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SD-OCT in African Americans increases glaucoma detection by nearly 40%
Researchers found that screening with spectral domain optical coherence tomography greatly decreased the cases of undiagnosed glaucoma, in a study of 50,000 African Americans age 50 years and older.
Using the SD-OCT, undiagnosed cases of glaucoma decreased from 75% to 38%, assuming a 60% follow-up rate after a failed screening test, as reported by Blumberg and colleagues in Investigative Ophthalmology and Visual Science.
Researchers also stated that for every 100 glaucoma patients screened with SD-OCT, there were five fewer patients with glaucoma-related severe visual field loss after 10 years than in their unscreened peers.
A secondary intent of the study assessed the cost of the screening implementation.
Screening results in a one-time cost of $98 per individual. When screening includes treatment, annual costs rose to $79 per patient screened over a 10-year period. The bulk of the incremental cost of screening is the result of disease management and treatment, according to the study.
The researchers concluded that SD-OCT screening in the African American population will minimize glaucoma-related visual morbidity, and the costs are worth the early detection and treatment advantages.
Disclosures: The authors have no financial disclosures.
Perspective
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Glaucoma remains one of leading causes of irreversible blindness worldwide. Early treatment of glaucoma can usually halt the progression, thus preventing significant vision loss. However, glaucoma is often an asymptomatic disease, especially in the early stages, so there is often a significant delay in diagnosis resulting in irreversible visual loss. What is needed is a reliable screening tool that would allow accurate early diagnosis in this asymptomatic group.
The purpose of this study was to estimate the potential outcomes of utilizing SD-OCT screening among African American patients in the U.S. combined with a predictive algorithm that incorporates clinical trial data on glaucoma progression, effects of treatment, adherence to follow up after screening and diagnostic performance of SD-OCT to estimate future visual field losses over a 10-year time period.
The results of the SD-OCT screening combined with the predictive algorithm demonstrated a decreased prevalence of undiagnosed glaucoma (75% to 38%) and severe visual field loss in patients with glaucoma (29.1% to 23.9%). Additionally, screening increased the prevalence of mild visual field loss in patients with glaucoma (9.2% to 18.7%).
The results of this study suggest that SD-OCT screening in an African American population could minimize glaucoma-related visual morbidity.
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Blumberg DM. IOVS. 2014;doi:10.1167/iovs.14-14014.