NHMRC Glaucoma Guidelines - ANZGIG

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NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 4 – The role of population screening ■ Chapter 4 The role of population screening Recommendation 1 Screen high risk groups Introduction The cost-effectiveness of general population screening for glaucoma has not been clearly established. Current literature provides no consensus regarding the timing or frequency of population screening. Population screening does not have to be limited to glaucoma detection, as it could screen for eye disease more broadly. An optimal test, or group of tests for glaucoma screening has not been identified. A number of tests are potentially feasible for detecting glaucoma in a screening program, including optic disc assessment, visual field (VF) assessment, intraocular pressure (IOP) and angle assessment (Burr, Mowatt, Hernández et al 2007; European Guideline Society [EGS] 2008). Guidelines suggest that perimetry (frequency doubling technology) also shows promise as a population-screening tool (American Academy of Ophthalmology [AAO] 2005b). There is consensus in the literature that targeted screening of individuals at-risk of glaucoma may be warranted. Targeted screening may be more cost-effective in specific sub-groups of the population such as older adults, African descent populations, and those with a family history of glaucoma. Further research is required to support this. This guideline details the evidence for risk factors in the development and progression of glaucoma. For specific recommendations concerning the identification of risk, refer to Chapter 6. There is no consensus in the literature regarding which health care providers should perform population screening. There are a number of health care providers with the skills and capacity to perform the appropriate tests. However, should a screening schedule be proposed in the future, local resources, inter-professional relationships, practice guidelines and legal indemnity will help determine the most appropriate screening approach at any given location. There is limited information regarding the use of screening in glaucoma types other than primary open angle glaucoma. National Health and Medical Research Council 37
NHMRC GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA Chapter 4 – The role of population screening Evidence Statement • Evidence strongly supports a screening approach that targets individuals at higher risk of developing glaucoma, rather than the general population. Point of Note It is beneficial to use more than one modality when screening for glaucoma. References American Academy of Ophthalmology [AAO] (2005b): Primary open-angle glaucoma preferred practice pattern. San Francisco: American Academy of Ophthalmology. Burr JM, Mowatt G, Hernández R, Siddiqui M, Cook J, Lourenco T, Ramsay C, Vale L, Fraser C, Azuara-Blanco A, Deeks J, Cairns J, Wormald R, McPherson S, Rabindranath K, Grant A (2007): The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technology Assessments; 11(41): 1-206. European Glaucoma Society [EGS] (2003): Terminology and guidelines for glaucoma (2nd edn.). Savona, Italy: European Glaucoma Society. 38 National Health and Medical Research Council
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NHMRC Glaucoma Guidelines - ANZGIG

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