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Glaucoma Dialogue IGR 10-3

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Comment by David Friedman on:

21848 The additional yield of a periodic screening programme for open-angle glaucoma: A population-based comparison of incident glaucoma cases detected in regular ophthalmic care with cases detected during screening, Stoutenbeek R; de Voogd S; Wolfs RC et al., British Journal of Ophthalmology, 2008; 92: 1222-1226

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Stoutenbeek and co-authors are to be congratulated for their systematic approach to a problem of considerable relevance. Public health decisions must consider cost and impact. A broader issue not addressed in the manuscript concerns the importance of embedding information on disease impact and the availability of treatment alternatives into a decision framework. Quality-of-life considerations are crucial to decision-making about resource allocation.

Cost-effectiveness of a screening program is apt to be greater by taking risk factors such as family history into account before undertaking extensive eye exams

The authors focus on end-stage blindness, which clearly has enormous quality-of-life implications, but there are intermediate stages of glaucoma with substantial life impact. Meanwhile, studies pointing to the value of early glaucoma treatment suggest that the aggregate profile of costs and adverse consequences associated with substantial false-positive classification of people at risk (as from a screening program) may be far preferable to that of substantial false-negative classification (as from cases being missed in the usual-care system). For the sake of public-health decision-making, an important message of the present work is that the cost-effectiveness of a screening program is apt to be greater by taking risk factors such as family history into account before undertaking extensive eye exams.

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