The Agency for Healthcare Research and Quality (AHRQ), a reviewing body that recommends medical treatments and clinical practices according to the strength of evidence, has recently stated its position on early assessment of asymptomatic glaucoma in the general population. In August 2011, it released a report indicating that it had not found any proven benefit in performing standard glaucoma tests such as Goldman tonometry, automated perimetry as well as more modern testing such as the Heidelberg retina tomography (HRT) in the detection or screening for glaucoma.
The American Academy of Ophthalmologists (AAO) and American Glaucoma Society (AGS) fired back saying the review was incomplete and thoughtless in terms of discounting the highest at risk population for glaucoma, which includes the elderly, African-Americans and Latinos who also incidentally belong to the underprivileged sector of society and have inadequate access to healthcare.
The eye health professionals were also disappointed in the way the AHRQ has merely narrowed down its evaluation of glaucoma screening techniques rather than considering the glaucoma suspect patient’s welfare as a whole. The value of early glaucoma diagnosis they say was not given emphasis, especially since early treatment intervention can best prevent optic nerve damage. The AHRQ’s one-sided view of general screening compromises those at high-risk who can benefit from early glaucoma assessment and diagnosis.
Since glaucoma is generally a symptomless disease, eye doctors unanimously advocate for early screening in persons who have the most genetic and medical propensity for open angle glaucoma: namely senior citizens, African-Americans, Hispanics and Asian Americans. If the pressure in the eye mounts and goes undetected over the years, permanent neural damage occurs. Accounting for glaucoma’s irreversibility and future disability from vision loss if not arrested ahead of time, the AAO and AGS are very much concerned about glaucoma’s individual and societal burden.
Several studies which show the significant emotional and economic impact of visual disability may have been overlooked by the AHRQ, the AAO-AGS says. Blindness is one of the most feared disabilities in the world, second only to cancer and heart disease. In one survey, 39% of those with severe visual impairments said that they wound trade their remaining years than go completely blind. The Alliance of Aging research says that glaucoma is also the fourth leading cause of loss of mobility and independence in the older age groups. Such loss of mobility often results in falls and accidents.
The AAO and AGS also cited studies such as the Los Angeles Latino Eye Studies of 2008 to 2011 and McKean’s to show how a patient’s quality of life is greatly affected even in those suffering from asymptomatic to mild glaucoma. These studies suggest that a decrease in the visual filed testing scores was proportional to the heath-related decline in the quality of life. This wes especially notable with driving, work productivity, role functions and mental health.
In summary, glaucoma specialists from AAO and AGS believe that the AHRQ recommendation does the American people great disservice in preventing handicaps from glaucoma. Although there is no single gold standard diagnostic modality for glaucoma detection, early assessment and treatment in high-risk groups could mean the difference between a life of blindness or freedom.
A life with glaucoma is long and hard, but as we have all been taught from childhood: the early bird catches the [glaucoma] worm.
1. AHRQ Glaucoma Screening Draft Report: http://www.effectivehealthcare.ahrq.gov/ehc/products/182/780/Glaucoma-Screening_Draft-Report_20110913.pdf
2. AAO-AGS Screening Comment:
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