Global, regional, and national trends in glaucoma burden among adults aged 45 years and older, 1990-2021

Purpose Glaucoma is the leading cause of irreversible blindness worldwide. This study aimed to assess global, regional, and national trends in glaucoma burden among adults aged ≥ 45 years from 1990 to 2021. Methods Data were obtained from the Global Burden of Disease (GBD) 2021 study. Prevalence and disability-adjusted life-years (DALYs) for glaucoma were analyzed by age, sex, region, and Socio-demographic Index (SDI). Joinpoint regression identified trend changes, and frontier analysis benchmarked country-level performance. Results Globally, age-standardized prevalence declined from 116.29 to 90.12 per 100,000 (average annual percentage change, AAPC = -0.82), and DALYs from 13.37 to 9.05 (AAPC = -1.24), while absolute cases increased by 86.33% due to population aging. Five significant trend changes were identified (1994, 2001, 2006, 2010, 2019). The largest prevalence reduction was in adults aged 90–94 years. East Asia experienced the most substantial declines. SDI showed a strong negative correlation with glaucoma burden. Sub-Saharan Africa had the highest burden, while high-SDI regions had the lowest. Conclusion Global age-standardized prevalence and DALYs for glaucoma declined between 1990 and 2021, with accelerated declines temporally coinciding with key therapeutic advances. The absolute number of affected individuals increased due to population aging, underscoring the need for targeted screening programs and public awareness campaigns emphasizing regular eye examinations for early detection.