Routine IOP screening effective in younger patients
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IOP screening may improve detection rates of glaucoma among a younger population and increase awareness of the disease, according to findings from a recent study.
Investigators conducted a retrospective chart review to evaluate the outcomes of noncontact tonometry screening for glaucoma, ocular hypertension and angle closure in adults 18 to 40 years of age at routine eye examinations in India. They screened 28,369 adults, of whom 296 were referred to the glaucoma unit between November 2017 and June 2018. Researchers categorized patients into a hypertensive group if their IOP exceeded 21 mm Hg or into a normotensive group if their IOP was equal to or below 21 mm Hg and they had other risk factors. Of these patients, 28.4% were hypertensive, and 70.3% were normotensive.
Further investigation of the hypertensive group revealed 16 patients with primary ocular hypertension, 12 patients with elevated IOP due to other causes, 22 glaucoma diagnoses and three angle closure glaucoma diagnoses.
In the normotensive group, two patients were diagnosed with primary ocular hypertension, 10 patients were diagnosed with glaucoma, and 17 patients were diagnosed with occludable angles. One patient in this group went undiagnosed.
“From a total of 28,369 young adult patients screened for IOP, 53 (0.19%) patients presented with elevated IOP and ultimately received a diagnosis of glaucoma, [ocular hypertension], secondary raised IOP or angle closure,” researchers wrote. “Therefore, one in 535 patients screened [for] IOP were found to have conditions that required either immediate treatment or ongoing monitoring.”
Early detection using noncontact tonometry cost $8 per patient, and early intervention was performed either medically or surgically in 43 (51%) hypertensive patients and 37 (18%) normotensive patients.
“While this study may not be generalizable to all developing countries, our results support that tonometry in young adults presenting for eye care is an effective and low-cost strategy to identify patients with or at risk of early-onset glaucoma,” researchers concluded.
They also said it could be used as a strategy to improve awareness of the disease in younger people.
Perspective
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Carl H. Jacobsen, OD, FAAO
What is a typical chief complaint from a young (younger than 40 years old) glaucoma patient? It is the same as any patient with glaucoma: “I need a new pair of glasses,” or something else not related to this insidious disease. Glaucoma detection is difficult, but younger patients with glaucoma especially concern me. They have many more years to suffer glaucoma damage than older patients, which leads to a greater risk for blindness. Their glaucoma diagnoses are often missed because they don’t fit the typical glaucoma demographic. Also, younger glaucoma patients may have a harder time accepting their diagnosis and adhering to their treatment plan. Is there a screening test that can help us identify these at-risk patients?
While IOP testing is unfortunately not a good glaucoma screening test for older patients, Friedman and colleagues in their retrospective chart review of more than 28,000 patients in India found that IOP measurement is a low-cost, effective screening test for glaucoma in the young. Of course, in your practice, this test is routine. Incorporating IOP in large screening programs can help identify young patients early and help raise glaucoma awareness in the patient population.
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