Glaucoma Screening in a High-risk Population

Abstract

Purpose 

To evaluate a screening protocol for detection of individuals with a higher risk of chronic open angle glaucoma for which a complete glaucoma evaluation is indicated.

Patients and Methods 

African Americans over 40 years of age in New Haven, CT. In the screening phase, volunteers filled out a questionnaire and underwent measurements of visual acuity, intraocular pressure (IOP) with a Tono-Pen and visual field with Frequency Doubling Technology. Participants were categorized into “glaucoma likely” or “unlikely,” but all were encouraged to follow up with a free complete glaucoma exam, which included applanation tonometry, pachymetry, visual fields with a Humphrey Visual Field Analyzer, gonioscopy, and fundoscopy. Based on the latter exam, patients were categorized into “glaucoma likely” (suspects and confirmed glaucoma) or “unlikely” groups.

Results 

One hundred eighty-four subjects completed both phases of the study and 76 of 93 patients (82%) who were classified as “glaucoma likely” in the final exam, were also classified as “glaucoma likely” in the screening. Adjusted analysis revealed family history of glaucoma in first degree relatives and screening IOP>21 mm Hg to have statistically significant associations with the final impression of “glaucoma likely.” A combination of these findings gave an overall sensitivity of 81.7% with a specificity of 55%.

Conclusions 

In the study population, the combination of an IOP>21 mm Hg and history of glaucoma in a first degree relative allowed the identification of a significant percentage of individuals with a higher risk of chronic open angle glaucoma, for which a complete glaucoma examination is indicated.