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Catalina Garzon, David S Friedman, Annamalai Odayappan, Rengaraj Venkatesh; The Impact of Routinely Measuring IOP in Younger Adults in a Large Eye Hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1980.
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Screening for glaucoma in young adults is challenging as the disease is uncommon in this population. In order to identify young adults with or at risk for developing glaucoma, the Aravind Eye Hospitals (AEH), India recently started routinely using non-contact tonometry to measure intraocular pressure (IOP) in young adults receiving a routine examination. A retrospective chart review was conducted to evaluate the outcomes of this at the AEH in Pondicherry, India.
We reviewed the records of adults (18 to 40 years) who were screened for IOP and referred to the glaucoma unit based on elevated IOP, abnormal optic nerve or iridocorneal angle appearance from November, 2017 to June 15th, 2018. The diagnoses in the medical records were determined by a glaucoma specialist using gonioscopy, dilated fundus exam, and in some cases visual field test and optical coherence tomography. Analyses include detection of glaucoma and ocular hypertension (OHT), and calculation of the yield of this screening paradigm.
28,369 patients were examined in the general units and 296 (1.05%) were referred to the glaucoma unit, 84 for an IOP > 21 mmHg (OHT) and 208 for other reasons. IOP was not assessed in 4 patients at the general units. The hypertensive group had a mean IOP of 29.3 ±8.4 mmHg with a range of 22-56 mmHg, and the following diagnoses: 46 (55%) patients with OHT, glaucoma or angle closure (true positives), 16 (19%) patients were healthy (false positives), and 22 (26%) patients required further examination. 10 out of 22 patients with glaucoma had been previously diagnosed. In contrast, the normotensive group had a mean IOP of 16±2.5 with a range of 10-20 mmHg, and the following diagnoses: 12 (6%) patients with OHT or glaucoma (true positives), 126 (61%) patients were healthy (false positives), and 69 (33%) patients required further examination. 6 out of 10 of these patients with glaucoma had been previously diagnosed.
One out of every 600 patients between 18 and 40 years of age examined in the general units was found to have IOP above 21 mmHg and ultimately was diagnosed as having angle closure, OHT, or glaucoma. Given the young age of individuals identified and the potential to treat and prevent disease, the benefits seem to outweigh the low cost of screening in this fashion.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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