Editors Selection IGR 22-1

Screening and Detection: Screening is key for vision loss prevention

Kaileen Yeh
Steve Mansberger

Comment by Kaileen Yeh & Steve Mansberger on:

92391 Screening for Open-Angle Glaucoma and Its Effect on Blindness, Aspberg J; Aspberg J; Aspberg J; Heijl A; Bengtsson B, American Journal of Ophthalmology, 2021; 228: 106-116

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Aspberg, Heijl and Bengtsson report the results of a retrospective cohort study, which examines the ability of population screening for open-angle glaucoma to decrease rates of low vision and blindness. The study population included men and women born between certain dates in Malmo, Sweden. Three groups were examined; the 'screened' group (n = 32918), the 'non-responders to screening' group (n = 9579), and an additional 'uninvited comparison' group (n = 7103) who were a comparison group from the clinic (case-finding) as a control. Of note, those who were subsequently diagnosed with primary open angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEXG) were also included in the Early Manifest Glaucoma Treatment Trial. The detection and confirmation of glaucoma were rigorous.

Patient data was analyzed from 1987 to 2017 with assessment of subsequent visual impairment of either or both eyes by visual acuity or central visual field data. There were no significant differences between the screened, non-responders, and uninvited groups in regards to risk factors, incidence of glaucoma, or types of laser or surgical treatments. The cumulative incidence of those screened (0.17%) was nearly half of those who were potential participants (0.32%), with a risk ratio of 0.52.

Strengths of the study include large sample size, length of time of follow-up, and low number lost to follow-up. A weakness includes the retrospective/observational nature. The inclusion of group 3 (the case-finding group) is a strength to decrease the possible confounding effect of self-selection bias. The study may not apply to other ethnicities since most of the study patients were white Europeans.

The study may not apply to other ethnicities since most of the study patients were white Europeans

On the other hand, the risk reduction may be even higher in populations with higher risk of glaucoma and slope of progressive glaucoma such as those with family history of glaucoma or those of African-descent. However, a lot of work will still need to be done to determine the 'who, what, where, and when' of glaucoma screening. Who to target for screening? What device or devices to screen? Where is the best location to screen such as the community or medical location? And how often should a community be screened for glaucoma. Overall, the authors should be congratulated for providing compelling data to demonstrate that screening for glaucoma decreases the morbidity of future visual impairment.

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