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  • Undiagnosed Glaucoma — A Pressing U.S. Problem

    Undiagnosed glaucoma is a pressing issue facing the United States: More than half of the estimated 3 million adults with glaucoma aren’t aware they have the condition. Overseas screening programs can offer solutions for this problem, said Joshua R. Ehrlich, MD, at a Saturday symposium on global ophthalmology practices.

    How to cut costs, boost efficiencies. “Historically, population-based glaucoma screening has been found to be very cost-ineffective,” Dr. Ehrlich said. But Dr. Ehrlich described how the United States can turn that history on its head.

    The key is to focus on people at the highest risk of disease and to implement cost-cutting strategies such as task-shifting, automation, or telehealth.

    Screening in China. A recent Lancet study detailed China’s remarkably cost-effective efforts to screen rural and urban communities for glaucoma. The program achieved a level of savings that has eluded many high-income nations. Their secret: Catching conditions most likely to lead to blindness. Though China screened for both primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG), the savings were primarily driven by detection of PACG, which is more prevalent in that country.

    Screening in India. India’s Aravind Eye Care system illustrates how technology and automation can stretch limited amounts of money and manpower. Aravind uses an automated online referral system for first-degree relatives of patients with PACG or POAG and offers free testing for those family members.

    A role for automation. Similar efforts in the United States have struggled with poor follow-up, Dr. Ehrlich said, “but the key here is that there’s a lot of automation.” For example, Aravind sends automated text messages to educate family members and uses voice messages to make sure the clinic reaches the relevant first-degree relatives.

    The take-home lesson. Innovative technology and a targeted approach can help the United States save time and money when it comes to glaucoma screening. —Anni Delfaro, PhD

    Financial disclosures. Dr. Ehrlich: American Glaucoma Society: S; Blue Cross Blue Shield Foundation of Michigan: S; National Eye Institute: S; National Institute on Aging: S; New World Medical Inc: S.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.

    Read more news from AAO 2019 and the Subspecialty Day meetings.