Recent production/ Population Screening of Primary Open-Angle Glaucoma

2007-11-14 09:08:50

Report prepared for AETMIS by Brigitte Côté et Nieves Rodriguez.

In recent years, the emergence of new diagnostic techniques for detecting this disease has again raised the issue of the advisability of implementing a population screening program. In this context, the Agency considered it appropriate to produce an update on this issue.

Based on the public health criteria to justify introducing a population screening program, this report begins by documenting the natural history and prevalence of the disease. It then analyzes studies on the efficacy of available treatments and diagnostic tests, presents scientifi c evidence on screening efficacy and information about the situation in Québec, and finally addresses the advisability of population screening.

From a broader public health perspective of reducing preventable blindness and of continually improving access to ophthalmology care and services, AETMIS finds that opportunistic screening activities are already in place, lead to referrals to ophthalmologists and absorb specialized resources; the extent, effectiveness and costs of opportunistic screening activities are not known. Also, some patients are at greater risk of a rapidly progressive form of glaucoma, but these risk factors are not fully known; and, finally, case-finding scenarios (opportunistic screening) targeting at-risk individuals and combining several diagnostic tests achieve a good performance for these groups.

Some of these issues may be clarified once a better understanding of current opportunistic screening is achieved. Defining criteria for optometrists to refer suspected glaucoma cases to ophthalmologists would contribute to more effective follow-up and treatment for these patients; it is up to the two professional associations to determine those criteria. Moreover, a literature watch on the performance and costeffectiveness of glaucoma screening especially for studies assessing combinations of several glaucoma screening tests), along with analysis of the results of the assessment underway in the United Kingdom, should help identify promising avenues for screening at-risk groups. It would be appropriate to verify their applicability to the Québec context in order to formulate research priorities for Québec.