重要性Two 2013 systematic reviews to inform the US Preventive Services Task Force (USPSTF) found insufficient evidence to assess benefits and harms of screening for primary open-angle glaucoma (OAG) in adults.
ObjectiveTo update the 2013 reviews on screening for glaucoma, to inform the USPSTF.
Data SourcesOvid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews (to February 2021); surveillance through January 21, 2022.
Study SelectionRandomized clinical trials (RCTs) of screening, referral, and treatment; and studies of screening test diagnostic accuracy.
Data Extraction and SynthesisOne investigator abstracted data and a second checked accuracy. Two investigators independently assessed study quality.
Results八十三个研究(N = 75 887)包括(30 trials and 53 diagnostic accuracy studies). One RCT (n = 616) found screening of frail elderly persons associated with no difference in vision outcomes vs no screening but with significantly greater falls risk (relative risk [RR], 1.31 [95% CI, 1.13-1.50]). No study evaluated referral to an eye health professional. For glaucoma diagnosis, spectral domain optical coherence tomography (providing high-resolution cross-sectional imaging; 15 studies, n = 4242) was associated with sensitivity of 0.79 (95% CI, 0.75-0.83) and specificity of 0.92 (95% CI, 0.87-0.96) and the Humphrey Visual Field Analyzer (for perimetry, or measurement of visual fields; 6 studies, n = 11 244) with sensitivity of 0.87 (95% CI, 0.69-0.95) and specificity 0.82 (95% CI, 0.66-0.92); tonometry (for measurement of intraocular pressure; 13 studies, n = 32 892) had low sensitivity (0.48 [95% CI, 0.31-0.66]). Medical therapy for ocular hypertension and untreated glaucoma was significantly associated with decreased intraocular pressure and decreased likelihood of glaucoma progression (7 trials, n = 3771; RR, 0.68 [95% CI, 0.49-0.96]; absolute risk difference −4.2%) vs placebo, but 1 trial (n = 461) found no differences in visual acuity, quality of life, or function. Selective laser trabeculoplasty and medical therapy had similar outcomes (4 trials, n = 957).
Conclusions and RelevanceThis review found limited direct evidence on glaucoma screening, showing no association with benefits. Screening tests can identify persons with glaucoma and treatment was associated with a lower risk of glaucoma progression, but evidence of improvement in visual outcomes, quality of life, and function remains lacking.
Glaucoma is the second leading cause of irreversible blindness in the US and the leading cause in Black and Latino persons,1,2and earlier stages can also affect quality of life and function.3In 2011, an estimated 2.71 million persons had open-angle glaucoma (OAG); this number was projected to reach 4.3 million in 2025.4
In 2013, the US Preventive Services Task Force (USPSTF) concluded that evidence was insufficient to assess benefits and harms of screening for primary OAG in adults (I statement). Two 2013 reviews5-7conducted to inform the USPSTF found no direct evidence on benefits of screening and inadequate evidence on the effects of treatment on impaired vision or quality of life, although treatment was associated with reduced intraocular pressure (IOP) and reduced progression of visual field deficits. This report was conducted to update the 2013 reviews, to inform the USPSTF for an updated recommendation.
Detailed methods and additional study details, including the diagnostic accuracy of screening tests with limited evidence (swept-source optical coherence tomography [OCT], optic disc photography, ophthalmoscopy/biomicroscopy/stereoscopy, pachymetry, afferent papillary defect, and a telemedicine screening intervention), are available in the full evidence report.8Figure 1shows the analytic framework and key questions (KQs) that guided the review.
Data Sources and Searches
Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched from January 2011 to February 9, 2021 (eMethods 1 in theSupplement）.Searches were supplemented by reference list review of relevant studies; studies from the prior USPSTF reviews5-7that met inclusion criteria were carried forward. Ongoing surveillance was conducted to identify major studies published since February 2021 that may affect the conclusions or understanding of the evidence and the related USPSTF recommendation. The last surveillance was conducted on January 21, 2022, and identified no studies affecting review conclusions. One retrospective observational study10comparing glaucoma screening with no screening was identified during surveillance but was not eligible for inclusion owing to observational design and serious methodological limitations (control group was nonparticipants/nonresponders, and the study did not control for potential confounders).
