Approximately 2.5 million individuals are affected with open-angle glaucoma, which is the leading cause of vision problems and blindness in the United States. Well, primary open-angle glaucoma is defined as optic neuropathy with an open anterior chamber angle. It is associated with the death of retinal ganglion cells and axons, progressively leading to vision loss. Increased age, family history of glaucoma, increased intraocular pressure increases the risk of developing glaucoma in an individual. African Americans have a higher prevalence of glaucoma and often present with more rapid disease progression.
A combination of degenerative changes in the optic disc and changes in the visual field in the form of peripheral vision loss makes the diagnosis of open-angle glaucoma. Also, the increased intraocular pressure was previously included in carrying out diagnosis, but it is not used now as not all patients with glaucoma have increased intraocular pressure or pressure in the eyes and vice versa. Most glaucoma tests available in the primary care setting are not accurate. There is no single standard to diagnose glaucoma accurately. The main aim in the treatment of primary open-angle closure is the reduction of intraocular pressure through medications, laser therapy, and sometimes surgery. Side effects of the glaucoma treatment include cataracts, others related to surgery, and topical medications. The magnitudes of over-diagnosis and overtreatment are unknown, though.
The main goal of screening is to identify and manage glaucoma before changes in vision develop. The natural history of glaucoma is not yet clear. Some patients have very slow progression, while others with risk factors may have a rapid progression to visual field defects and impairment. The cost of screening depends on the tests involved in the diagnosis. Few routine tests are inexpensive, but few specialized tests with newer instruments and techniques are costly.
The U.S. Preventive Services Task Force makes recommendations about the effectiveness of specific screening of disease in individuals with risk factors but no related signs and symptoms based on the balance between harm and benefits of the screening. Due to the lack of an established gold standard against which the individual screening tests can be compared, the USPSTF could not find adequate evidence on the accuracy of screening for primary open-angle glaucoma in adults. In conclusion, the USPSTF was not able to determine the effectiveness of screening for glaucoma on clinical outcomes, and the balance between harms and benefits of screening is not yet determined with certainty. Hence, glaucoma screening is not recommended for everyone. Screening may be encouraged in individuals with risk factors like age, family history of glaucoma or peripheral vision changes.