Prevalence of glaucoma in Germany: results from the Gutenberg Health Study

  • René Höhn
  • Stefan Nickels
  • Alexander K. Schuster
  • Philipp S. Wild
  • Thomas Münzel
  • Karl J. Lackner
  • Irene Schmidtmann
  • Manfred Beutel
  • Norbert Pfeiffer



To determine the prevalence of glaucoma according to the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) classification in an adult German cohort.


The Gutenberg Health Study is a population-based, prospective cohort study in the Rhine-Main Region in mid-western Germany with a total of 15,010 participants. In this study, the first 5000 subjects with an age range between 35 and 74 years were included. Optic disk pictures were obtained by a non-mydriatic fundus camera (Visucam™) and analyzed using the Visupac™ software. Glaucoma prevalence was determined in two steps. First, the ISGEO classification was applied using “hypernormal subjects” (normal visual field) as reference. In the second analysis, we additionally considered the disk area (DA) in relation to the vertical cup-to-disk ratio by quantile regression. All results are given as weighted numbers for the population of Mainz/Bingen.


The prevalence of definite glaucoma in our sample was 1.44% (n = 72). The prevalence adjusted for disk area was 1.34% (n = 67). The prevalence gradually increased in both models with each decade of age (from 0.9 to 2.4%, respectively). In both models, none of the glaucoma cases had a small optic disk (< 1.6 mm2). Glaucoma prevalence in medium optic disks was 1.0% (without DA adjustment) vs. 1.6% (with DA adjustment) and in large optic disks 5.6 vs. 2.5%.


The prevalence of definite glaucoma was similar to other European population-based cohorts, with slightly higher prevalence in younger subjects. Our analysis highlighted the influence of optic disk size in determining the diagnosis of glaucoma based on cup-to-disk ratio in epidemiological studies.


Glaucoma Prevalence Population-based cohort Gutenberg Health Study ISGEO 



We thank all study participants for their willingness to provide data for this research project and we are indebted to all coworkers for their enthusiastic commitment.


The Gutenberg Health Study is funded through the government of Rhineland Palatinate (“Stiftung Rheinland-Pfalz für Innovation”, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim, PHILIPS Medical Systems and Novartis Pharma, including an unrestricted grant for the Gutenberg Health Study. PSW is funded by the Federal Ministry of Education and Research (BMBF 01EO1003). Funders were involved in the development of the study design as scientific consultants. However, they played no role in data collection, analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

The study protocol and study documents were approved by the local ethics committee of the Medical Chamber of Rhineland-Palatinate, Germany (reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015). According to the tenets of the Declaration of Helsinki, written informed consent was obtained from all participants prior to their entry into the study.

Conflict of interest

Dr. Pfeiffer received honoraria for lectures or consulting from Thea, Isarna, Novartis, Alcon, Medscape, Boehringer Ingelheim, Ivantis. Dr. Schuster received financial support for other projects by Heidelberg Engineering and Bayer Healthcare. Dr. Wild has received research funding from Boehringer Ingelheim, PHILIPS Medical Systems, Sanofi-Aventis, Bayer Vital, Daiichi Sankyo Europe and receiced honoraria for lectures or consulting from Boehringer Ingelheim, Bayer HealthCare, Bayer Vital, Public Health–Heinrich-Heine-University Düsseldorf, Astra Zeneca and Sanofi-Aventis. All other authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • René Höhn
    • 1
    • 2
  • Stefan Nickels
    • 1
  • Alexander K. Schuster
    • 1
  • Philipp S. Wild
    • 3
    • 4
    • 5
  • Thomas Münzel
    • 6
  • Karl J. Lackner
    • 7
  • Irene Schmidtmann
    • 8
  • Manfred Beutel
    • 9
  • Norbert Pfeiffer
    • 1
  1. 1.Department of OphthalmologyUniversity Medical Center MainzMainzGermany
  2. 2.Department of Ophthalmology, InselspitalUniversity Hospital Bern, University of BernBernSwitzerland
  3. 3.Preventive Cardiology and Preventive Medicine/Center for CardiologyUniversity Medical Center MainzMainzGermany
  4. 4.Center for Thrombosis and Hemostasis (CTH)University Medical Center MainzMainzGermany
  5. 5.German Center of Cardiovascular Research (DZHK)Partner Site Rhine-MainMainzGermany
  6. 6.Center for Cardiology IUniversity Medical Center MainzMainzGermany
  7. 7.Department of Clinical Chemistry and Laboratory MedicineUniversity Medical Center MainzMainzGermany
  8. 8.Institute of Medical Biostatistics, Epidemiology and InformaticsUniversity Medical Center MainzMainzGermany
  9. 9.Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center MainzMainzGermany

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