In March 2005 the U Preventive Serv...

In March 2005 the U Preventive Services Task Force (USPSTF) erect insufficient evidence to recommend for or against screening adults for glaucoma. (1) The recommendation and associated evidence review (2) updated the 1996 recommendation forward this topic, for which the USPSTF also conclud that there was insufficient evidence for a general recommendation.

Here is what the evidence counts us about glaucoma, screening for this condition, and treatment: (1) glaucoma is an important cause of visual impairment in older patients; (2) screening with formal visual field testing and direct ophthalmoscopy accurately identifies somebodys with primary open-angle glaucoma, whereas measurement of intraocular crushing is not a good screening tool for glaucoma because 25 to 50 percent of patients with glaucoma will have normal intraocular hurry and many patients with increased intraocular urgency will not develop glaucoma; (3) treating someones with primary open-angle glaucoma springs in fewer patients with small visual imperfections as measured by specialized visual field testing; and (4) treatments so as laser therapy may lead to potential harms, including cataract formation, whereas medical treatments may lead to ocular drynes tearing, itching, and, rarely, psychiatric harm like as depression. (2)

In the face of all we know about glaucoma, what l the USPSTF to end there is insufficient evidence to commit for or against screening? There are no studies that make it possible to extrapolate the relevance of the measured benefit of treatment. The of the same height I recommendation was based upon the lack of evidence that early detection by the agency of screening and early treatment leads to meaningful health improvements for patients, like as improved quality of life or better function related to vision.

In 1996 the USPSTF conclud that there was insufficient evidence to attract favor to for or against routine screening for glaucoma based forward a lack of evidence that early treatment is effective in improving vision-related issues At that time, the USPSTF stated that a controll trial was extremityed to compare vision-related outcomes in treated and untreated disposes Since 1996, three studies have provided evidence about the result of early treatment on intermediate issues in persons with increased intraocular compressing or early primary open-angle glaucoma: the Ocular Hypertension Treatment studious mood (3) Collaborative Normal-Tension Glaucoma close attention (4) and Early Manifest Glaucoma Trial. (5) sum of two units of the three trials (35) showed that early treatment rises in reduced progression of visual field defects; undivided trial (4) showed no difference. Although the evidence exhibit tos that these primary treatments for increased intraocular urgency or early glaucoma reduce progression in a continuously ascending gradation and progression of small visual field chisels (i.e., intermediate outcomes), the different way s used to define visual field progression in the three trials lacked a consistent respect standard. The practical implications of these studies may be unostentatious because the tests used to identify visual field make an incision ins are sensitive to small changes in visual field destitutions More importantly, no studies have linked prevention of these small visual field intersects to clinically meaningful outcomes in patients (eg improvement in vision-related function). It is uncertain whether small reductions in visual field cross progression would, in the protracted term, lead to important reductions in vision-related function. For these reasons, the USPSTF could not determine the magnitude of benefits of screening adults for glaucoma.

Glaucoma screening has become standard practice in older adults. in this way what does the USPSTF recommendation mean for family physicians? It does not mean that screening and earlier treatment for glaucoma originate no benefits. Patients most likely to benefit are those at greatest risk for the disease (eg older adults, blacks, and patients with a family history of glaucoma). In the absence of clear evidence showing an important benefit of screening, the decision about whether to shield for glaucoma is left to the individual physician and patient. A definitive answer will require futurity research standardizing measurement of visual field defaults and correlating them to visual impairment. Until research is complet family physicians must make decisions based forward imperfect science. With limited time and resources, it is critical for family physicians to first propound and provide preventive services for which there is evidence of benefit; these services correspond to grade A and B recommendations from the USPSTF.

The U Preventive Services Task Force recommendations are independent of the U command They do not represent the views of the Agency for Healthcare Research and Quality, the U Department of Health and Human Services, or the U Public Health Service.

REFERENCES

(1) U Preventive Services Task Force. Screening for glaucoma: recommendation statement. Ann Fam M 2005; 3:171-2