The additional yield of screening for open‐angle glaucoma in a population with high prevalence of pseudoexfoliation: The Thessaloniki Eye Study
Dimitrios A. Giannoulis, Anne L. Coleman, Masao Roy Wilson, Alon Harris, Evangelia Papakonstantinou, Panagiota Ntonti, Fei Yu, Vassilis Kilintzis, Anna‐Bettina Haidich, Theofanis Pappas, Eleftherios Anastasopoulos, Iordanis Vagiakis, Anastasia Raptou, Grigoria Tzoanou, Fotis TopouzisAbstract
Purpose
To identify incident open‐angle glaucoma (OAG) cases detected through regular ophthalmic care and from screening in a population‐based cohort and study the additional yield of screening in a population with high prevalence of pseudoexfoliation (PEX).
Methods
Longitudinal, population‐based study in Thessaloniki, Greece. Among eligible subjects, 1092 were examined at the follow‐up stage. Previously undiagnosed glaucoma was defined as the absence of prior self‐reported glaucoma or ocular hypertension or prior medical/surgical treatment. Glaucoma severity was assessed using the Hodapp‐Parrish‐Anderson criteria.
Results
The population at risk, after excluding glaucoma patients diagnosed at baseline, consisted of 1042 participants. Forty‐six subjects developed incident OAG and 27 of them (58.7%, 95% CI: 43.5–71.7) were undiagnosed at follow‐up visit, corresponding to a 2.6% (95% CI: 1.6–3.6) 12‐year incidence rate of undiagnosed OAG. After stratification, the incidence of undiagnosed OAG was 1.8% in non‐PEX subjects (14 of 772) and 4.8% in PEX subjects (13 of 270). Glaucoma stage did not differ significantly between previously diagnosed and undiagnosed cases ( p = 0.46 for better eye and p = 0.72 for worse eye). Among undiagnosed cases, 7 had moderate or worse visual field loss in both eyes, and 17 in at least one eye.
Conclusions
The overall rate of undiagnosed incident OAG in this population‐based cohort was substantial. A screening programme could have detected a significant number of glaucoma cases. The high rates of undiagnosed glaucoma among PEX subjects could suggest a higher additional yield of screening in this group. More studies are needed to evaluate the cost‐effectiveness of screening in populations with high PEX prevalence.