Pharmacy Times

Glaucoma: To Screen or Not to Screen

Author: Jeannette Y. Wick, RPh, MBA, FASCP

A nationwide glaucoma screening program for African Americans, who are at particularly high risk for the condition, could be clinically effective.

Few countries have established national screening programs for primary open-angle glaucoma (POAG), the most common form of glaucoma. Barriers to effective screening include the disease’s considerable physiologic variation and the challenge of differentiating between people who have normal optic nerves and those who have early disease. Further, up to 40% of optic fibers can be damaged before vision loss occurs. The criteria for population-based screening generally has several drivers:
No single test for glaucoma exists. Clinicians can use visual field testing, ophthalmoscopic observation of the optic nerve head, and/or tonometric intraocular pressure (IOP) measurement. Widespread screening for IOP will not catch all cases of glaucoma, however, since some patients have normotensive varieties of the condition.
 
Primary care providers should urge patients who are at high risk for glaucoma—those who have family histories, have elevated IOPs, are African American, are older than 40 years, or have myopia—to be screened annually. However, no data exists indicating how many people are screened, and studies are needed to demonstrate the effectiveness, acceptability, and costs of screening programs in various populations.
 
Researchers from Beth Israel Deaconess Medical Center and Harvard Medical School published one such study in the March 2012 issue of Archives of Ophthalmology. Using data from the Eye Diseases Prevalence Research Group and the Baltimore Eye Study, they used a computer-based mathematical model to determine if screening in 1 high-risk group—African Americans—could be cost effective.
 
They found that a national glaucoma screening policy for African American individuals between the ages of 50 and 59 years without known glaucoma would:
The researchers projected that the screening program would cost $80 per screened individual and determined that it could be clinically effective, although its impact on visual impairment and blindness levels might be modest.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.