Two investigators independently reviewed titles, abstracts, and full-text articles using predefined eligibility criteria (eMethods 2 in theSupplement）.人口筛查成人40年s or older without known OAG; for treatment, patients had OAG or glaucoma suspect.
筛查是一个完整的眼科检查various components, and imaging tests; this article focuses on spectral-domain OCT (provides high-resolution cross-sectional imaging of ocular structures including the retina and optic nerve, the principal sites of glaucomatous changes), visual field testing (to assess whether there are deficits in the field of vision; in glaucoma, peripheral vision is typically lost before central vision), and tonometry (to measure intraocular pressure). For treatment, this article focuses on first-line medical treatments (prostaglandin analogues, β-blockers, α-2 agonists, and carbonic anhydrase inhibitors) vs placebo, selective laser trabeculoplasty (SLT) vs first-line medical treatments or no treatment, and recently approved medications vs first-line medications. Outcomes were IOP, visual field loss, visual acuity, optic nerve damage, visual impairment (defined as visual acuity <20/70 or <20/100), quality of life, function, and harms. Randomized clinical trials of screening and treatment and cohort and cross-sectional studies on screening test diagnostic accuracy were included; diagnostic accuracy studies that used a case-control design were excluded, due to potential spectrum bias.11Inclusion was restricted to English-language articles, and studies published only as abstracts were excluded.
Data Abstraction and Quality Rating
One investigator abstracted details about the study design, patient population, setting, interventions, analysis, follow-up, and results from each study. A second investigator reviewed abstracted data for accuracy. Two independent investigators assessed the quality of each study as good, fair, or poor using predefined criteria (eMethods 3 in theSupplement) developed by the USPSTF.9Disagreements were resolved by consensus. In accordance with the USPSTF Procedure Manual, studies rated poor quality because of critical methodological limitations were excluded.
For all KQs, the overall strength of evidence was rated “high,” “moderate,” “low,” or “insufficient” based on study limitations, consistency, precision of estimates, reporting bias, and applicability, using the approach described in the USPSTF Procedure Manual.9
Meta-analysis was conducted to summarize effects of treatments and diagnostic accuracy of screening tests. Details of the meta-analytic methods are provided in eMethods 4 in theSupplement. Briefly, for treatment, a random-effects profile likelihood model was used to pool studies of first-line treatment vs placebo or no treatment on likelihood of glaucoma progression (based on progression of visual field loss, with or without optic nerve changes), serious adverse events, and withdrawal due to adverse events and on difference in mean IOP. Analyses were stratified by medication type, and prespecified study-level subgroup analyses were conducted on glaucoma status (OAG, ocular hypertension, or mixed), quality, baseline IOP, and duration of follow-up. For diagnostic accuracy, a bivariate logistic random-effects model was used to summarize sensitivity and specificity of screening tests for glaucoma simultaneously, while incorporating the correlation between sensitivity and specificity. Stratified analyses were conducted based on control type (healthy eye, glaucoma suspect, or ocular hypertension) and study quality.
All meta-analyses were conducted using Stata/SE version 14.2 or 16.1 (StataCorp). Statistical heterogeneity was assessed using theI2statistic.12Two-sided tests withPvalues <.05 were considered statistically significant.
Across all key questions, 83 studies (reported in 96 publications, total 75 887 participants) were included (30 trials and 53 diagnostic accuracy studies) (Figure 2）.13-108Sixteen studies were carried forward from the 2013 reviews, and 67 studies were new.
Key Question 1.What are the effects of screening for OAG vs no screening on (a) IOP, visual field loss, visual acuity, or optic nerve damage or (b) visual impairment, quality of life, or function?
One trial (n = 616) of frail elderly persons, not included in the 2013 reviews, found no significant difference between vision screening vs no screening in distance visual acuity (mean logarithm of the minimum angle of resolution [logMAR], 0.27 vs 0.25;P = .32), near visual acuity (mean logMAR, −0.01 vs −0.03;P = .26) or vision-related quality of life after 1 year (eTables 1-2 in theSupplement）.95Screening was conducted by an optometrist and included components for identifying glaucoma (IOP, direct ophthalmoscopy, and visual field); interventions for screen-positive persons included referral for eye care, occupational therapy, or both. Seventy-two percent of control patients had visited an eye care professional in the last year, which could have attenuated potential screening benefits.
