.12, 95% CI 0.02\u20130.99), and high-tension glaucoma (HTG) (OR 0.02, 95% CI 0.00\u20130.09). Compared with patients who had undergone their last visit for eye care within 1\u202fyear, patients who had last seen an eye care provider &amp;gt;2\u202fyears prior to the time of screening were more likely to be undiagnosed at the time of screening (all\n                      <jats:italic>p<\/jats:italic>\n                      values &amp;lt;0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Younger age, longer duration since the last eye care visit, better PVA, smaller VCDR, and normal-tension glaucoma (NTG) were all significantly associated with an increased likelihood of previously undiagnosed primary glaucoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1671225","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T05:42:22Z","timestamp":1768196542000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Undiagnosed glaucoma and its risk factors in the Yinzhou community-based glaucoma screening program"],"prefix":"10.3389","volume":"13","author":[{"given":"Qi","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengtian","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanli","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhong","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yize","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbo","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juntao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinkang","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanbo","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1016\/j.ophtha.2014.05.013","article-title":"Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis","volume":"121","author":"Tham","year":"2014","journal-title":"Ophthalmology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1016\/s0161-6420(94)31090-6","article-title":"The prevalence of primary open-angle glaucoma in a population-based study in the Netherlands. The Rotterdam study","volume":"101","author":"Dielemans","year":"1994","journal-title":"Ophthalmology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1016\/s0161-6420(96)30449-1","article-title":"Prevalence of open-angle glaucoma in Australia. The Blue Mountains eye study","volume":"103","author":"Mitchell","year":"1996","journal-title":"Ophthalmology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/S0161-6420(98)94031-3","article-title":"The prevalence of glaucoma in the Melbourne visual impairment project","volume":"105","author":"Wensor","year":"1998","journal-title":"Ophthalmology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1001\/archopht.1994.01090180121046","article-title":"The Barbados eye study. Prevalence of open angle glaucoma","volume":"112","author":"Leske","year":"1994","journal-title":"Arch Ophthalmol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1001\/jama.1991.03470030069026","article-title":"Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore eye survey","volume":"266","author":"Tielsch","year":"1991","journal-title":"JAMA"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1136\/bjo.77.1.17","article-title":"Prevalence of glaucoma in the west of Ireland","volume":"77","author":"Coffey","year":"1993","journal-title":"Br J Ophthalmol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1001\/archopht.1996.01100140435011","article-title":"Glaucoma in Mongolia. A population-based survey in H\u00f6vsg\u00f6l province, northern Mongolia","volume":"114","author":"Foster","year":"1996","journal-title":"Arch Ophthalmol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.1016\/S0161-6420(00)00275-X","article-title":"Open-angle glaucoma in an urban population in southern India: the Andhra Pradesh eye disease study","volume":"107","author":"Dandona","year":"2000","journal-title":"Ophthalmology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1641","DOI":"10.1016\/j.ophtha.2004.03.029","article-title":"The prevalence of primary open-angle glaucoma in Japanese: the Tajimi study","volume":"111","author":"Iwase","year":"2004","journal-title":"Ophthalmology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1016\/j.ophtha.2010.10.016","article-title":"Prevalence of primary open-angle glaucoma in Central South Korea the Namil study","volume":"118","author":"Kim","year":"2011","journal-title":"Ophthalmology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1001\/archopht.120.4.471","article-title":"Glaucoma in Zulus: a population-based cross-sectional survey in a rural district in South Africa","volume":"120","author":"Rotchford","year":"2002","journal-title":"Arch Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1016\/j.ophtha.2013.01.043","article-title":"Prevalence and severity of undetected manifest glaucoma: results from the early manifest glaucoma trial screening","volume":"120","author":"Heijl","year":"2013","journal-title":"Ophthalmology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1111\/ceo.13564","article-title":"Integrating opportunistic glaucoma screening into general health examinations in China: a pilot study","volume":"47","author":"Zhang","year":"2019","journal-title":"Clin Experiment Ophthalmol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1016\/S0161-6420(01)00799-0","article-title":"Prevalence and predictors of open-angle glaucoma: results from the visual impairment project","volume":"108","author":"Weih","year":"2001","journal-title":"Ophthalmology"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1136\/bjophthalmol-2020-317718","article-title":"Risk factors for previously undiagnosed primary open-angle glaucoma: the EPIC-Norfolk eye study","volume":"106","author":"Chan","year":"2022","journal-title":"Br J Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"238","DOI":"10.3109\/09286586.2016.1168850","article-title":"Undiagnosed primary open-angle Glaucoma in Korea: the Korean National Health and nutrition examination survey 2008-2009","volume":"23","author":"Kim","year":"2016","journal-title":"Ophthalmic Epidemiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.ajo.2014.08.023","article-title":"Burden of undetected and untreated glaucoma in the United States","volume":"158","author":"Shaikh","year":"2014","journal-title":"Am J Ophthalmol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/j.ophtha.2004.01.029","article-title":"Detection of undiagnosed glaucoma by eye health professionals","volume":"111","author":"Wong","year":"2004","journal-title":"Ophthalmology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.ogla.2021.07.010","article-title":"Differentiating diagnosed and undiagnosed primary angle-closure Glaucoma and open-angle Glaucoma: a population-based study","volume":"5","author":"Iwase","year":"2022","journal-title":"Ophthalmol Glaucoma"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1136\/bjo.2005.081224","article-title":"The number of people with glaucoma worldwide in 2010 and 2020","volume":"90","author":"Quigley","year":"2006","journal-title":"Br J