Screening Systems For Open Angle Glaucoma Assessed

Main Category: Eye Health / Blindness
Article Date: 22 Nov 2007 - 2:00 PDT

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New research published by the National Institute for Health Research's Health Technology Assessment (NIHR HTA) programme suggests that screening the general population for open angle glaucoma (OAG) would not be cost-effective, but that a system of targeted screening may be. Glaucoma is the leading cause of irreversible blindness worldwide. OAG, the most common form of glaucoma, is without symptoms in the early stages. Early detection and treatment may reduce the burden of sight loss and consequent disability associated with the condition.

Researchers from the University of Aberdeen assessed whether screening for OAG meets the UK National Screening Committee criteria, comparing different screening strategies and reviewing the existing research evidence to see whether they were effective or cost-effective. The strategies investigated included a 'technician' strategy, where people considered to be at risk of OAG would be invited to receive two tests (a measurement of intraocular pressure and a second test not pre-specified). In this strategy those who tested positive for OAG would be referred for specialised optometrist assessment. In the second 'glaucoma optometrist' strategy, patients would be invited to see a specialised optometrist for assessment straight away.

They concluded that the technician strategy was more cost-effective than the glaucoma optometrist strategy, although cost-effectiveness was highly sensitive to the perspective on costs (NHS or societal). Overall, the findings of the research suggest that screening the general population for OAG would not be not cost-effective, and does not meet the NSC criteria for a screening programme. However targeted screening of high-risk groups may be effective, although measures to systematically identify those at risk and quality assure the programme would be required.

"Many cases of OAG are undetected and there are a number of people who are more at risk of the condition than others, such as those with a first-degree relative with glaucoma, or those of black ethnicity," says lead researcher, Dr Jennifer Burr. "Our research suggests that a targeted screening system could be considered, although further research is required.

"In addition, glaucoma detection can be improved by enhancing the performance of current testing, and adding a technology-based initial assessment before referral to a specialist seems the more cost-effective option. We hope that the findings of our research will help to inform any future organisational changes in community eye care services."

Published in Health Technology Assessment Journal Series Vol.11.41. To view and download the full report visit here.

Notes:

1. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with over 400 issues published to date. The journal's 2006 Impact Factor (5.29) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, http://www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.

2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients.

http://www.nihr.ac.uk

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