Key Question 2.What are the harms of screening for OAG vs no screening?
The trial described in KQ1 found screening associated with significant increased risk for falls vs no screening (incidence rate ratio, 1.57 [95% CI, 1.20-2.05]; risk of 1 or more falls, 65% vs 50%; relative risk [RR], 1.31 [95% CI, 1.13-1.50]). Screening was associated with increased risk for fractures that was not statistically significant (RR, 1.74 [95% CI, 0.97-3.11]). In the trial, 46% of patients had fallen in the past year.95
Key Question 3.What are the effects of referral to an eye health provider vs no referral on (a) IOP, visual field loss, visual acuity, or optic nerve damage or (b) visual impairment, quality of life, or function?
No study addressed this KQ.
Key Question 4.What is the accuracy of screening for diagnosis of OAG?
Fifty-three studies evaluated the diagnostic accuracy of screening tests (reported in 59 publications, n = 65 464) (eTables 3-4 in theSupplement）.13-15,18-20,23,24,26-30,32-36,38-40,45-47,49,50,54,57-59,61-64,66-74,78,79,82,83,85,88,91,93,94,96,98-102,108Most studies evaluated spectral-domain OCT (29 studies, n = 11 434), tonometry (17 studies, n = 49 742), and visual field assessment (10 studies, n = 11 633). No study evaluated the diagnostic accuracy of a comprehensive ophthalmological examination. Seven studies were rated good quality,15,18,32,39,71,73,85and the remainder were rated fair quality (eTable 5 in theSupplement）.fair-quality方法论上的局限studies included nonindependent evaluation of the reference standard from the screening test and uncertain interval between index and reference tests.
Spectral-domain OCT using retinal nerve fiber layer thickness was associated with a pooled sensitivity of 0.79 (95% CI, 0.75-0.83) and specificity of 0.92 (95% CI, 0.87-0.96) for identifying glaucomatous eyes, based on 15 studies (n = 4242) (eFigure 1 in theSupplement); the pooled area under the receiver operating characteristic curve was 0.90 (95% CI, 0.86-0.93), based on 16 studies (n = 4060). Findings were similar for spectral-domain OCT using ganglion cell complex thickness (pooled sensitivity, 0.74 [95% CI, 0.68-0.80] and specificity, 0.91 [95% CI, 0.80-0.96] based on 9 studies [n = 1522] [eFigure 2 in theSupplement]; pooled area under the receiver operating characteristic curve, 0.88 [95% CI, 0.84-0.92], based on 6 studies [n = 765]). The Humphrey Visual Field Analyzer was associated with a pooled sensitivity of 0.87 (95% CI, 0.69-0.95) and specificity of 0.82 (95% CI, 0.66-0.92), based on 6 studies (n = 11 244) (eFigure 3 in theSupplement）.Tonometry for measurement of intraocular pressure was associated with a pooled sensitivity of 0.48 (95% CI, 0.31-0.66) and specificity of 0.94 (95% CI, 0.90-0.96), based on 13 studies (n = 32 892) (eFigure 4 in theSupplement）.Findings for diagnostic accuracy were consistent in analyses stratified by control type (healthy eyes, glaucoma suspect, or ocular hypertension) or study quality (Table 1andTable 2）.
Key Question 5.What is the accuracy of instruments for identifying patients at higher risk of OAG?
One fair-quality cross-sectional study (n = 145) not included in the 2013 reviews found a questionnaire associated with low sensitivity (0.20 [95% CI, 0.03-0.56]) but high specificity (0.96 [95% CI, 0.91-0.99]) for identifying persons with glaucoma (eTables 6-8 in theSupplement）.79
Key Question 6.What are the effects of medical treatments for OAG vs placebo or no treatments on (a) IOP, visual field loss, visual acuity, or optic nerve damage or (b) visual impairment, quality of life, or function?
