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Glaucoma screening effective in high-risk populations

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A glaucoma screening program may be effective for disease detection in high-risk populations, according to a population-based study. The authors said the Heidelberg Retina Tomograph II may also be a useful tool for detecting glaucomatous optic nerve damage and could be integrated into an overall disease detection strategy.

Paul J. Harasymowycz, MD, and colleagues at the University of Montreal analyzed data from 303 people determined to be at high-risk for glaucoma to study whether confocal scanning laser ophthalmoscopy is a valid tool to detect glaucomatous optic nerve damage in this population. All participants underwent HRT II testing as well as a standard ophthalmologic exam that included gonioscopy, IOP measurement and optic disc grading. For the purposes of this study, “high risk” was determined as having at least one of the following: Caribbean or African descent, older than 50 years or a family history of open-angle glaucoma. The mean patient age was 62 years, mean IOP was 16.3 mm Hg, and 85 participants had a family history of glaucoma; 196 patients were white, 59 were of Caribbean or African descent, and the remainder were of other races.

Of the 264 right eyes analyzed, 215 were deemed normal, 36 were suspect, and 13 were glaucomatous. Of the 265 left eyes analyzed, 213 were normal, 38 were suspect, and 14 were glaucomatous. HRT II was performed successfully in 531 of 601 eyes.

The authors said the “best correlation is seen when our gold standard (clinical diagnosis) groups suspects with normals and the HRT II diagnosis based on the MRA has borderlines groups with normals.”

Despite the “advanced age and comorbid pathologic features of those assessed, the HRT II examination was possible in 88% of screened participants,” the authors said. In addition, the quality of the photos was “very high,” and in the intent-to-screen analysis, for all glaucomatous patients in whom the HRT II examination was impossible, “both failure of examination and poor visual acuity could serve as alerts for additional ophthalmic testing in screening strategies that would include HRT II use,” they said.

The study is published in the December issue of Ophthalmology.