Optimizing Glaucoma Screening in a High-Risk Population
American Journal of Ophthalmology, August 2017
Zhao et al. reported first-year findings of the Screening to Prevent (SToP) Glaucoma study. Not surprisingly, the results confirm that many underserved individuals have undetected ophthalmic conditions requiring medical attention.
SToP Glaucoma is an ongoing project from the U.S. Centers for Disease Control and Prevention to implement an effective sustainable program for detecting glaucoma and other eye diseases in high-risk individuals. It focuses on African Americans who are 50 years old or older and live in inner-city neighborhoods of Baltimore. A goal of the project is to screen 9,000 individuals in a 5-year period.
The screening process is twofold. The first part occurs in a local community venue. A questionnaire is administered by trained personnel, who also assess visual acuity (VA), measure intraocular pressure, and perform digital fundus imaging and visual field testing. Individuals with positive findings are referred for subsequent (definitive) examination at the Wilmer Eye Institute. Both screenings are provided at no cost.
Of 901 people who were screened by October 2015, 95% were African American. All told, 107 (12%) required only corrective lenses, and 356 (40%) were referred for definitive diagnosis of other suspected eye conditions. Only 43% of referred individuals followed through with the definitive exam.
The most common reasons for referral were ungradable fundus image (39% of those referred), best-corrected VA worse than 20/40 (15%), and ungradable autorefraction (12%). The most common diagnoses established from definitive examination were glaucoma (51%) and cataract (40%). Based on the original study group of 901, the program’s overall yield for significant eye disease (defined as glaucoma, cataract, diabetic retinopathy, or age-related macular degeneration) was approximately 15%.
The original article can be found here.