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Editors Selection IGR 17-1

Glaucoma Screening: Screening High-Risk Populations

Comment by Rupert Bourne on:

73164 Optimizing Glaucoma Screening in High-Risk Population: Design and 1-Year Findings of the Screening to Prevent (SToP) Glaucoma Study, Zhao D; Guallar E; Gajwani P et al., American Journal of Ophthalmology, 2017; 180: 18-28

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The Screening to Prevent (SToP) Glaucoma study has designed and tested a community-based glaucoma screening strategy for high risk populations, in this case African-American men and women aged over 50 years. SToP Glaucoma aims to screen 9000 African-American men and women over 5 years, and in this paper the authors present the results of the first year of the program after recruiting 10%.

This work offers a fascinating insight into a high risk community and demonstrates knowledge of an unmet need within this population (42% knew they needed to see an eye doctor but hadn't) which was justified given the fact that a third of people in the sample saw less than 20/40 in at least one eye, and 51% of those referred had glaucoma. Recruitment of participants was via local community organizations and faith organisations and focused on locations frequented by older adults. Briefly, SToP consists of 2 visits, the first is a free screening visit lasting 10-20 minutes in a local community venue, and those who screen positive are offered a referral (definitive) examination visit at the Wilmer Eye Institute. The screening visit consists of presenting and best-corrected visual acuity, nonmydriatic fundus photography, and intraocular pressure measurement. Anyone with BCVA of worse than 20/40 is referred. A trained onsite technician evaluates the cup/ disc ratio and checks the images for other retinal abnormalities and those with 0.7 &se; CDR <0.9 and IOP < 23, with no known history of glaucoma, and no other reason for referral underwent frequency doubling perimetry.

A third of people in the sample saw less than 20/40 in at least one eye, and 51% of those referred had glaucoma

There are several components of this well-designed community program that are appealing:

1. The service component. Eg. e-tracking patients for onward care, providing free mail-in prescription glasses for those with solely uncorrected refractive error.
2. Mid-level non-medical personnel performed all tests at screening. Review of all the fundus images after the screening visit by a glaucoma specialist enhanced safety/quality.
3. Rapid screening methods without mydriasis also allowed diseases other than glaucoma to be detected at this first visit.

The authors plan to learn from this initial experience to increase attendance (from 43%) for the referral visit and scale the program to the greater Baltimore/Washington metropolitan area. Data on utilisation of eye care services after diagnosis by SToP and patient-reported outcome and experience measures of their care within SToP and their onward care within the local care system will be of interest.

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