Effect of Community Screening on the Demographic Makeup and Clinical Severity of Glaucoma Patients Receiving Care in Urban China

Liang, Yuanbo; Jiang, Jingzhi; Ou, Wen; Peng, Xianyao; Sun, Ruizhu; Xu, Xin; Yang, Juanyuan; Hu, Cheng; Ye, Cong; Congdon, Nathan; Liu, Fan

doi:10.1016/j.ajo.2018.07.013

Cited by 30 publications

(45 citation statements)

References 44 publications

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“…Consistent with our previous finding in this setting that those detected with glaucoma through outreach screening had significantly milder damage than those diagnosed in clinic. 36 Early detection through screening and appropriate intervention may delay or prevent the progression of the disease and lead to improved quality of life for glaucoma patients.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…Because of insufficient data, it was inappropriate to provide separate prevalence estimates for bilateral POAG blindness for rural and urban areas and so a single estimate was provided for both. We used data from a glaucoma screening programme of 27 144 participants in Wenzhou, China, 6 that was carried out by a coauthor (YL) between March, 2014, and September, 2015, to estimate the propor tion of patients with POAG with mild disease as 36•8%, moderate disease as 35•9%, and severe disease as 27•3%.…”

Section: Glaucoma Prevalencementioning

confidence: 99%

“…5 Among those who are diagnosed, glaucoma has already caused severe damage in the majority. 6 However, several studies have reported that populationbased glaucoma screening programmes are not costeffective in high income countries such as the UK 7,8 and Finland. 9 We believe that glaucoma screening might be cost effective in a Chinese setting for two reasons.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model

Tang

Liang

O’Neill

et al. 2019

The Lancet Global Health

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Background Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of global blindness. Nearly half of all people with PACG are of Chinese descent. Population-level glaucoma screening has generally not been found to be cost-effective in high-income countries; however, this assessment has rarely been done in lowincome or middle-income countries. We aimed to assess the cost-effectiveness and cost-utility of population-level glaucoma screening in China. Methods We developed decision-analytic Markov models for separate and combined screening for PACG and primary open angle glaucoma (POAG) to evaluate costs and benefits of community-level screening versus opportunistic case finding from a societal perspective. A cohort of individuals was followed in the model from age 50 years through a total of 30 1-year Markov cycles. Analyses were done separately for rural and urban settings. We did a meta-analysis of glaucoma prevalence studies in China to obtain prevalence estimates for PACG and POAG. Screening costs were taken from a Chinese screening programme and treatment costs from a tertiary Chinese eye hospital. Main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) using years of blindness avoided. We did one-way deterministic and simulated probabilistic sensitivity analyses to reflect uncertainty around ICURs and ICERs. Findings Compared with no screening, combined screening of POAG and PACG in rural China is predicted to result in an ICUR of US$569 (95% CI 17 to 4180) and an ICER of $1280 (−58 to 7940), both of which are below the WHO cost-effectiveness threshold of one to three times rural gross domestic product. For the urban China setting, combined screening is predicted to result in fewer net costs and greater gain in health benefits than no screening. Findings were robust in all sensitivity analyses. Over 30 years, a total of 246 (95% CI 63 to 628) and 1325 (510 to 2828) years of blindness are predicted to be avoided for every 100 000 rural and urban residents screened, respectively. Interpretation Population screening for glaucoma (POAG and PACG combined) is likely to be cost-effective in both urban and rural China. Future studies should investigate the effectiveness of interventions to improve acceptance of definitive care among people screened.

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“…Second, we chose the same diagnostic criteria used in other studies worldwide as well as in the local area to obtain comparable and reliable results. For example, the definitions of glaucoma used in the YODI were also used in the Wenzhou Glaucoma Screening Program [75]. We also implemented the same protocol of sample collection as the other metabolomics study [43] for clarity and consistency.…”

Section: Discussionmentioning

confidence: 99%

“…5. Glaucoma suspect[75]: A glaucoma suspect was considered if any of the following characteristics were observed in either eye: 1) IOP > 21 mmHg; 2) Optic disc margin hemorrhage on the fundus disc-centered photography; 3) Cup-disc ratio (CDR) ≥ 0.65, CDR asymmetry ≥ 0.2 or neural rim tissue ≤ 0.1; 4) Diffused or localized retinal nerve fiber layer defect on fundus photography.…”

mentioning

confidence: 99%

Design and baseline data of a population-based metabonomics study of eye diseases in eastern China: the Yueqing Ocular Diseases Investigation

et al. 2020

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Background: China is undergoing a massive transition toward an urban and industrial economy. These changes will restructure the demographics and economy which will eventually influence the future patterns of disease. The risk factors of vision-impairing eye diseases remain ambiguous and poorly understood. Metabolomics is an ideal tool to understand and shed light on the ocular disease mechanisms for earlier treatment. This article aims to describe the design, methodology and baseline data of the Yueqing Ocular Diseases Investigation (YODI), a developed county population-based study to determine the prevalence and primary causes of visual impairment; also with metabonomics analysis we aimed to identify, predict and suggest some preventive biomarkers that cause blindness. Methods: A population-based, cross-sectional study. Randomized clustering sampling was used to identify adults aged 50 years and older in Xiangyang Town, Yueqing county-level City. The interviews covered demographic, behavioral, ocular risk factors and mental health state. The ocular examination included visual acuity, autorefraction, intraocular pressure, anterior and posterior segment examinations, fundus photography, retinal tomography and angiography, and visual field testing. Anthropometric measurements included height and weight, waist and hip circumference, blood pressure, pulse rate, electrocardiogram, and abdominal ultrasound scan. A venous blood sample was collected for laboratory tests and metabonomics studies. Results: Of the 5319 individuals recruited for the YODI, 4769 (89.7%) subjects were enrolled for analyses. The median age was 62.0 years, and 45.6% were male. The educational level of illiteracy or semi-illiteracy, primary, middle and high school or above was 29.8%, 45.5%, 20.1%, and 3.3%, respectively. Majority of the participants were female, younger, and less educated when compared with nonparticipants. The average body mass index and waist-hip ratios were 24.4 ± 3.4 kg/m 2 and 0.9 ± 0.1 respectively. Blood sample collection reached a sample size of 1909 (479 from subjects with selfreported diabetes and 1430 from one-third of the 4290 subjects without self-reported diabetes). Conclusions: The YODI provides population-based data with a high response rate (89.7%) on the prevalence and primary causes of major vision-impairing eye diseases in developed county areas in eastern China. Metabonomics analysis from YODI will provide further association of metabolic characteristics with the visual impairment eye diseases. The risk prediction model could be created and has the potential to be generalized to developed eastern areas in China for prevention.

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Effect of Community Screening on the Demographic Makeup and Clinical Severity of Glaucoma Patients Receiving Care in Urban China

Cited by 30 publications

References 44 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

Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model

Design and baseline data of a population-based metabonomics study of eye diseases in eastern China: the Yueqing Ocular Diseases Investigation

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