Seventeen trials (n = 4665) evaluated medical treatments for OAG vs placebo or no treatment.56,86,89,107Nine trials37,48,53,55,56,76,89,90,107were in the 2013 review6and 8 trials21,22,41,84,86,87,97,106were added (eTable 9 in theSupplement）.21,22,41,84,86,87,97,106Two trials enrolled patients with untreated, newly diagnosed OAG,22,413 trials enrolled mixed populations (OAG or ocular hypertension,21,87,106and 12 trials enrolled patients with ocular hypertension. Mean baseline IOP ranged from 19.6 to 27.3 mm Hg (≥22 mm Hg in all trials except for the trials of patients with early untreated OAG22,41）.Ten trials evaluated a β-blocker, 5 trials a carbonic anhydrase inhibitor, 1 trial a prostaglandin analogue, and 1 trial an α agonist.97One trial allowed various topical therapies, with a target IOP of 24 mm Hg or less or 20% or greater IOP reduction.56The duration of follow-up ranged from 1.5 months22,84to 120 months48(>1 year in 10 trials). Four trials were rated good quality41,53,77,90and 12 fair quality21,37,48,55,56,84,86,87,89,97,106,107(eTable 10 in theSupplement）.fair-quality方法论上的局限trials included unclear reporting of randomization, allocation concealment, and blinding methods; and high attrition in some studies.
Treatment was significantly associated with greater reduction in IOP vs placebo or no treatment (16 trials, n = 3706; mean difference, −3.14 mm Hg [95% CI, −4.19 to −2.08];I2 = 95%) (eFigure 5 in theSupplement）.There was a subgroup difference by drug class (P < .001), although estimates favored treatment for all drug classes. The mean difference in IOP ranged from −3.75 mm Hg (95% CI, −5.43 to −2.06;I2 = 92%) for β-blockers (9 trials, n = 455) to −1.20 mm Hg (95% CI, −2.30 to −0.61) for carbonic anhydrase inhibitors (4 trials, n = 1635). Treatment with topical therapy also significantly decreased risk of glaucoma progression (defined as progression of visual field defects,37,41progression of visual field defects or optic disc change,56,76,77or progression to glaucoma diagnosis among patients with ocular hypertension48,53,89) vs placebo or no treatment (7 trials, n = 3771; RR, 0.68 [95% CI, 0.49-0.96],I2 = 53%; absolute risk difference (ARD), −4.8% [95% CI, −8.5% to −1.0%]) (eFigure 6 in theSupplement）.There was no subgroup difference based on drug class. For both outcomes, findings consistently favored treatment in analyses stratified according to baseline status (OAG, ocular hypertension, or mixed), baseline IOP, or study quality, although some subgroup differences were present (Table 3）.
One trial (n = 461), the UK Glaucoma Treatment Study (UKGTS) found no differences between latanoprost vs placebo in visual acuity (logMAR, −0.01 vs −0.02;P = .9) or general or vision-related quality of life at 24 months.41,51
Key Question 7.What are the harms of medical treatments for OAG vs placebo or no treatments?
Eight trials (in 9 publications) of medical treatments vs placebo or no treatment reported harms (eTable 9 in theSupplement）.21,37,41,56,76,77,87,90,106There were no statistically significant differences in risk of serious adverse events (3 trials, n = 3140; RR, 1.14 [95% CI, 0.60-1.99];I2(eFigure 7 = 32%)Supplement),41,56,76,77withdrawal due to adverse events (5 trials, n = 648; RR, 2.40 [95% CI, 0.71-19.32];I2 = 0%) (eFigure 8 in theSupplement),21,37,41,90,106or any adverse event (2 trials, n = 1538; RR, 1.56 [95% CI, 0.59-4.03];I2 = 82%).41,76,77然而,估计不精确的估计for any adverse event had substantial statistical heterogeneity. Two trials found treatment associated with increased risk of ocular adverse events (most commonly localized itching, irritation, dryness, or taste issues) vs placebo (RR, 1.21 [95% CI, 1.10-1.33] in a trial of various treatments76,77and RR, 3.52 [95% CI, 2.46-5.02]56in a trial of dorzolamide).
