Precision Population-Based Screening for Glaucoma

Glaucoma is the leading cause of irreversible blindness globally, and efforts are ongoing across the field of ophthalmology to facilitate early detection and treatment for this optic neuropathy, which can be insidious and asymptomatic in its early and moderate stages.Much focus has been dedicated to identifying high-risk populations due to concern for underidentification and subsequently undertreatment.Frediani et al 1 examined a complementary concern of overidentifying or overreferring low-risk populations.The authors analyzed retrospective data from a large, diverse managed care population in Southern California to better understand referral patterns among adults (aged 18 to 40 years), presenting for first-time eye examinations.By modeling data across a 5-year period, some key findings from their study were that (1) the diagnostic yield of glaucoma referrals in this population of adults aged 18 to 40 years was low, (2) a simple 3-variable model consisting of age, intraocular pressure, and cup-disc ratio may have risk stratified patients and yielded a high negative predictive value, and (3) racial and ethnic disparities existed regarding loss to follow-up for glaucoma referrals even among an insured population.Population-based glaucoma screening has not been strongly supported by public health guidelines in the US.For example, in 2013, the US Preventive Services Task Force determined that the evidence "was insufficient to assess the balance of benefits and harms of screening for primary open angle glaucoma in adults," with the most recent update in evidence conducted in 2022, which did not change this assessment. 2However, there are increasing conversations and advocacy among the ophthalmologic community in favor of population-based screening for glaucoma, particularly for high-risk populations.These are well-described in a series of articles recently featured in a Journal of Glaucoma supplement. 3Many population-based screening programs across medicine are aimed at