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Editors Selection IGR 23-1
Screening and Detection: To screen or not to screen?
Comment by David Friedman on:
100679 Screening for Glaucoma in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force, Chou R; Selph S; Blazina I et al., JAMA (Journal of the American Medical Association), 2022; 327: 1998-2012
The US Preventive Services Task Force (USPSTF) sets a high bar for recommending screening for medical conditions. They require high quality evidence that screening is better than not screening in terms of long-term outcomes, and this includes identifying possible harms of screening as well as benefits. This has often resulted in controversy surrounding USPSTF recommendations. The results of this current review and update of the literature are therefore not surprising: the USPSTF has once again determined that the evidence is insufficient to recommend screening for primary open-angle glaucoma (POAG).
The USPSTF has once again determined that the evidence is insufficient to recommend screening for primary open-angle glaucoma (POAG)
This article by Chou and colleagues updates the systematic review performed in 2013 to determine if screening is effective and to also assess the impact of treatment on outcomes. The focus for screening was on optical coherence tomography (SD-OCT) and visual fields (VF) for identifying individuals 40 years of age and older who do not have known POAG. Screening studies using case control designs were excluded as these are subject to bias. Screening with SD-OCT had a pooled mean 79% sensitivity and 92% specificity while VF had sensitivity of 87% and specificity of 82%. Treatment was also assessed, and IOP-lowering medications were associated with lower risk of progression (RR = 0.68), and treatment was not associated with increased risk of serious adverse events. Selective laser trabeculoplasty was also found to be safe and to provide outcomes similar to using medications. Overall, the authors conclude: 'Screening tests can identify persons with glaucoma and treatment was associated with a lower risk of glaucoma progression, but evidence of improvement in visual outcomes, quality of life, and function remains lacking.'