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Editors Selection IGR 9-3

Vision 2020 Screening Campaigns

Comment by George Lambrou on:

24504 Cataract and glaucoma case detection for Vision 2020 programs in Africa: an evaluation of 6 possible screening tests, Cook C; Cockburn N; van der Merwe J et al., Journal of Glaucoma, 2009; 18: 557-562

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The understanding, diagnosis and management of glaucoma have progressed with tremendous strides in the last forty years ‐ at least in developed countries. In developing countries though, glaucoma continues to exact a heavy toll in terms of avoidable visual impairment and suffering, alone or in combination with cataract. One of the main hurdles in those countries is the deployment of screening programs able to detect intermediate or late cases still amenable to sight-preserving treatment. In this paper, Cook et al. (975) have evaluated a number of tests that may possible be used to this purpose: pinhole visual acuity, afferent pupil response, airpuff tonometry, confrontation finger-counting visual field, frequencydoubling technology visual field and lens-free direct ophthalmoscopy. Their study sample consisted of 105 subjects, including one-third patients with cataract, one-third patients with glaucoma and onethird normal controls, all recruited in a tertiary clinic setting (Groote Schuur Hospital, Cape Town, South Africa).

Afferent pupil defect testing combined with direct ophthalmoscopy could possibly detect glaucoma with specifity and sensitivity above 90% in Vision 2020 screening campaigns

Of the six tests, pinhole visual acuity, using a cut-off of 6/18 (or 20/60 or 0.33) in one or both eyes proved to be the most suitable test for detection of 'cataract or glaucoma', with specificity and sensitivity values above 90%. To achieve similar results for detection of glaucoma alone, two tests ‐ afferent pupil defect examination and lens-free direct ophthalmoscopy using C/D_v > 0.7 as cut-off ‐ had to be combined. Although the design of the study may have introduced a number of biases that the authors themselves acknowledge, the results point to a set of inexpensive and easy to implement tests, which can be deployed in large screening campaigns in developing countries, after validation in a number of pilot district Vision 2020 programs.

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