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. 1994 Dec;44(389):561–565.

Glaucoma screening clinic in general practice: prevalence of occult disease, and resource implications.

J H Sheldrick 1, A J Sharp 1
PMCID: PMC1239079  PMID: 7677842

Abstract

BACKGROUND. Previous studies have shown that for every known case of glaucoma there is another case of occult disease. Most cases of glaucoma are detected by optometrists. AIM. This study set out to determine the prevalence of occult glaucoma in a practice population and assess the likely resource implications of introducing a glaucoma screening programme into a general practice setting. METHOD. The 1153 patients registered with one practice in Leicester who were aged 55-69 years on 1 January 1992 and who were not known to have glaucoma prior to screening were invited to a screening clinic. Prior to screening there were 11 known cases of glaucoma in this age group. Screening was carried out by a practice nurse. Patients who failed the screening tests were referred according to the study protocol to the ophthalmology department of the Leicester Royal Infirmary and examined by one ophthalmologist. The number of cases of occult glaucoma and other eye disease detected, the cost per case screened and case detected, and the number of referrals generated were evaluated. RESULTS. Nine hundred and fifty people (82%) accepted the invitation and attended for glaucoma screening. Of those screened 115 (12%) were referred for ophthalmic assessment. Glaucoma was confirmed in 14 of the referred patients (12%) while a further 15 (13%) were found to have ocular hypertension. All but one of those people diagnosed as having glaucoma recalled having been examined by their optician within the last five years; for 50% the period was less than two years. Nineteen of the patients referred (17%) had other ocular pathology detected by the ophthalmologist and no abnormality was detected in 65 patients referred (57%). The estimated cost to the practice (excluding hospital outpatient costs) per case screened using the study protocol was 6 pounds and the cost per case detected was 408 pounds. CONCLUSION. Glaucoma screening may be successfully undertaken in a general practice setting by non-ophthalmically trained staff who have received tuition in the use of the equipment. It is well received by the population served but the capital cost of equipment is likely to be too high for most practices to afford. The reaffirmation of at least one occult case of glaucoma for every known case is particularly alarming in the absence of a national screening programme and the asymptomatic course of this treatable, blinding disease. Closer cooperation between general practitioners and optometrists will be the practical way ahead for most practices.

