Expert panel: More research needed on glaucoma screening benefits

A guidelines group suggests more research is needed into the benefits of routine glaucoma screening in older adults. Photo by Ylem/Wikimedia Commons

These draft recommendations apply only to vision screening in the primary care setting and for people who have not reported any problems with eyesight, the task force said.

Although eyecare specialists agree more research is needed, some said they are concerned that the lack of clarity in the guidance could discourage physicians from recommending screening and cause patients at risk for vision loss to not pursue it.

“Impaired vision and glaucoma are serious and common conditions that affect many people’s independence and quality of life,” task force member Dr. Katrina Donahue said in a press release.

“Unfortunately, there is not enough evidence to determine if screening for these conditions in the primary care setting can help people who have not noticed problems with their vison,” said Donahue, a professor and vice chair of research at the University of North Carolina-Chapel Hill.

Glaucoma is a group of eye diseases that cause vision loss and blindness due to damage to the optic nerve in the back of the eye, according to the National Eye Institute.

While glaucoma progresses slowly, it is the second-leading cause of irreversible blindness nationally, affecting about 2% of adults age 40 years and older and about 10% of those age 80 years and older, the institute estimates.

Common risk factors for glaucoma include older age and family history of the disease, though Black and Hispanic Americans are at higher risk for the condition than White Americans, it says.

Vision impairment, a reduction in the sharpness or clarity of vision and, in older adults, can negatively affect quality of life and the ability to perform daily tasks, according to the American Foundation for the Blind.

It is a leading cause of disability , impacting about 5% of the population in the United States, the Centers for Disease Control and Prevention estimates.

Although routine screening would help identify cases of glaucoma and vision impairment, it can be costly for both physicians and patients, particularly given that vision care is not currently covered by Medicare, ophthalmologist Natasha Nayak Kolomeyer told UPI in an email.

However, not offering routine screening, even in people who do not report problems with their vision, could mean that cases of glaucoma or other impairment are caught later, when eyesight has been significantly compromised, said Kolomeyer, who practices at Willis Eye Hospital in Philadelphia.

“I understand there is a significant burden of proof that is required to provide a standardized recommendation, [but] I have dozens of patients … who were diagnosed with glaucoma at an advanced stage, when they had less than 10% percent of their vision left,” Kolomeyer said.

“They ask me a legitimate question: ‘Why did we not discover glaucoma sooner if they had insurance and were seeing their primary care doctor regularly?'” she said.

It is “important to get routine vision screenings,” particularly for those age 40 and older with a family history of glaucoma, Kolomeyer added.

The U.S. Preventative Services Task Force, an independent, volunteer panel of national experts in prevention and evidence-based medicine, urges adults struggling with eyesight to talk with their doctors to ensure they receive needed care.

“[We are] calling for more research to fully evaluate the benefits and harms of screening people for glaucoma and impaired vision in primary care who have not noticed any issues with their vision,” task force vice chair Dr. Carol Mangione said in a press release.

“In the absence of evidence, clinicians should use their judgement when deciding whether or not to screen individual patients,” said Mangione, chief of general internal medicine and health services research at the David Geffen School of Medicine at the University of California-Los Angeles.