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.