Eye Disorders

USPSTF Updates Screening Recommendations for Primary Open-Angle Glaucoma

06/08/2022

The US Preventive Services Task Force (USPSTF) has concluded that there is insufficient evidence to recommend for or against screening for primary open-angle glaucoma (POAG) in asymptomatic adults aged 40 years or older (I statement) in the primary care setting.

The task force conducted a systematic review on the accuracy of screening tests for glaucoma that included 53 studies, which often evaluated more than 1 diagnostic test. Among the most common diagnostic tests studied were spectral-domain optical coherence tomography (OCT) (n=23), tonometry (n=17) and visual fields (n=9). Data from 65,464 participants were included in this review.

“While the USPSTF found adequate evidence that screening tests can identify POAG, these screening tests are not commonly found in primary care settings,” authors wrote. “Additionally, it found limited evidence that treatment of POAG directly improves health outcomes (such as visual impairment, vision-related function, or quality of life) or that changes in intermediate outcomes (such as changes in the optic nerve or IOP) result in improved health outcomes. Because there was not a clear linkage, it was unclear if changes in intermediate outcomes translate into tangible health outcomes for patients.”

Areas where additional research is needed include:

  • Trials with increased representation of Black and Hispanic/Latino patients
  • Trials with referral to eye care specialists that use contemporary screening and diagnostic tools
  • Risk assessment tools for early identification of individuals at risk of POAG
  • Long-term impact of treatment in individuals with POAG on visual impairment, vision-related function, and quality of life

This recommendation statement comes as an update to the group’s 2013 recommendation, which also concluded there was insufficient evidence to make a recommendation.

 

—Leigh Precopio

 

Reference:

Mangiona CM, Barry MJ, Nicholson WK, et al; US Preventive Services Task Force.  Screening for primary open-angle glaucoma; US Preventive Services Task Force recommendation statement. JAMA. 2022;327(20):1992-1997. doi: 10.1001/jama.2022.7013