Evidence Lacking for Glaucoma, Impaired Vision Screening

The US Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to recommend screening for primary open-angle glaucoma (POAG), the now common form of glaucoma, and also concludes the current evidence does not support a recommendation to screen for impaired visual acuity in patients aged 65 or older who are asymptomatic.

The USPSTF statement was published online May 24 in the Journal of the American Medical Association.

“It’s not a recommendation for or against screening but a call for more research,” said Katrina Donahue MD, MPH, in an interview with Medscape Medical News. Donahue is a member of the task force, a family physician, and a professor and vice chair of research at the University of North Carolina at Chapel Hill. “We looked at the evidence and concluded that it is insufficient to recommend or against screening for POAG in primary care in patients aged 40 and older without signs or symptoms.”

Glaucoma affects an estimated 2.7 million people in the United States, is the second-leading cause of irreversible blindness, and is the leading cause of blindness in Black and Hispanic / Latinx individuals. The USPSTF routinely makes recommendations about the effectiveness of preventive care services, and this recommendation concurs with its 2013 statement on screening for glaucoma.

“While not all adults will see an eyecare provider, they do regularly see their primary care clinician,” Donahue said. “Because of the serious consequences of glaucoma, we really wanted to see if primary care clinicians could help impact this. But unfortunately, we just don’t have the evidence to determine if screening in the primary care setting can help people who haven’t noticed problems with their vision.We are calling for more research in how to address this.We recommend that people who do have concerns with their vision talk to their clinician, so they can get the care they need. “

Donahue noted that the task force recognizes that Black and Hispanic individuals are at increased risk of developing glaucoma and other health conditions. “Based on the limited evidence, we are not able to make a separate recommendation for screening for glaucoma in the Black and Hispanic / Latino communities,” Donahue said.

Because of the seriousness of glaucoma, Donahue and fellow task force members wanted to examine the evidence to assess if screening in the primary care setting will make a difference.

“Glaucoma is certainly a serious condition, and that is why we are looking at the evidence,” Donahue said. “We wanted to see if patients coming in the door could be helped [at the primary care level] in terms of impacting this condition. “

Screening for Visual Impairment

Similarly, the task force concluded the evidence is insufficient to support screening for visual impairment in individuals 65 or older, Donahue noted.

“Unfortunately, there is not enough evidence to know whether screening for visual impairment in people who have noticed any symptoms is beneficial to their overall health,” said Donahue. “The Task Force is calling for more research on how to best address vision issues in people who have not reported any concerns.”

The number of adults aged 60 years or older with impaired visual acuity (defined as best corrected visual acuity Worse than 20/40 but better than 20/200) was estimated at 2.9 million in 2015.

“For this topic, there was not enough evidence to make a recommendation either for or against screening for visual acuity for any population, so we are calling for more research on how primary care clinicians can best help address these issues,” said Donahue.

Still, the recommendations from the task force do not preclude primary care practitioners from screening patients for glaucoma or impaired visual acuity if they think it is warranted, she said.

“In the absence of evidence, primary care clinicians should use their judgment about whether to screen patients if patients have noticed any problems with their vision,” she said.

Donahue noted that the role of the Task Force is to improve people’s health by making evidence-based recommendations about the benefits and harms of preventive services.

Donahue has disclosed no relevant financial relationships.

REST. Published online May 24, 2022. USPSTF Recommendation, Editorial

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