Glaucoma burden in the Western Pacific Region from 1990 to 2023: country-level disparities, demographic drivers, and metabolic risk attribution.

OBJECTIVE: To assess country-level disparities, temporal trends, demographic drivers, and high fasting plasma glucose-attributable glaucoma burden in the Western Pacific Region from 1990 to 2023. DESIGN: Population-based observational study using secondary analyses of the Global Burden of Disease (GBD) database (1990-2023). SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Populations of countries and territories in the WPR; no individual-level participants or external control group. METHODS, INTERVENTION, OR TESTING: We extracted country-level estimates of glaucoma prevalence and disability-adjusted life years (DALYs) from GBD 1990-2023. Age-standardized rates (ASRs) were used to compare locations and time trends. Sex- and age-stratified analyses were performed. Decomposition analysis quantified the contributions of population growth, population aging, and epidemiologic change to changes in prevalent case numbers. Risk attribution analyses assessed the contribution of high fasting plasma glucose (HFP) to glaucoma DALYs. MAIN OUTCOME MEASURES: Glaucoma prevalence, DALYs, and their ASRs in the WPR; country-level heterogeneity; sex/age patterns; decomposition of case number changes; HFP-attributable burden. RESULTS: Marked heterogeneity in glaucoma burden was observed across the WPR, with the highest age-standardized burdens observed in Mongolia, the Philippines, Cambodia, and Viet Nam, and comparatively lower age-standardized rates in several island territories. Age-standardized trends were divergent: the age-standardized prevalence rate showed a modest overall increase, whereas the age-standardized DALY rate declined over time. In contrast, the absolute burden increased in many settings, reflecting the effects of population growth and aging. Older adults, particularly older women, represented key populations with a high glaucoma burden. Decomposition analysis indicated that population growth and aging were major drivers of increasing absolute burden. HFP-attributable glaucoma DALYs increased more rapidly in the WPR than globally, highlighting the potential value of integrating glaucoma prevention with chronic disease management. CONCLUSIONS: These findings provide updated regional evidence on glaucoma burden and its demographic and metabolic contributors in the WPR. Because disease burden alone does not determine prevention priorities, future planning should also incorporate economic burden, health-system capacity, access to eye care, and treatment coverage when designing country-specific glaucoma screening, referral, and long-term care strategies.