Screening for primary open-angle glaucoma in the developed world: are we there yet?

Area of Science:

• Ophthalmology
• Public Health
• Health Technology Assessment

Background:

• A 1995 assessment concluded against a formal primary open-angle glaucoma (POAG) screening program in Quebec due to uncertainty and high costs.
• The feasibility of POAG screening requires re-evaluation in light of recent diagnostic and therapeutic advancements.

Purpose of the Study:

• To assess the potential for establishing a POAG screening program.
• To consider recent developments in glaucoma diagnosis and treatment.

Main Methods:

• Review of new developments in glaucoma diagnosis and treatment since the mid-1990s.
• Identification of changes impacting the feasibility and organization of glaucoma screening.

Main Results:

• Advanced technologies (confocal scanning laser ophthalmoscopy, optical coherence tomography, scanning laser polarimetry) enable early detection of structural damage.
• Psychophysical tests (frequency doubling perimetry, short wavelength automated perimetry) aid in earlier functional damage detection.
• Lowering intraocular pressure (IOP) is key; pachymetry influences IOP measurement. New treatments (prostaglandin analogues, selective laser trabeculoplasty) offer improved safety and efficacy.

Conclusions:

• Cost-effectiveness of POAG screening is influenced by the certainty of effective and reliable screening.
• Advancements in diagnosis, treatment, and potential increases in POAG prevalence warrant a re-evaluation of screening programs.