Eye Health General Health

Glaucoma Screening: Yea or Nay?

Task force questions need for screenings during regular eye exams

The U.S. Preventive Services Task Force (USPSTF) is at it again. This time the task force, a group of national experts in prevention and evidence-based medicine that works to improve health by making recommendations about clinical preventive services, says there is insufficient evidence to prove glaucoma screening, part of most routine eye exams for adults in the United States, reduces blindness risk or improves quality of life. (It’s the group behind the recent mammogram and PSA test recommendations.)
According to the task force, current evidence isn’t strong enough to assess the balance of benefits and harms of screening for primary open-angle glaucoma, the most common form of the disease and the leading cause of peripheral vision loss in this country. Nearly 2 percent of everybody older than 40 has some degree of this form of glaucoma.
Though USPSTF found insufficient evidence to determine whether people who are screened for early asymptomatic glaucoma have a reduced risk of impaired vision, it did find that early treatment keeps visual field defects from getting worse.
Confused yet? There’s more. Screening people who don’t show symptoms is troublesome because glaucoma’s progression varies from person to person. In some individuals, the task force says, primary open-angle glaucoma does not progress (or progresses so slowly that it never really affects a person’s vision).
As someone recently diagnosed (during a routine eye exam, by the way) with primary open-angle glaucoma, I say phooey to the USPSTF. My screening caught increased (we’re talking off-the-charts increased) ocular pressure before my visual field suffered much damage and enabled my eye doctors (my “new best friends,” says David Weiss, an Arlington, Virginia, optometrist) to start the early treatment necessary to save my sight.
Black folks, Dr. Weiss informs me, are at increased risk of developing glaucoma and tend to develop it at a younger age. The disease also progresses faster in us. For these reasons, Dr. Weiss advocates glaucoma screening—starting as early as the late 20s for blacks. The USPSTF acknowledged these facts in their “recommendation statement” and suggested that some subpopulations, the elderly and African Americans among them, might benefit (emphasis mine) from screening.
If you have a family history of glaucoma (I don’t) or concerns about developing the disease, talk to your eye doctor. He or she knows your eyes better than the USPSTF.

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