Intraocular pressure (IOP) screenings in relatively young adults is controversial, but new data suggests they are inexpensive and can catch at risk patients at a rate of 5.35%. A research team from the United States and India found IOP screenings in people between the ages of 18 and 40 identified one in 535 individuals with glaucoma or at risk of developing the disease, with a screening cost of just $8 per diagnosed patient.
“While the clinical presentation of early-onset glaucoma at diagnosis is variable, elevated pressures can be a critical risk factor in the development and progression of the disease,” the researchers wrote in their paper. “Based on our findings, the overall low cost to identify young patients with high IOP justifies the routine use of clinic-based IOP screening.”
The investigators conducted a retrospective chart review of adults in the study’s age bracket who had IOP screenings from 2017 to 2018 at Aravind Eye Hospital in Pondicherry, India. A glaucoma specialist used gonioscopy, dilated fundus exams and, occasionally, visual field tests and OCT to screen for glaucoma, ocular hypertension (OHT), angle closure and other study parameters.
A total of 28,369 adults under 40 were screened, and 296 (1.05%) were referred to the glaucoma unit, 84 for an IOP greater than 21mm Hg and 208 for other reasons.
The hypertensive group had a mean screening IOP of 29.3±8.4mm Hg and the following diagnoses: OHT (19%), secondary raised IOP (14%), glaucoma (26%), angle closure (4%), healthy (11%) and need for further examination (26%). Of note: 55% of patients with glaucoma were previously undiagnosed.
In comparison, the normal-tension group had a mean IOP of 16±2.5mm Hg. Their diagnoses were: OHT (1%), glaucoma (5%), occludable angles (8%), healthy (47%) and need of further examination (33%). Nearly 40% of these patients with glaucoma were previously undiagnosed.
One out of every 535 young adults screened had both IOP greater than 21mm Hg and angle closure, OHT, secondary raised IOP or glaucoma, the researchers noted.
“Given their young age and the potential to treat and delay progression, the benefits seem to outweigh the low cost of this screening,” the researchers wrote in their paper on the study.
|Friedman DS, Garzon C, Odayappan A, et al. The impact of routinely measuring IOP in younger adults to screen for glaucoma in a large eye hospital. J Glaucoma. February 24, 2020. [Epub ahead of print].|