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Screening for Primary Open-Angle Glaucoma in the Primary Care Setting: An Update for the US Preventive Services Task Force

¹ Oregon Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Ore
² Cecil G. Sheps Center for Health Service, Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC

CORRESPONDING AUTHOR: Craig Fleming, MD, Kaiser Permanente Northwest Center, for Health Research 3800 North Interstate Ave, Portland OR, 97227, craig.fleming{at}kp.org

ABSTRACT

PURPOSE Primary open-angle glaucoma (POAG) is a leading cause of blindness and vision-related disability. This review examines the effectiveness of screening for and treatment of early POAG in asymptomatic persons.

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 US Preventive Services Task Force criteria.

RESULTS No randomized, controlled trials of population screening for POAG have been reported. Two randomized controlled trials compared the efficacy of treatment to lower intraocular pressure with no treatment for persons who have early primary open-angle glaucoma. In a Swedish trial, treatment reduced progression at 5 years from 62% without treatment to 45% with treatment (absolute risk reduction [ARR] 17%, number needed to treat 5.8, P = .007). In a US trial of patients with early POAG and normal intraocular pressure, progression at 5 years was observed in 39% of those without treatment and 33% of those with treatment (P = .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 resulting from 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 show that early recognition and treatment of glaucoma in asymptomatic patients are effective in improving vision-specific functional outcomes and health-related quality of life.

Key Words: Glaucoma, open-angle • mass screening • intraocular hypertension • evidence-based medicine • review [publication type] • AHRQ

This article has been cited by other articles:

				R. Harris Screening for glaucoma BMJ, September 17, 2005; 331(7517): E376 - E377. [Full Text] [PDF]

				K. C. Stange In This Issue Ann. Fam. Med, March 1, 2005; 3(2): 98 - 99. [Full Text] [PDF]

				U.S. Preventive Services Task Force Screening for Glaucoma: Recommendation Statement Ann. Fam. Med, March 1, 2005; 3(2): 171 - 172. [Full Text] [PDF]

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