Potential Harms
Harms caused by treatment of glaucoma include formation of cataracts and those resulting from surgery and from topical medications. Overdiagnosis and overtreatment are possible because not all persons who are diagnosed with and treated for glaucoma progress to visual impairment; the magnitude of overdiagnosis and overtreatment is unknown.
Costs
The cost of screening varies widely depending on the tests used. Testing with hand-held tonometers and ophthalmoscopes can be done quickly and inexpensively. However, the diagnostic accuracy of these inexpensive tests is not known. According to the National Business Group on Health, the average screening eye examination costs $71. Screening with specialized tests for glaucoma and with newer computerized instruments is more expensive.
Potential Benefits
Benefits of Detection and Early Treatment
The U.S. Preventive Services Task Force (USPSTF) found no direct evidence on the benefits of screening.
The USPSTF found convincing evidence that treatment of increased intraocular pressure (IOP) and early glaucoma reduces the number of persons who develop small, clinically unnoticeable visual field defects and that treatment of early asymptomatic primary open-angle glaucoma (POAG) decreases the number of persons whose visual field defects worsen.
However, the USPSTF found inadequate evidence that screening for or treatment of increased IOP or early asymptomatic POAG reduces the number of persons who will develop impaired vision or quality of life.
Current Practice
Approximately 62% of Medicare patients enrolled in a health maintenance organization (HMO) were screened for glaucoma in 2009. In 2008, approximately 53% of whites, 47% of African Americans, and 37% of Hispanics reported an annual eye care visit.