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Primary Care Screening for Ocular Hypertension and Primary Open-Angle Glaucoma
Evidence Syntheses, No. 34
Craig Fleming, MD, Evelyn Whitlock, MD, MPH, Tracy Beil, MS, and Barbara Smit, MD, PhD.
Author Information and AffiliationsStructured Abstract
Purpose:
Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related disability. This review examines the effectiveness of screening and treatment of asymptomatic individuals with early POAG.
Methods:
We identified studies of glaucoma screening and treatment from MEDLINE, the Cochrane Library, and glaucoma experts. Two reviewers abstracted relevant studies and graded articles according to U.S. Preventive Services Task Force criteria.
Data Synthesis:
No randomized, controlled trials of population screening for POAG have been reported. We found no population-based studies demonstrating that screening is feasible, accurate, or reliable for detecting early glaucoma. Two randomized, controlled trials examined the efficacy of treatment to lower intraocular pressure (IOP) compared with no treatment for persons with early primary open-angle glaucoma. In a Swedish trial, treatment reduced progression at 5 years from 62% without treatment to 45% with treatment (ARR 17%, NNT 5.8, p = 0.007). In a U.S. trial of patients with early POAG and normal IOP, progression at 5 years was observed in 39% without treatment and 33% with treatment (p = 0.21). The benefit of delaying progression of visual field loss on vision-related function in patients with early POAG is unclear. The principal harm of treatment is loss of visual acuity due to an increased risk of cataract formation.
Conclusions:
Treatment to lower intraocular pressure may delay progression of visual field deficits in some asymptomatic individuals with early POAG. Further studies of population screening are needed to demonstrate that early recognition and treatment of glaucoma in asymptomatic patients is effective in improving vision-specific functional outcomes and health-related quality of life.
Contents
- Preface
- Acknowledgments
- 1. Introduction
- 2. Methods
- 3. Results
- Key Question 1. Is there new evidence that screening for open-angle glaucoma reduces severe visual impairment?
- Key Question 3. Is there new evidence that feasible screening tests are accurate and reliable in detecting increased intraocular pressure or open-angle glaucoma?
- Key Question 4. Is there new evidence that treating increased intraocular pressure reduces the incidence of primary open-angle glaucoma?
- Key Question 5. Is there new evidence that treating increased intraocular pressure reduces severe visual impairments?
- Key Question 6. Is there new evidence that treating open-angle glaucoma with drugs, laser, and/or surgery reduces severe visual impairment?
- Key Question 7. Is there new evidence that screening results in adverse effects? Is screening acceptable to patients?
- Key Question 8. Is there new evidence that treatment of increased intraocular pressure and/or open-angle glaucoma results in adverse effects?
- Excluded Studies
- Ongoing Trials
- 4. Discussion
- Appendix A: Search Strategy: MEDLINE® 1994 through January, 2004
- Appendix B: Inclusion/Exclusion Criteria
- Appendix C: Excluded Studies
- References
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0024, Task Order No. 2. Technical Support of the U.S. Preventive Services Task Force. Prepared by: Oregon Evidence-based Practice Center, Portland, OR.
The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
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