Screening for glaucoma: rationale and strategies

Purpose of review Late diagnosis of glaucoma is a leading factor in vision loss associated with this disease. Screening programs seek to diagnose glaucoma at an earlier, more treatable stage. Our purpose was to review the influence of screening location and testing strategies in glaucoma screening. Recent findings Screening high-risk groups appears effective, although general population-based screening programs have not been cost effective. Community-based screening programs have achieved limited success due to lack of follow-up of screened patients. High-risk patients often do not present for office-based screening programs. Screening strategies that employ a single test or few tests are generally more effective compared with strategies using multiple tests, due to avoidance of false positives. Compared with currently available screening tests, frequency-doubling technology (FDT) perimetry has shown higher sensitivity and specificity. Recent evidence suggests that automated assessment of the optic nerve and retinal nerve fiber layer may be superior to FDT perimetry, but the techniques remain unproven in screening settings. Summary Community-based screening of high-risk groups with functional testing using FDT perimetry can be effective, but newer automated structural measurements of the optic nerve and retinal nerve fiber layer may allow improved glaucoma screening sensitivity and specificity in the future.