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Editors Selection IGR 24-3

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Comment by Augusto Azuara Blanco 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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In this study from the Netherlands a repeated screening program for glaucoma, designed to detect incident cases, provided a very small yield, and only a small minority of patients had severe disease to be at risk of developing end-stage glaucoma during their life time. The study was based on a large sample of participants over 55 years. The implication of this study is that repeated screening may not be a cost-effective option to decrease glaucoma blindness.

Several comments or questions may be relevant:
The results may not be applicable to other countries with different health care systems. In the Netherlands the majority of adults (84%) visit an optician or an ophthalmologist at least once every five years. Thus, in other countries with less successful provision of primary care the results of periodic screening may be more beneficial.

People with poor socio-economic background are less likely to attend screening tests and more likely to have severe glaucoma

A proportion of patients did not participate in the initial screening effort (response rate of 78%). Of the screened cohort, another 22% did not participate in the repeated call. It is not known whether the patients who did not attend the screening tests are likely to have similar glaucoma prevalence and severity. For example, people with poor socio-economic background are less likely to attend screening tests and more likely to have severe glaucoma.
The authors appear to ignore the potential impact of glaucoma in quality of life in early or moderate stages and only consider the benefits of screening as prevention of end-stage glaucoma.
Lastly, I would like to thank the authors for their very important work.

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