Key Question 8.What are the effects of newly US Food and Drug Administration (FDA)–approved medical treatments (latanoprostene bunod and netarsudil) vs older medical treatments on (a) IOP, visual field loss, visual acuity, or optic nerve damage or (b) visual impairment, quality of life, or function?
Eight trials (n = 4113) compared latanoprostene bunod or netarsudil vs an older glaucoma medication in mixed populations of patients with OAG or ocular hypertension (eTable 11 in theSupplement）.16,17,25,52,60,75,92,103-105The duration of follow-up was 3 months in all trials except for 3, which had 1-month104or 12-month follow-up.25,52三个试验16,75,105were rated good quality and 5 trials were rated fair quality (eTable 12 in theSupplement）.25,52,60,92,104fair-quality方法论上的局限trials included unclear reporting of randomization, allocation concealment, and blinding of outcome assessors; some trials also had high and differential attrition.
All trials focused on IOP. In 5 trials (n = 2860), netarsudil was noninferior to or associated with similar effects on IOP vs older glaucoma medications.16,52,60,92三个试验(n = 1253) found latanoprostene bunod significantly associated with greater reduction in IOP vs older glaucoma medications (mean difference, −1.0 to −1.3 mm Hg).103,104The trials did not evaluate visual impairment, quality of life, or function.
Key Question 9.What are the harms of newly FDA-approved medical treatments vs older medical treatments?
The trials described in KQ8 also reported harms. Three trials (n = 1875) found netarsudil associated with increased risk of ocular adverse events vs timolol.52,60,92The most commonly reported ocular adverse events were conjunctival redness or hemorrhage, corneal deposits (cornea verticillata, typically asymptomatic), blurry vision, tearing, and itching. The proportion of patients with ocular adverse events ranged from 73% to 88% with netarsudil and from 41% to 50% with timolol; RRs ranged from 1.51 to 2.07 at 3 to 12 months (ARDs ranged from 26% to 38%). One trial (n = 480) of netarsudil vs latanoprost (RR, 1.76 [95% CI, 1.50-2.07])25and 2 trials (n = 840) of latanoprostene bunod vs timolol (pooled RR, 1.72 [95% CI, 1.22-2.42])103also found the newer therapy significantly associated with increased risk of ocular adverse events. Netarsudil was associated with significantly increased risk of withdrawal due to adverse events vs timolol (3 trials, n = 1875; RRs ranged from 4.73 to 38.20; ARDs ranged from 8% to 34%)52,60,92or latanoprost (2 trials, n = 985; RR, 7.40 [95% CI, 2.94-18.65] at 3 months16and 1 trial, n = 480; RR, 12.82 [95% CI, 4.71-34.85] at 12 months25）.For latanoprostene bunod vs latanoprost (1 trial, n = 413104) or timolol (2 trials, n = 840),103estimates for withdrawal due to adverse events indicated no differences or were imprecise (eTable 11 in theSupplement）.
Key Question 10.激光trabeculoplasty的影响是什么OAG vs no trabeculoplasty or medical treatment on (a) IOP, visual field loss, visual acuity, or optic nerve damage or (b) visual impairment, quality of life, or function?
Four trials (in 5 publications; n = 957) evaluated SLT vs a topical prostaglandin analogue (eTables 13 and 14 in theSupplement）.42,43,65,80,81All trials except for 165were added for this update. The largest study was the good-quality Laser in Glaucoma and Ocular Hypertension Trial (LiGHT), which enrolled 718 participants with OAG (77%) or ocular hypertension (23%) and visual acuity approximately 20/120 or better; mean baseline IOP was 24.5 mm Hg.42,43LiGHT found 360° SLT and medical therapy associated with similar effects on IOP, visual acuity, visual field, general quality of life, and glaucoma-specific utility, symptoms, and quality of life at 3 years. Three smaller, fair-quality trials (n = 32, 40, and 167) also found SLT and medical therapy associated with similar reduction in IOP at 4 to 12 months and 5 years65,80,81; the trials did not evaluate other ocular and health outcomes.
Key Question 11.激光trabeculoplasty OA的危害是什么G vs no trabeculoplasty or medical treatment?
