There are no systematic reviews or studies that provide evidence for direct or indirect links between glaucoma screening and visual field loss, visual impairment, optic nerve damage, intraocular pressure, or patient-reported outcomes. Also economic simulation models of cost effectiveness of screening report inconclusive results with large uncertainties. There is no evidence that interventions (e.g, training) improve opportunistic case finding.
Review: PubMed by October 2010 with key words Glaucoma and cost*
No randomized screening trials were found of the clinical effectiveness or cost-effectiveness of screening for preventing visual disability. Simulation models of cost-effectiveness of systematic screening for glaucoma in Finland and in UK agree partly and suffer from unreliability of input data to be able to draw definitive conclusions «Tuulonen A. Economic considerations of the diagnos...»1.
Finnish simulation model 2
An organized screening program was modeled and compared to opportunistic case finding using a simulation model in a population aged 50–79 years at 5 year intervals. The cost of one QALY gained by screening was €9023 (5% discount rate). During 20 years, in the population of 1 million the cumulative costs exceeding opportunistic case finding in Finland were €30 million avoiding 930 years of visual disability in 701 persons. The results were sensitive to the estimates of specificity of screening tests, screening cost, discount rate, follow-up cost, prevalence of suspected glaucoma and prevalence of glaucoma.
An organized screening program could be a cost-effective strategy especially in older age groups in Finland. Also patients with glaucoma diagnosis were screened in the model. Therapy was not initiated or was withdrawn from patients with ocular hypertension, i.e. only manifest glaucoma was treated. The threshold specificities of diagnostic tests for screening being less costly and more efficient were 96-98% «Vaahtoranta-Lehtonen H, Tuulonen A, Aronen P . Cos...»2.
Systematic review and UK simulation model
The model simulated that screening might be cost-effective in a 50-year-old cohort at a prevalence of 4% with a 10-year screening interval. General population screening at any age would not to be cost-effective. Selective screening of groups with higher prevalence (family history, black ethnicity) might be worthwhile, although this would only cover 6% of the population. Extension to include other at-risk cohorts (e.g. myopia and diabetes) would include 37% of the general population, but the prevalence is then too low for screening to be considered cost-effective. In addition to prevalence, the cost-effectiveness of the screening program was highly sensitive to the perspective on costs. In this model, cost-effectiveness was not particularly sensitive to the accuracy of screening tests. False-positives were not considered in the model «Burr JM, Mowatt G, Hernández R ym. The clinical ef...»3.
Systematic review by October 2011
MEDLINE®, Embase, LILACS, and CENTRAL through October 6, 2011, and MEDLINE and CENTRAL (March 2, 2011) and screened an existing database to identify relevant systematic reviews. There is limited evidence on the effects of screening for OAG «Ervin AE, Boland MV, Myrowitz EH . Screening for G...»4.
Australian simulation model
The results suggested the if diagnosis rates of opportunistic case finding could be improved by educating clinicians (without considering costs of training), it would be associated with a rise in eye care costs as more people were treated. Simultaneously, disability adjusted life years (DALYs) would decrease «Taylor HR, Crowston J, Keeffe J . Tunnel vision: t...»5.
Study
In the UK the real-life impact of evidence-based NICE indicated no improvement in accuracy for detecting an abnormal IOP and there was a reduction in accuracy in detecting an abnormal optic disc «Ratnarajan G, Newsom W, French K ym. The effect of...»6.
Study
The post-NICE guideline rising number of referrals did not lead to indentifying more glaucoma patients «Shah S, Murdoch IE. NICE - impact on glaucoma case...»7.