Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Open-angle glaucoma: To screen or not to screen?

Paul Pender, MD
Conditions
June 23, 2022
Share
Tweet
Share

In a published statement in JAMA Network on May 24/31, 2022, the U.S. Preventive Services Task Force found that there was insufficient evidence for screening for primary open-angle glaucoma in adults. They could not find a way to balance harms versus benefits for screening in general. But is this reasoning faulty?

It is well known that Black and Hispanic populations suffer a greater incidence and severity of glaucoma, and these populations deserve screening. The Task Force suggests that demographics for glaucoma damage result from disparities in access to the health care system, rather than from genetic predisposition. The Task Force concludes that although there are useful diagnostic tests to determine glaucoma, tests are not beneficial for screening purposes. In the official statement, screening results in more harm from over-treatment, such as cataract formation from glaucoma surgery and eye irritation from medications.

By saying that screening in the primary care setting has no merit unless there are signs and symptoms of glaucoma, the Task Force ignores the fact that signs and symptoms appear only late in the clinical course. The classic example is the major league baseball player Kirby Puckett. He didn’t know he had glaucoma until his peripheral vision deteriorated to the point that he could not track fly balls—ending his professional career. Had he been screened earlier by an ophthalmologist, simply because of his race, he might have been treated earlier and had a longer pro baseball career.

Usually, the course of deterioration of the optic nerve is long and slow, making it hard to evaluate longitudinally what interventions may help to prevent damage. Calls for more research in this area, as made by the Task Force, are both cynical and empty in my opinion. The Task Force statement of blindness as a major consequence of glaucoma in Black and Hispanic populations should drive screening in these populations to prevent serious, irreversible damage to vision. Quality of life is affected by glaucoma, whether it involves catching fly balls, driving, or reading.

My take on the Task Force statement is that clinical judgment should rule as to whether or not screening is indicated for glaucoma. Family history, race, diabetes, and other risk factors should be considered for such screening, especially in the face of potential asymptomatic damage. How often have doctors said, “If you had only come in sooner …”

To the Task Force, I pose the following question: If your mother, father, brother, sister, or child had known risk factors for glaucoma, wouldn’t you want your loved one evaluated before signs and symptoms develop?

Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.

Image credit: Shutterstock.com

Prev

Every intern encounters moments of patient care that become poignant memories

June 23, 2022 Kevin 0
…
Next

Combining personalized education and digital technology to improve glucose monitors [PODCAST]

June 23, 2022 Kevin 0
…

Tagged as: Ophthalmology

Post navigation

< Previous Post
Every intern encounters moments of patient care that become poignant memories
Next Post >
Combining personalized education and digital technology to improve glucose monitors [PODCAST]

ADVERTISEMENT

More by Paul Pender, MD

  • Why meaningful patient connections matter in medicine

    Paul Pender, MD
  • Global aspirations for value-based health care

    Paul Pender, MD
  • Employer health plans need a makeover

    Paul Pender, MD

Related Posts

  • Do you see me or your computer screen?

    Michele Luckenbaugh
  • Qualifying conditions for medical marijuana

    Patricia Frye
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN
  • What does Kelly Loeffler’s health plan do to coverage for preexisting conditions?

    Robert Laszewski
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • Type 1 diabetes is no fun

    Ryan Ritchie

More in Conditions

  • How chronic stress harms the heart in minority communities

    Monzur Morshed, MD and Kaysan Morshed
  • Could antibiotics beat heart disease where statins failed?

    Larry Kaskel, MD
  • Universities must tap endowments to sustain biomedical research

    Adeel Khan, MD
  • Apprenticeship reshapes medical training for confident clinicians

    Claude E. Lett III, PA-C
  • Why palliative care is more than just end-of-life support

    Dr. Vishal Parackal
  • My improbable survival of stage 4 cancer

    Kelly Curtin-Hallinan, DO
  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • How chronic stress harms the heart in minority communities

      Monzur Morshed, MD and Kaysan Morshed | Conditions
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How chronic stress harms the heart in minority communities

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • The dying man who gave me flowers changed how I see care

      Augusta Uwah, MD | Physician
    • Universities must tap endowments to sustain biomedical research

      Adeel Khan, MD | Conditions
    • Exploring the science behind burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Apprenticeship reshapes medical training for confident clinicians

      Claude E. Lett III, PA-C | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • When life makes you depend on Depends

      Francisco M. Torres, MD | Physician
    • Guilty until proven innocent? My experience with a state medical board.

      Jeffrey Hatef, Jr., MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • How chronic stress harms the heart in minority communities

      Monzur Morshed, MD and Kaysan Morshed | Conditions
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How chronic stress harms the heart in minority communities

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • The dying man who gave me flowers changed how I see care

      Augusta Uwah, MD | Physician
    • Universities must tap endowments to sustain biomedical research

      Adeel Khan, MD | Conditions
    • Exploring the science behind burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Apprenticeship reshapes medical training for confident clinicians

      Claude E. Lett III, PA-C | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...