Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project

Pizzi, Laura T.; Waisbourd, Michael; Hark, Lisa A; Sembhi, Harjeet; Lee, Paul; Crews, John E.; Saaddine, Jinan B.; Steele, D.; Katz, L. Jay

doi:10.1136/bjophthalmol-2016-310078

Cited by 17 publications

(9 citation statements)

References 31 publications

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“…Other costs were assumed to vary by ±20% of the base case value. The cost to identify a single glaucoma suspect was calculated by dividing the screening session‐related fees by the total number of glaucoma suspects that were detected, while the cost for detection of a definite case of glaucoma was defined as the total cost of the screening and definitive examinations divided by the number of definite glaucoma patients diagnosed.…”

Section: Methodsmentioning

confidence: 99%

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Zhang

Sun

Liu

et al. 2019

Clinical Exper Ophthalmology

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Importance Under‐detection and late diagnosis are major causes of glaucoma‐related visual impairment. Cost‐effective opportunistic glaucoma screening is of great interest in the early identification and prevention of glaucoma. Background To describe the results of a health examination centre‐based opportunistic glaucoma screening and referral model. Design This single centre cross‐sectional study was conducted in a health examination centre affiliated to a tertiary hospital in Shenyang, northeastern China. Participants From 21 March to 30 September 2016, 14 367 individuals aged ≥ 30 years undergoing routine physical examinations were invited for this glaucoma screening. Methods Presenting visual acuity, non‐contact pneumotonometry and non‐mydriatic fundus photography were evaluated. Fundus photographs were classified as non‐glaucoma, possible, probable and definitive glaucoma. Participants with probable and definite glaucomatous discs or intraocular pressure ≥ 24 mmHg were referred for definitive examinations. Main Outcome Measures Detection rate of glaucoma suspects and ocular hypertension (OHT). Cost to identify a single case with suspected and diagnosed glaucoma was also calculated. Results Altogether, 277 glaucoma suspects and 327 ocular hypertension suspects were identified. Among 190 participants with probable/definite glaucomatous discs, 93 (48.9%) accepted further examination. Among these, 78 were diagnosed as glaucoma, seven as suspects and eight were excluded. Only 98 ocular hypertension suspects (30.0%) accepted further examinations: eight had primary angle closure and 23 had confirmed ocular hypertension. The cost to identify a single glaucoma suspect and definite glaucoma case were US$135 and US$857, respectively. Conclusions and Relevance This novel screening model provides opportunities to improve glaucoma detection at low cost. Interventions to improve follow‐up are needed.

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Section: Methodsmentioning

confidence: 99%

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Zhang

Sun

Liu

et al. 2019

Clinical Exper Ophthalmology

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“…Our simple calculations exclude the outlay of the designing/fabricating of the ‘Feeling the Pressure’ Pop-Up which was approximately 33 000 GBP. Taken together the costs per case identified in our study are high especially in relation to figures from systematic reviews of other screening and case-detection schemes 52–55. Still, a fairer assessment of the overall cost effectiveness of the ‘Feeling the Pressure’ Pop-Up ought to consider our case finding of elevated BP as reported elsewhere 18.…”

Section: Discussionmentioning

confidence: 56%

Feeling the pressure: a cross-sectional study exploring feasibility of a healthcare Pop-Up for intraocular pressure measurements in shopping centres in England

et al. 2019

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ObjectivesTo test the hypothesis that a shopping centre Pop-Up health check combining an intraocular pressure (IOP) check with a general health check (blood pressure (BP)) is more readily accepted by the general public than an IOP check only. We investigate public awareness of IOP compared with BP and the feasibility of measuring IOP in large numbers in a Pop-Up.DesignA cross-sectional study using a tailor-made healthcare Pop-Up.SettingThe ‘Feeling the Pressure’ Pop-Up was sited in eight regionally-different shopping centres in England.ParticipantsAdult members of the public in shopping centres.MethodsOn one day we measured IOP only and on another measured BP and IOP. IOP was measured by Icare IC100 tonometer (Helsinki, Finland). Potential participants were asked about their awareness of IOP and BP and when they last visited their optometrist.ResultsMore people attended the combined BP + IOP days (461; 60%; 95% CI 56% to 64%) than IOP-only days (307; 40%, 95% CI 37% to 43%) over 16 days of testing. We recorded IOP in 652 participants (median (IQR) age and IOP of 54 (42 to 68) years and 13 (11 to 15) mm Hg, respectively). Fewer people reported awareness about IOP (19%, 95% CI 16% to 23%) compared with BP (71%, 95% CI 66% to 75%). Of 768 participants, 60 (8%) reported no previous optometric eye examination and 185 (24%) reported >2 years since their most recent examination.ConclusionsMeasuring IOP in large numbers of the public via a shopping centre Pop-Up is feasible. Public engagement was greater when a BP check was offered alongside an IOP check, suggesting unfamiliar health checks can be promoted by aligning them with a more familiar check. Our findings hint at strategies for public health schemes that engage the public with their eye health.

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“…Traditionally, fundus photograph is an essential tool for glaucoma evaluation, because of convenience, affordability, and the clinical impact that has proven useful for documentation of the nerve's appearance at a given time, allowing more detailed scrutiny then, and later comparison for change. 6 Glaucoma screening by using fundus photography has not been recommended to the general population 23,24 in part due to the fact that the optic nerve head has inter-individual variability and due to the detection of structural change at its early stages is usually dependent on subjective interpretation. 25,26 However, computer-aided diagnosis of fundus images has shown promise in the diagnosis of glaucoma which can overcome the inter-intra variability.…”

Section: Discussionmentioning

confidence: 99%

Deep Learning Ensemble Method for Classifying Glaucoma Stages Using Fundus Photographs and Convolutional Neural Networks

Cho

Hwang

Chung

et al. 2021

Current Eye Research

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Purpose: This study developed and evaluated a deep learning ensemble method to automatically grade the stages of glaucoma depending on its severity. Materials and Methods: After cross-validation of three glaucoma specialists, the final dataset comprised of 3,460 fundus photographs taken from 2,204 patients were divided into three classes: unaffected controls, early-stage glaucoma, and late-stage glaucoma. The mean deviation value of standard automated perimetry was used to classify the glaucoma cases. We modeled 56 convolutional neural networks (CNN) with different characteristics and developed an ensemble system to derive the best performance by combining several modeling results. Results: The proposed method with an accuracy of 88.1% and an average area under the receiver operating characteristic of 0.975 demonstrates significantly better performance to classify glaucoma stages compared to the best single CNN model that has an accuracy of 85.2% and an average area under the receiver operating characteristic of 0.950. The false negative is the least adjacent misprediction, and it is less in the proposed method than in the best single CNN model. Conclusions: The method of averaging multiple CNN models can better classify glaucoma stages by using fundus photographs than a single CNN model. The ensemble method would be useful as a clinical decision support system in glaucoma screening for primary care because it provides high and stable performance with a relatively small amount of data.

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Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project

Cited by 17 publications

References 31 publications

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Feeling the pressure: a cross-sectional study exploring feasibility of a healthcare Pop-Up for intraocular pressure measurements in shopping centres in England

Deep Learning Ensemble Method for Classifying Glaucoma Stages Using Fundus Photographs and Convolutional Neural Networks

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