Ophthalmol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e103222","DOI":"10.1371\/journal.pone.0103222","article-title":"The prevalence of primary angle closure glaucoma in adult Asians: a systematic review and meta-analysis","volume":"9","author":"Cheng","year":"2014","journal-title":"PLoS One"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s40264-017-0589-z","article-title":"Evaluation of electronic healthcare databases for post-marketing drug safety surveillance and Pharmacoepidemiology in China","volume":"41","author":"Yang","year":"2018","journal-title":"Drug Saf"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e001493","DOI":"10.1136\/bmjophth-2023-001493","article-title":"Quality assessment of non-mydriatic fundus photographs for glaucoma screening in primary healthcare centres: a real-world study","volume":"8","author":"Chen","year":"2023","journal-title":"BMJ Open Ophthalmol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ajo.2018.07.013","article-title":"Effect of community screening on the demographic makeup and clinical severity of Glaucoma patients receiving Care in Urban China","volume":"195","author":"Liang","year":"2018","journal-title":"Am J Ophthalmol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1016\/j.ophtha.2011.01.058","article-title":"Factors associated with false positives in retinal nerve fiber layer color codes from spectral-domain optical coherence tomography","volume":"118","author":"Kim","year":"2011","journal-title":"Ophthalmology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ophtha.2006.05.073","article-title":"Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes","volume":"114","author":"Nolan","year":"2007","journal-title":"Ophthalmology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"P209","DOI":"10.1016\/j.ophtha.2015.10.047","article-title":"Comprehensive adult medical eye evaluation preferred practice pattern(\u00ae) guidelines","volume":"123","author":"Feder","year":"2016","journal-title":"Ophthalmology"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1136\/bjo.86.2.238","article-title":"The definition and classification of glaucoma in prevalence surveys","volume":"86","author":"Foster","year":"2002","journal-title":"Br J Ophthalmol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e019698","DOI":"10.1136\/bmjopen-2017-019698","article-title":"Using big data to improve cardiovascular care and outcomes in China: a protocol for the CHinese electronic health records research in Yinzhou (CHERRY) study","volume":"8","author":"Lin","year":"2018","journal-title":"BMJ Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s12874-021-01325-7","article-title":"Overcoming the problems caused by collinearity in mixed-effects logistic model: determining the contribution of various types of violence on depression in pregnant women","volume":"21","author":"Khalili","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1016\/j.cjca.2020.11.010","article-title":"Missing data in clinical research: a tutorial on multiple imputation","volume":"37","author":"Austin","year":"2021","journal-title":"Can J Cardiol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1016\/j.ophtha.2012.02.029","article-title":"Validity of self-reported eye disease and treatment in a population-based study: the Los Angeles Latino eye study","volume":"119","author":"Patty","year":"2012","journal-title":"Ophthalmology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1136\/bjophthalmol-2012-301499","article-title":"Avoidable sight loss from glaucoma: is it unavoidable?","volume":"96","author":"Kotecha","year":"2012","journal-title":"Br J Ophthalmol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1016\/j.ophtha.2007.06.013","article-title":"Awareness of incident open-angle glaucoma in a population study: the Barbados eye studies","volume":"114","author":"Hennis","year":"2007","journal-title":"Ophthalmology"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3109\/09286586.2013.867510","article-title":"Characteristics of undiagnosed primary open-angle glaucoma: the Tajimi study","volume":"21","author":"Iwase","year":"2014","journal-title":"Ophthalmic Epidemiol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.ajo.2007.09.013","article-title":"Factors associated with undiagnosed open-angle glaucoma: the Thessaloniki eye study","volume":"145","author":"Topouzis","year":"2008","journal-title":"Am J Ophthalmol"},{"key":"ref38","first-page":"2251","article-title":"Risk factors for late presentation in chronic glaucoma","volume":"40","author":"Fraser","year":"1999","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/jamaophthalmol.2015.1478","article-title":"Prevalence, risk factors, and visual features of undiagnosed Glaucoma: the Singapore epidemiology of eye diseases study","volume":"133","author":"Chua","year":"2015","journal-title":"JAMA Ophthalmol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.21037\/atm-20-2939","article-title":"Exploring the growth patterns of medical demand for eye care: a longitudinal hospital-level study over 10 years in China","volume":"8","author":"Yuan","year":"2020","journal-title":"Ann Transl Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.4103\/0301-4738.73681","article-title":"Importance of population-based studies in clinical practice","author":"Ronnie","year":"2011","journal-title":"Indian J Ophthalmol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1001\/jama.2020.21899","article-title":"Glaucoma in adults-screening, diagnosis, and management: a review","volume":"325","author":"Stein","year":"2021","journal-title":"JAMA"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1001\/archophthalmol.2012.145","article-title":"Attitudes of physicians, patients, and village health workers toward glaucoma and diabetic retinopathy in rural China: a focus group study","volume":"130","author":"Yan","year":"2012","journal-title":"Arch Ophthalmol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"8250","DOI":"10.1167\/iovs.11-7472","article-title":"Prevalence of primary open angle glaucoma in a rural adult Chinese population: the Handan eye study","volume":"52","author":"Liang","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"2120","DOI":"10.1016\/j.ophtha.2010.03.005","article-title":"Prevalence and outcomes of cataract surgery in rural China the China nine-province survey","volume":"117","author":"Zhao","year":"2010","journal-title":"Ophthalmology"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.ajo.2018.06.004","article-title":"Cataract surgical coverage and visual acuity outcomes in rural China in 2014 and comparisons with the 2006 China Nine-Province survey","volume":"193","author":"Zhao","year":"2018","journal-title":"Am J Ophthalmol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1671225\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T05:42:23Z","timestamp":1768196543000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1671225\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2025.1671225"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1671225","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1671225"}}