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Undiagnosed, overdiagnosed glaucoma cases may have major repercussions
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PRAGUE — Both undiagnosed glaucoma and overdiagnosed glaucoma are significant challenges in Western countries, with major clinical implications for individuals and society, according to one specialist speaking at the European Glaucoma Society Congress.
The population-based Thessaloniki Eye Study, presented here by Fotis Topouzis, MD, PhD, confirmed the data of other large cohorts: At least half of glaucoma cases are undiagnosed.
Fotis Topouzis
“In a population of 2,554 participants aged 60 years or over, we found a 50% rate of undiagnosed glaucoma,” Topouzis said.
Primary open-angle glaucoma was found to be four times more likely to be undiagnosed compared with exfoliation glaucoma. Not having seen an eye doctor in the past 12 months and a smaller cup-to-disc ratio were other associated factors.
“As a result of this, a high number of patients remain without treatment. Only 43% of glaucoma patients in our study received any treatment,” Topouzis said.
An alarming prevalence of 66.7% overdiagnosed glaucoma was also found.
“Only one-third of the patients who had been previously diagnosed with glaucoma had the diagnosis confirmed in the study. The vast majority were undergoing treatment, and a smaller proportion had had laser or surgery,” Topouzis said.
Interestingly, factors associated with overdiagnosis were similar to those identified with underdiagnosis. Patients who had seen an eye doctor in the last 12 months had three times increased likelihood to be overdiagnosed, and a higher cup-to-disc ratio was associated with a four times increase. Other factors identified were family history, history of cataract surgery and higher IOP.
Implications are severe in both cases, Topouzis said. One-third of subjects with undiagnosed glaucoma had progressed to advanced stages. If untreated, progression to blindness is the natural history of severe disease. On the other hand, fear of blindness, side effects of unnecessary treatment, increased costs for individuals and society, and the waste of clinical resources are consequences of overdiagnosis.
“Identifying risk factors for undiagnosed and overdiagnosed glaucoma is important in addressing these challenges,” Topouzis said. – by Michela Cimberle
Reference:
Topouzis F. Undiagnosed glaucoma vs. over-diagnosis. Presented at: European Glaucoma Society Congress; June 19-22, 2016; Prague.
Disclosure: Topouzis reports he is a consultant to Novartis, Alcon and Théa.