Glaucoma screening during regular optician visits: the feasibility and specificity of screening in real life

Vries, Margriet M. de; Stoutenbeek, Remco; Müskens, Rogier P.H.M.; Jansonius, Nomdo M.

doi:10.1111/j.1755-3768.2011.02355.x

Cited by 10 publications

(15 citation statements)

References 28 publications

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“…The results of our study regarding the high proportion of referred individuals found not to have any eye disease at the hospital are similar to other recent studies. [12][13][14] However, the IOP thresholds suggested for referral in some previous studies were higher than those considered here. 13,14 Using the IOP threshold of ≥27 mmHg, suggested by Founti et al, 14 would have led to more than one patient in ten with a positive outcome being missed in our study.…”

Section: Discussioncontrasting

confidence: 72%

“…[8][9][10] There is currently no cost-effective screening method for glaucoma, and glaucoma suspects are often detected through opportunistic case finding by optometric practitioners (ie optometrists and opticians). Several studies over the past decade have reported that a high number of patients referred for glaucoma by optometric practitioners do not have any eye disease, [11][12][13][14] leading to unnecessary health care costs and patient stress. Recent studies have shown that it is possible to reduce the number of falsepositive referrals by introducing different glaucoma referral filtering services, 11,12,15 while others have proposed higher intraocular pressure (IOP) thresholds for IOP-only referrals.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up

Nilsson

Peters

2021

OPTH

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Purpose: To evaluate the long-term predictive value of the need to treat patients referred by optometric practitioners, regarding glaucoma, in Malmö, Sweden, using intraocular pressure (IOP) as the primary referral criterion. Patients and Methods: This retrospective study included 94 of 108 (87%) individuals referred to the Skåne University Hospital in Malmö, Sweden, for elevated IOP during 2012-2013. Data were extracted from patient records by the end of 2019. Positive outcome was defined as glaucoma, treated suspected glaucoma or treated ocular hypertension (OH) at referral or during the follow-up period. Positive predictive values (PPV) were calculated using different hypothetical thresholds for age and IOP-levels. Long-term follow-up was used to evaluate whether the first visit diagnoses would change over time, and if this would affect the effectiveness of the referrals. Results: Elevated IOP was the only referral criterion in 84% (n=79). In 28 patients (35%) among the IOP-only referrals, no ocular disease was found, and 26 patients (33%) had a positive outcome at the first visit. Median follow-up time was 6.4 years. PPV according to diagnosis after follow-up was 42% (95% CI: 32-54%) for IOP-only referrals. Including thresholds of ≥45 years of age in combination with an IOP of ≥25 mmHg in the referral criteria would have reduced the number of IOP-only referrals by 27% (21 of 79), and increased the PPV to 57% (95% CI: 45-71%) at the last visit. No positive outcome would have been missed, among those that were followed-up after the first visit, when applying these thresholds for referral, over a follow-up period of six years. Conclusion: Using only elevated IOP as referral criterion showed a poor accuracy for predicting those that require IOP lowering treatment. The long-term follow-up allowed us to verify the applicability of higher hypothetical threshold requirements on age and IOP for glaucoma referrals from optometric practices.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up

Nilsson

Peters

2021

OPTH

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“…Screening could be made more efficient by focusing on high-risk groups. However, currently known (nongenetic) risk factors are not strong enough to allow for screening limited to high-risk groups, as too many cases would be overlooked 101,119 Similarly, the currently known genes (from GWAS and other techniques) do not explain the observed heritability completely, and as such, screening based on genes is currently considered premature as well. 57 Knowledge on heritability drives further gene finding (aiming to annihilate the discrepancy between heritability and variance explained by known genes), ultimately aiming for efficient screening and personalized health care based on genetic profiles.…”

Section: Discussionmentioning

confidence: 99%

Heritability of glaucoma and glaucoma-related endophenotypes: Systematic review and meta-analysis

Asefa

Neustaeter

Jansonius

et al. 2019

Survey of Ophthalmology

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We have systematically extracted all available heritability (h 2) estimates of glaucoma and related endophenotypes from the literature and summarized the evidence by meta-analysis. Glaucoma endophenotypes were classified into 10 clusters: intraocular pressure, anterior chamber size, central corneal thickness, cup-to-disc ratio, disc size, cup size, corneal hysteresis, retinal nerve fiber layer thickness, cup shape, and peripapillary atrophy. Random-effects meta-analyses were performed for each cluster. For clusters with n ≥ 10 h 2 estimates, we also performed subgroup and meta-regression analyses. The literature search yielded 53 studies. The h 2 of primary open-angle glaucoma ranged from 0.17 to 0.81, and was 0.65 for primary angle-closure glaucoma in a single study. The pooled endophenotype h 2 estimates were

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“…A specificity of 90% was reported for glaucoma detection by Dutch opticians, who performed Frequency‐Doubling Technology (FDT) and intraocular pressure measurements on 352 participants (Vries et al. ). A major strength of that study was the consecutive enrolment of participants; however, sensitivity was not reported.…”

Section: Discussionmentioning

confidence: 99%

Detection of visual field defects by opticians – with Damato Multifixation Campimetry Online

Olsen

Cour

Damato

et al. 2018

Acta Ophthalmologica

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Purpose: To study Damato Multifixation Campimetry Online (DMCO), an inexpensive online visual field test, used for screening at optician shops in Denmark. Methods: This was an evaluation of a diagnostic test and customers were included if minimum 50 years old, with a visual acuity of minimum 0.5 and with less myopia than 6 D. Standard equipment was a computer, a wireless mouse and a computer monitor. We used the 'DMCO STANDARD 4,5' algorithm for screening. DMCO results were electronically transmitted to the authors. Customers with a positive DMCO test received an eye examination including the reference standard Humphrey Visual Field Analyzer 30-2 SITA Fast test. A subset of control participants with a negative DMCO test received the same examination in order to estimate the number of false and true negatives. DMCO specificity and sensitivity were estimated according to five reference standards with 95% confidence intervals. Results: The population comprised 627 individuals, 381 women and 246 men, from 13 optician shops. Mean age was 62 years (SD 7.4). DMCO was positive in 32 individuals and 27 individuals were classified as 'true positives' with diagnoses such as glaucoma, cataract and neurological visual field defects. Of the 595 individuals with a negative DMCO test, 110 were examined and nine individuals were classified as 'false negatives' according to diagnoses. Depending on reference the specificity was 97-99% and sensitivity was 14-69%. Conclusion: Screening with DMCO demonstrated high specificity, whereas sensitivity was unsatisfactory. Future studies with enough power to estimate the true sensitivity is needed.

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Glaucoma screening during regular optician visits: the feasibility and specificity of screening in real life

Cited by 10 publications

References 28 publications

Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up

Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up

Heritability of glaucoma and glaucoma-related endophenotypes: Systematic review and meta-analysis

Detection of visual field defects by opticians – with Damato Multifixation Campimetry Online

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