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Selected References

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  1. Aclimandos W. A., Galloway N. R. Blindness in the city of Nottingham (1980-1985). Eye (Lond) 1988;2(Pt 4):431–434. doi: 10.1038/eye.1988.78. [DOI] [PubMed] [Google Scholar]
  2. Armstrong T. A. Evaluation of the Tono-Pen and the Pulsair tonometers. Am J Ophthalmol. 1990 Jun 15;109(6):716–720. doi: 10.1016/s0002-9394(14)72442-0. [DOI] [PubMed] [Google Scholar]
  3. Atkinson P. L., Wishart P. K., James J. N., Vernon S. A., Reid F. Deterioration in the accuracy of the pulsair non-contact tonometer with use: need for regular calibration. Eye (Lond) 1992;6(Pt 5):530–534. doi: 10.1038/eye.1992.112. [DOI] [PubMed] [Google Scholar]
  4. Austoker J. Breast cancer screening and the primary care team. BMJ. 1990 Jun 23;300(6740):1631–1634. doi: 10.1136/bmj.300.6740.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bankes J. L., Perkins E. S., Tsolakis S., Wright J. E. Bedford glaucoma survey. Br Med J. 1968 Mar 30;1(5595):791–796. doi: 10.1136/bmj.1.5595.791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bengtsson B. The prevalence of glaucoma. Br J Ophthalmol. 1981 Jan;65(1):46–49. doi: 10.1136/bjo.65.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Brenner M. H., Curbow B., Javitt J. C., Legro M. W., Sommer A. Vision change and quality of life in the elderly. Response to cataract surgery and treatment of other chronic ocular conditions. Arch Ophthalmol. 1993 May;111(5):680–685. doi: 10.1001/archopht.1993.01090050114040. [DOI] [PubMed] [Google Scholar]
  8. Brittain G. P., Austin D. J., Kelly S. P. A prospective survey to determine sources and diagnostic accuracy of glaucoma referrals. Health Trends. 1988 May;20(2):43–44. [PubMed] [Google Scholar]
  9. Clearkin L., Harcourt B. Referral pattern of true and suspected glaucoma to an adult ophthalmic outpatient clinic. Trans Ophthalmol Soc U K. 1983;103(Pt 3):284–287. [PubMed] [Google Scholar]
  10. Crick R. P. Chronic glaucoma: a preventable cause of blindness. Lancet. 1974 Feb 9;1(7850):205–207. [PubMed] [Google Scholar]
  11. Damato B. E. Oculokinetic perimetry: a simple visual field test for use in the community. Br J Ophthalmol. 1985 Dec;69(12):927–931. doi: 10.1136/bjo.69.12.927. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ghafour I. M., Allan D., Foulds W. S. Common causes of blindness and visual handicap in the west of Scotland. Br J Ophthalmol. 1983 Apr;67(4):209–213. doi: 10.1136/bjo.67.4.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gibson J. M., Rosenthal A. R., Lavery J. A study of the prevalence of eye disease in the elderly in an English community. Trans Ophthalmol Soc U K. 1985;104(Pt 2):196–203. [PubMed] [Google Scholar]
  14. Harrison R. J., Wild J. M., Hobley A. J. Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease. BMJ. 1988 Nov 5;297(6657):1162–1167. doi: 10.1136/bmj.297.6657.1162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hitchings R. A. Screening for glaucoma. Br Med J (Clin Res Ed) 1986 Feb 22;292(6519):505–506. doi: 10.1136/bmj.292.6519.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hollows F. C., Graham P. A. Intra-ocular pressure, glaucoma, and glaucoma suspects in a defined population. Br J Ophthalmol. 1966 Oct;50(10):570–586. doi: 10.1136/bjo.50.10.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones S. J., Vernon S. A., Cater L., Henry D. J. Costing a community based screening programme for the detection of glaucoma. Eye (Lond) 1990;4(Pt 1):98–102. doi: 10.1038/eye.1990.11. [DOI] [PubMed] [Google Scholar]
  18. KURLAND L. T., TAUB R. G. The frequency of glaucoma in a small urban community. Am J Ophthalmol. 1957 Apr;43(4 Pt 1):539–544. doi: 10.1016/0002-9394(57)90806-1. [DOI] [PubMed] [Google Scholar]
  19. Kini M. M., Leibowitz H. M., Colton T., Nickerson R. J., Ganley J., Dawber T. R. Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham eye study. Am J Ophthalmol. 1978 Jan;85(1):28–34. doi: 10.1016/s0002-9394(14)76661-9. [DOI] [PubMed] [Google Scholar]
  20. König H. L. Tonometry in general practice--its use in early detection of primary open-angle glaucoma. S Afr Med J. 1986 Mar 1;69(5):309–311. [PubMed] [Google Scholar]
  21. Laidlaw D. A., Bloom P. A., Hughes A. O., Sparrow J. M., Marmion V. J. The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection. BMJ. 1994 Sep 10;309(6955):634–636. doi: 10.1136/bmj.309.6955.634. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. MacKean J. M., Elkington A. R. Referral routes to hospital of patients with chronic open-angle glaucoma. Br Med J (Clin Res Ed) 1982 Oct 16;285(6348):1093–1095. doi: 10.1136/bmj.285.6348.1093. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Miller S. J., Karseras A. G. Blind registration and glaucoma simplex. Br J Ophthalmol. 1974 Apr;58(4):455–461. doi: 10.1136/bjo.58.4.455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Phillips M. A. Early detection of chronic simple glaucoma in general practice. J R Coll Gen Pract. 1977 Oct;27(183):601–604. [PMC free article] [PubMed] [Google Scholar]
  25. Quigley H. A., Addicks E. M., Green W. R. Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy. Arch Ophthalmol. 1982 Jan;100(1):135–146. doi: 10.1001/archopht.1982.01030030137016. [DOI] [PubMed] [Google Scholar]
  26. Raffle A. E., Alden B., Mackenzie E. F. Six years' audit of laboratory workload and rates of referral for colposcopy in a cervical screening programme in three districts. BMJ. 1990 Oct 20;301(6757):907–911. doi: 10.1136/bmj.301.6757.907. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Schmidt J. G. The epidemiology of mass breast cancer screening--a plea for a valid measure of benefit. J Clin Epidemiol. 1990;43(3):215–225. doi: 10.1016/0895-4356(90)90002-7. [DOI] [PubMed] [Google Scholar]
  28. Steinmann W. C. The "who" and "how" of detecting glaucoma. Br Med J (Clin Res Ed) 1982 Oct 16;285(6348):1091–1093. doi: 10.1136/bmj.285.6348.1091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Strong N. P. How optometrists screen for glaucoma: a survey. Ophthalmic Physiol Opt. 1992 Jan;12(1):3–7. [PubMed] [Google Scholar]
  30. Tuck M. W. Referrals for suspected glaucoma: an International Glaucoma Association survey. Ophthalmic Physiol Opt. 1991 Jan;11(1):22–26. [PubMed] [Google Scholar]
  31. Vernon S. A., Henry D. J., Cater L., Jones S. J. Screening for glaucoma in the community by non-ophthalmologically trained staff using semi automated equipment. Eye (Lond) 1990;4(Pt 1):89–97. doi: 10.1038/eye.1990.10. [DOI] [PubMed] [Google Scholar]
  32. Vernon S. A., Henry D. J. Do optometrists screen for glaucoma? Eye (Lond) 1989;3(Pt 6):743–746. doi: 10.1038/eye.1989.115. [DOI] [PubMed] [Google Scholar]
  33. Vernon S. A., Quigley H. A. A comparison of the OKP visual field screening test with the Humphrey field analyser. Eye (Lond) 1992;6(Pt 5):521–524. doi: 10.1038/eye.1992.110. [DOI] [PubMed] [Google Scholar]
  34. Yablonski M. E., Zimmerman T. J., Kass M. A., Becker B. Prognostic significance of optic disk cupping in ocular hypertensive patients. Am J Ophthalmol. 1980 Apr;89(4):585–592. doi: 10.1016/0002-9394(80)90071-9. [DOI] [PubMed] [Google Scholar]

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