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Serious implications exist for both undiagnosed, overdiagnosed glaucoma
Primary open-angle glaucoma was four times more likely to be undiagnosed as compared with exfoliation glaucoma in the Thessaloniki Eye Study.
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Both undiagnosed glaucoma and overdiagnosis of glaucoma can have major implications for patients and clinics, according to a speaker at the European Glaucoma Society congress.
Fotis Topouzis, MD, PhD, presented the findings of the Thessaloniki Eye Study, which found that more than 50% of glaucoma patients identified in a population-based cohort 60 years or older are undiagnosed, a rate that is consistent with other major eye studies.
However, the study also revealed a 66.7% prevalence of overdiagnosis of glaucoma in the patient cohort, Topouzis said.
“Both undiagnosed glaucoma and overdiagnosis are significant challenges in the field of glaucoma diagnosis with major clinical implications. Identifying risk factors for undiagnosed glaucoma and overdiagnosis is important in addressing these challenges,” Topouzis said.
Study participants
The study included 2,554 participants aged 60 years or older. Primary open-angle glaucoma was four times more likely to be undiagnosed compared with exfoliation glaucoma, Topouzis said.
Patients who had not seen an eye doctor or ophthalmologist in the previous 12 months were six times more likely to be undiagnosed with glaucoma, he said.
“In addition, we found that the [cup-to-disc] ratio was highly associated with undiagnosed glaucoma. The smaller the [cup-to-disc] ratio, the higher the likelihood of being undiagnosed. As a result of high rates of undiagnosed glaucoma, a high number of glaucoma patients remained without treatment. Only 43% of glaucoma patients in our study received any treatment,” Topouzis said.
On the other hand, only one-third of the patients who previously had a glaucoma diagnosis had the diagnosis confirmed in the study. The remaining two-thirds of these patients were receiving treatment for glaucoma, and a small proportion even had laser or surgery, he said.
Shared factors
Both undiagnosed glaucoma and overdiagnosis of glaucoma shared several risk factors in the study. As an example, patients who had seen an ophthalmologist in the past 12 months had a three times more likely chance to be overdiagnosed with glaucoma compared with those who had not seen an eye doctor in the past year.
Both undiagnosed and overdiagnosis have severe implications. In undiagnosed patients who remain untreated, there is significant risk of glaucoma progression to visual impairment and blindness. Overdiagnosed patients experienced unnecessary fear of blindness, expenses for needless glaucoma treatments, side effects of unnecessary treatment and increased waste of clinical resources, Topouzis said. – by Michela Cimberle and Robert Linnehan
- Reference:
- Topouzis F. Undiagnosed glaucoma vs. over-diagnosis. Presented at: European Glaucoma Society congress; June 19-22, 2016; Prague.
- For more information:
- Fotis Topouzis, MD, PhD, can be reached at Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece; email: ftopouzis@otenet.gr.
Disclosure: Topouzis reports he is a consultant to Novartis, Alcon and Théa.