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Nicholas Wiltshire, Jani Bekker, William Eric Sponsel, Stephen Cook; Co-screening for glaucoma and diabetic retinopathy utilizing fundus photography and glaucoma score. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2085. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the efficiency of co-screening for glaucoma with DR fundus photo screening using the glaucoma score system. This method was used to try to differentiate people at low risk for glaucoma from those at high risk. The objective was to determine the level of confidence this approach this approach can provide at the point of screening to advise for referral or no referral.
General population screening was held on two consecutive Fridays as part of World Sight month. Biometric details, history, IOP, visual acuity and fundus photographs were documented. Fundus images were graded for retinopathy and disc features and glaucoma risk was calculated using the Glaucoma Score (Figure 1) methodology (NW&JB). Participants were referred for full clinical evaluation based on the grade of retinopathy and their glaucoma score. All those scored as either 'glaucoma suspect' or 'likely glaucoma' were referred for Ophthalmological examination and high-tech work up. Independent chart review was subsequently conducted by an Ophthalmologist (SC) to provide a gold standard.
164 people were screened (106F, 58M, mean age: 43.2) using the co-screening methodology; 34 were determined to be glaucomatous and referred for high-tech investigation. Of those referred 10 were determined to be confirmed glaucoma, 17 were deemed to be suspects and 7 were cosidered to be nonglaucomatous. Thus, 79.14% (27/34) of the patients referred were referred correctly.
The capital cost of non-mydriatic fundus cameras in Africa is significant, but they have been shown to be highly cost-effective in DR screening. Given the high prevalence of glaucoma throughout Africa, it makes sense obtain relevant screening data and to evaluate all the fundus images for glaucoma, as well. The cost of unnecessary referral to the person who has been screened is significant, and the cost of failing to take the opportunity to co-screen, allowing non-diabetic glaucomatous individuals to pass through retinal screening is high morbidity. With nearly 80% rate of glaucoma detection using the Glaucoma Score and fundus photos assessment, we have confidence about explaining risks and referring positive screenees. This should help reduce follow-up dropout rate and further increase efficacy. All these measures should translate to significant total cost reduction and increased patient satisfaction.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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