Ophthalmologists must find solutions for overdiagnosis, overtreatment in glaucoma
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Overdiagnosis and overtreatment are growing problems in glaucoma, and ophthalmologists must work toward finding solutions, according to a lecturer at the American Glaucoma Society meeting.
“We are all taking care of a growing cohort of the ‘worried well’ who either don’t have glaucoma or are being followed intensively for preperimetric disease unlikely to lead to disability during their lifetime,” James D. Brandt, MD, said during the AGS Lecture. “Overtesting, overdiagnosing and overtreating [are] using resources that might be better used elsewhere. And if you don’t think that CMS and policymakers are paying attention to this process across medicine, you’re wrong, and we as a field need to get ahead of that curve.”
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In addition to issues with cost, side effects and access to disability insurance, anxiety and depression, particularly in younger patients, are major concerns associated with glaucoma diagnosis due to the fear of blindness, even in those with normal visual fields.
To mitigate this issue, Brandt said that ophthalmologists “should refrain from giving a diagnosis of glaucoma until we are certain. There’s no need to rush.”
He said there is a need for studies on the issue of overdiagnosis, especially as factors such as digital overdiagnosis become more prominent with the growth of telemedicine and home testing. He encouraged evidence-based initiatives to better educate physicians about the consequences of overdiagnosis and overtreatment.
“Diagnosis in glaucoma is absolutely ripe for study and ... a window is opening to better quantify and understand the problem and its drivers,” he said.
In addition, incorporating risk models such as polygenic risk scores into glaucoma predictive models may help better identify patients at high risk for rapidly progressive disease.
“If we don’t study this problem and develop guidance and solutions for it, I guarantee that forces bigger than the AGS or the house of ophthalmology will come calling,” Brandt said.
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Brandt JD. The worried well: Overdiagnosis and overtreatment of glaucoma. Presented at: American Glaucoma Society meeting; Feb. 29-March 3, 2024; Huntington Beach, California (hybrid meeting).
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