Have you ever found yourself in the middle of a busy clinic, drowning in cases of glaucoma and wondering how so many patients could have glaucoma? You are not alone. Dr. L. Jay Katz and a team of colleagues from Philadelphia recently published their findings from "The Philadelphia glaucoma detection and treatment project."1 In this initiative, 43 community centers located in underserved areas of Philadelphia hosted glaucoma screenings. Overall, 1,649 individuals were screened and 40% of those screened were given some form of glaucoma diagnosis.
While I was initially startled by the high prevalence of glaucoma diagnoses, it actually fits well with my clinical observations from working in and around New York City; glaucoma is highly prevalent in underserved communities.
After performing a slit lamp exam, gonioscopy, and dilated examination with selective visual field testing, the study organizers gave a glaucoma suspect diagnosis to 20% of participants, and 9% were identified as having primary open angle glaucoma. An equal number (9%) were diagnosed as primary angle closure suspects, and primary angle closure glaucoma was diagnosed in 1% of the participants. Risk factors for these diagnoses were older age, higher pressure, and a family history of glaucoma.
Of the 164 patients diagnosed with open angle glaucoma, 61% were previously aware of their diagnosis. The study results highlight the high prevalence of glaucoma and related diagnoses in underserved communities, and also demonstrates that in a population with elevated risk, glaucoma screenings can indeed be high-yield.
1. Waisbourd M, Pruzan NL, Johnson D, Ugorets A, Crews JE, Saaddine JB, Henderer JD, Hark LA, Katz LJ. The Philadelphia Glaucoma Detection and Treatment Project: Detection Rates and Initial Management. Ophthalmology. 2016 May 22. [Epub ahead of print]
Dr. Nathan M. Radcliffe is the director of the glaucoma service and a clinical assistant professor at New York Univeristy Langone Ophthalmology Associates and is a cataract and glaucoma surgeon at the New York Eye Surgery Center.