Marketwire
WASHINGTON, DC and SAN FRANCISCO, CA, Nov 03, 2011 (MARKETWIRE via COMTEX) --
The American Academy of Ophthalmology and the American Glaucoma
Society are calling for a new evaluation of glaucoma screening and
treatment in response to recent draft reviews prepared by the Agency
for Healthcare Research and Quality (AHRQ). The draft reviews assess
the effectiveness of glaucoma screenings and treatment, concluding
that there is no evidence for or against glaucoma screenings, or a
correlation between glaucoma treatment and visual impairment. This is
significant as AHRQ shares its reviews with the U.S. Preventive
Services Task Force, whose recommendations have implications for
Medicare and private-payer coverage decisions, and could hinder
access to care for minorities who are at high risk for glaucoma.
Open-angle glaucoma affects an estimated 2.2 million people in the
United States, with that number expected to increase to 3.3 million
in 2020 as the population ages. Overall, there appears to be a
threefold higher prevalence of open-angle glaucoma in African
Americans relative to non-Hispanic whites in the United States.
Glaucoma is the second-most common cause of blindness in African
Americans. Blindness from glaucoma is at least six times more
prevalent in African Americans than in non-Hispanic whites. Evidence
on Hispanics/Latinos suggests that they have prevalence rates of
open-angle glaucoma that are comparable to African Americans.
The Academy and the American Glaucoma Society provided comments to
AHRQ noting errors in both how the reviews were conducted, as well as
the resulting conclusions. Glaucoma treatment has been demonstrated
to reduce visual-field progression and is also linked to preservation
of health-related quality of life. Among the 18 specific concerns
cited by the Academy and the AGS are:
-- The AHRQ review focused on the technical aspects of glaucoma screening
and overlooked the significant burden that untreated glaucoma and
associated blindness has on individuals. This includes economic,
social and functional impacts on patients, as well as on society.
-- While glaucoma specialists agree that screening the overall population
for glaucoma has limited value, conducting screenings that target
high-risk groups will be more effective. The fact that there are
identified high-risk populations that are appropriate targets for
screening is an essential issue that was not addressed in the review.
-- There is more evidence on the linkage between quality of life and
glaucoma treatment than was presented in the review.
-- The association between visual-field loss with diminished
health-related quality of life is not discussed in the review.
Glaucoma treatment has been demonstrated to reduce visual-field
progression and is also linked to preservation of health-related
quality of life.
"The AHRQ reviews and recommendations for screening and treatment of
glaucoma fail to properly weigh the overall effectiveness of proven
methods of patient care, and therefore could have significant
negative societal impact on the medical community's ability to
control the disease," said glaucoma specialist Joseph Caprioli, MD,
professor of ophthalmology at UCLA and chairman of the Academy's
Practice Improvement Committee. "Glaucoma is largely asymptomatic in
its early stages, but will cause significant, irreversible visual
impairment without treatment. Preserving a high quality of life for
individuals with glaucoma needs to be emphasized -- and remain the
highest priority -- when considering screening and treatment."
Ophthalmologists in their response to AHRQ, noted that it is
important to continue screening for open-angle glaucoma because
patients are asymptomatic until late in the disease process, when
visual loss and functional impairment are irreversible. They
referenced the fact that the populations most at-risk for glaucoma
and blindness are also the most vulnerable populations in our
society, and the least likely to have regular access to "routine" eye
care. These factors make intentional outreach strategies for disease
detection in these populations necessary. The Academy and AGS assert
there is value in identifying or incentivizing high-risk groups to
have a comprehensive diagnostic eye examination. If detected early,
patients with primary open-angle glaucoma can be treated to either
slow or prevent the progression of visual-field loss. Even mild
visual-field loss decreases a patient's health-related quality of
life.
Although a randomized controlled trial demonstrating the value of
screening with improved quality of life and patient-reported outcomes
may not exist, glaucoma specialists believe that there are
similarities between findings seen with the early treatment of
glaucoma and reduced disease progression with less visual-field loss,
and reduction in health-related quality of life that should be
considered as part of the overall review of glaucoma screening for
at-risk populations.
The complete response by the Academy and the American Glaucoma
Society can be found here
(
http://www.aao.org/aao/outofcs/wre/AAO-AGS_screening_comment.pdf )
and here
(
http://www.aao.org/aao/outofcs/wre/AAO-AGS_treatment_comment.pdf ).
About the American Academy of Ophthalmology
The American Academy of
Ophthalmology is the world's largest association of eye physicians
and surgeons -- Eye M.D.s -- with more than 30,000 members worldwide.
Eye health care is provided by the three "O's" -- ophthalmologists,
optometrists and opticians. It is the ophthalmologist, or Eye M.D.,
who can treat it all: eye diseases and injuries, and perform eye
surgery. To find an Eye M.D. in your area, visit the Academy's Web
site at
www.aao.org . The Academy's EyeSmart(R) public education
program works to educate the public about the importance of eye
health and to empower people to preserve their healthy vision, by
providing the most trusted and medically accurate information about
eye diseases, conditions and injuries. Visit
www.geteyesmart.org to
learn more.