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The additional yield of a periodic screening programme for open-angle glaucoma: a population-based comparison of incident glaucoma cases detected in regular ophthalmic care with cases detected during screening
  1. R Stoutenbeek1,2,
  2. S de Voogd2,
  3. R C W Wolfs2,3,
  4. A Hofman2,
  5. P T V M de Jong2,4,5,
  6. N M Jansonius1,2
  1. 1
    University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2
    Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3
    Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
  4. 4
    The Netherlands Institute for Neuroscience, RAAS, Amsterdam, The Netherlands
  5. 5
    Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
  1. Dr N M Jansonius, Department of Ophthalmology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; n.m.jansonius{at}


Aim: To study the additional yield of a periodic screening programme for open-angle glaucoma (OAG) by comparing, in a population-based setting, incident OAG (iOAG) cases detected in regular ophthalmic care with those detected during screening.

Methods: Participants aged 55 and over from the population-based Rotterdam Study underwent the same ophthalmic examination at baseline (1991–3) and follow-up (1997–9), including visual field testing and simultaneous stereo optic disc photography. Of 3842 participants, 87 (2.3%) developed iOAG during a mean follow-up time of 6.5 years. Of these 87 iOAG cases, 78 (90%) were included in this study.

Results: Of the 78 iOAG cases detected at follow-up, 23 (29%) had already been detected before during regular ophthalmic care. The remaining 55 (71%) undetected iOAG cases more often showed glaucomatous optic neuropathy without glaucomatous visual field loss (29 of 55 (53%)) as compared with the detected cases (four of 23 (17%); p = 0.009). Of the undetected iOAG cases, only four had developed significant visual field loss in their better eye.

Conclusion: The additional yield of a periodic OAG screening programme is lower than expected from published prevalence data. In the discussion, the authors estimate that—in a white population with a low prevalence of pseudoexfoliation—about one in 1000 screened persons could be saved from bilateral end-stage OAG.

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  • Funding: The Netherlands Organization for Health Research and Development (ZonMw) grant 2200.0035, The Hague. Foundations: Stichting Nederlands Oogheelkundig Onderzoek, Nijmegen/Rotterdam; Optimix, Amsterdam; Netherlands Organisation for Scientific Research (NWO), The Hague; Physico Therapeutic Institute, Rotterdam; Blindenpenning, Amsterdam; Sint Laurens Institute, Rotterdam; Bevordering van Volkskracht, Rotterdam; Blindenhulp, The Hague; Algemene Nederlandse Vereniging ter Voorkoming van Blindheid, Doorn; Rotterdamse Blindenbelangen Association, Rotterdam; OOG, The Hague; kfHein, Utrecht; Prins Bernhard Cultuurfonds, Amsterdam; Van Leeuwen Van Lignac, Rotterdam. All in The Netherlands. Unrestricted grants were obtained from Topcon Europe BV, Capelle aan de IJssel, The Netherlands, and from Heidelberg Engineering, Dosselheim, Germany.

  • Competing interests: None.

  • Ethics approval: Ethics approval by the Medical Ethics Committee of the Erasmus University Rotterdam was obtained.

  • Patient consent: Obtained.