United States Preventive Services Task Force glaucoma guidance from 2022 reviewed current challenges and opportunities for screening in primary care settings.
Although glaucoma is a leading cause of irreversible blindness, the United States Preventive Services Task Force (USPSTF) concluded there was insufficient evidence to recommend routine screening for primary open-angle glaucoma in adults without symptoms. However, a new review in the Journal of Glaucoma, noted that guidelines from the American Academy of Ophthalmology and the American Diabetes Association, as well as additional data from the literature, may suggest otherwise.
The review authors described targeted screening strategies based on risk factors such as age, race, family history, history of eye trauma, steroid use, and elevated intraocular pressure that primary care providers (PCPs) could adopt to be more actively involved in glaucoma screening. “Recommendations from trusted primary providers have likely kept millions of individuals from becoming blind.”
Several community-based screening studies were reviewed that successfully identified glaucoma cases in high-risk populations. The SToP Glaucoma study in Baltimore, for instance, focused on African Americans over 50 years old finding a high prevalence of glaucoma among those screened. Similarly, the NYC-SIGHT study targeted adults in New York City's public housing. Among them, more than 26% were suspected to have glaucoma based on abnormal ocular findings.
The USPSTF report discussed tonometry, ophthalmoscopy after dilation, perimetry, gonioscopy, pachymetry, and optical coherence tomography or optic disc photography as necessary diagnostics, but “performing all of these tests is not practical or necessary for screening in a primary care office setting. Only some of these tests were used in recent community-based screening studies,” the researchers said.
Rather than this extensive battery of tests, they suggested using ophthalmic photography equipment that can be used to evaluate other anterior segment and retinal diseases in addition to glaucoma. They also encouraged more education on glaucoma for PCPs, both in school and in continuing medical education programs, such as society meetings. Finally, they provided a screening questionnaire for PCPs to explore patient history for indications of glaucoma risk.
“PCPs are the only point of contact with the world of health care for most individuals. Efforts should be made to mitigate missed opportunities to appropriately identify patients with blinding conditions such as glaucoma in the primary care setting,” they concluded.