USPSTF: Insufficient evidence to make recommendations on glaucoma, impaired vision

The U.S. Preventive Services Task Force has issued draft recommendations that state there is not enough evidence to assess the balance of benefits and harms of screening some adults for primary open-angle glaucoma and impaired visual acuity.

The primary open-angle glaucoma “I” recommendation applies to individuals aged older than 40 years, while the impaired visual acuity “I” recommendation applies to those aged older than 65 years, the task force said.

“In the absence of evidence, clinicians should use their judgement when deciding whether or not to screen individual patients,” Carol Mangione, MD, MSPH, vice chair of the USPSTF and chief of the division of general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles, said in a press release.

The main risk factors for primary open-angle glaucoma are older age, family history, Black or “Latinx” race or ethnicity, increased intraocular pressure, thinner central cornea, optic disc hemorrhage, large optic disc cup-to-disc ratio and lower ocular perfusion pressure, according to the task force. Meanwhile, the main risk factor for most kinds of impaired visual acuity is older age.

Both the primary open-angle glaucoma and impaired visual acuity draft recommendations concur with the previous USPSTF recommendations in these clinical areas, the task force said. The previous recommendations also have the support of the American Academy of Family Physicians, according to the task force.

Regarding screening for primary open-angle glaucoma, the task force said that more studies are needed to examine the benefits of domain-optical coherence tomography and swept source-optical coherence tomography in vision-related outcome, function and quality of life compared with no screening at all; glaucoma screening strategies geared towards higher-risk populations compared with screening of all adults; and the accuracy of tools used to distinguish those at risk for the condition.

For impaired visual acuity screening, there is a need for more trials that evaluate the impact of referrals from primary care providers to eye care providers for comprehensive eye examinations as well as interventions that link older adults who screen positive for visual acuity to the proper follow-up care and ways to overcome obstacles to such care.

Comments on both draft recommendation statements are being accepted until Nov. 22 and can be submitted via www.uspreventiveservicestaskforce.org/tfcomment.html.

Editor’s Note: The USPSTF published its final recommendation on impaired visual acuity with no change made to its draft. 

References

U.S. Preventive Services Task Force issues draft recommendation statements on screening for glaucoma and impaired visual acuity. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/glaucoma-impaired-vision-screening-draft-rec-bulletin.pdf. Published Oct. 26, 2021. Accessed Oct. 26, 2021.

U.S. Preventive Services Task Force. Screening for glaucoma in adults: A systematic review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/glaucoma-screening-adults-older-adults. Published Oct. 26, 2021. Accessed Oct. 26, 2021.

U.S. Preventive Services Task Force. Screening for glaucoma: U.S. Preventive Services Task Force draft recommendation statement. https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/glaucoma-screening-adults-older-adults. Published Oct. 26, 2021. Accessed Oct. 26, 2021.

U.S. Preventive Services Task Force. Screening for impaired visual acuity in older adults: A systematic review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/impaired-visual-acuity-screening-older-adults. Published Oct. 26, 2021. Accessed Oct. 26, 2021.

U.S. Preventive Services Task Force. Screening for impaired visual acuity in older adults: U.S. Preventive Services Task Force draft recommendation statement. https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/impaired-visual-acuity-screening-older-adults. Published Oct. 26, 2021. Accessed Oct. 26, 2021.