SLT光试验没有发现差异nd medical therapy in likelihood of any adverse event (73% vs 72%), ocular adverse events (52% vs 61%), or serious ocular adverse events (2.2% vs 1.7%) (eTable 13 in theSupplement）.42,43Evidence on harms of SLT vs medical therapy from other trials was limited by suboptimal reporting and imprecision.65,80,81
Table 4summarizes the evidence reviewed for this update. Although 1 trial found no difference between vision screening (including components for glaucoma diagnosis) vs no screening on vision outcomes or vision-related quality of life,95the vision screening intervention was not specific for glaucoma, imaging was not used as part of the screening intervention, and the proportion of patients referred for glaucoma management was small. In addition, potential benefits could have been attenuated because most patients had visited an eye care professional in the prior year. Unexpectedly, the trial found screening associated with increased falls risk and potential increased fractured risk. The reason was unclear but could be due in part to evaluation of a frail elderly population at high falls risk or difficulty adapting to large corrections in vision or use of multifocal lenses. No study evaluated outcomes associated with referral to an eye health professional vs no referral.
10月的诊断准确性,spectral-domain和visual field assessment using the Humphrey Automated Field Analyzer were associated with moderate to high accuracy for identifying glaucoma compared with a comprehensive eye examination. Although visual field assessment is generally performed in eye specialty settings, OCT could be ordered from a primary care clinic. Swept-source OCT, a newer OCT technology with increased scan speed and resolution, appears to provide improved visualization of ocular structures, but evidence on glaucoma diagnostic accuracy is currently limited.109Tonometry was associated with high specificity but low sensitivity, consistent with data indicating that a significant proportion of patients with glaucoma have normal IOP. As detailed in the full report, evidence on other screening tests, including swept-source OCT, optic disc photography, ophthalmoscopy and biomicroscopy, and pachymetry was limited.8Evidence on risk instruments to identify persons with glaucoma was restricted to 1 study that showed low sensitivity79; therefore, no well-validated risk assessment instrument is currently available.
Consistent with the 2013 review6that informed the previous USPSTF recommendation on this topic, this update found first-line medical treatments associated with lower IOP; effects on mean IOP vs placebo or no treatment generally ranged from 2 to 3 mm Hg. Medical treatments were also associated with reduced risk of glaucoma progression, based on visual field or optic disc changes. New evidence is available on effect of treatments on visual acuity and vision-related function or quality of life, most notably from the UKGTS,41latanoprost与安慰剂比较,发现没有difference in visual acuity or overall or vision-related quality of life at 2 years. However, because visual acuity changes and associated effects on quality of life are a late finding of glaucoma progression, large studies with longer duration of follow-up would be necessary to adequately evaluate these outcomes. Data on harms of topical medical therapies were limited but did not indicate an increased risk of serious adverse events, although they were associated with nonserious ocular adverse events (eg, redness, irritation, itching, burning, tearing). Newly approved topical medications for glaucoma (netarsudil and latanoprost bunod) were associated with similar or greater IOP-reducing effects vs older medications but increased risk of adverse events. For SLT vs medical therapy, LiGHT found similar effects on IOP, visual acuity, visual field, and quality of life, with no differences in serious adverse events or ocular adverse events.42,43Findings regarding treatment are most applicable to patients with ocular hypertension or early, untreated OAG, the populations typically enrolled in the trials.
This evidence review has several limitations. First, there was statistical heterogeneity in pooled analyses on effects of medical therapy vs placebo or no treatment on IOP. However, inconsistency was in the magnitude but not direction of effect, which favored medical therapy across studies, and differences between drug classes in IOP-lowering effects were small (1 to 2 mm Hg). In addition, because of anticipated heterogeneity, a random-effects model was used for pooling. Second, statistical heterogeneity was also present in pooled analyses of sensitivity and specificity. However, standard bivariable methods for measuring statistical heterogeneity in studies of diagnostic accuracy do not account for the variability in sensitivity and specificity estimates related to threshold effects, and results were robust in stratified and sensitivity analyses. Third, direct evidence on benefits and harms of screening vs no screening and effects of treatment vs no treatment for ocular hypertension or early OAG on visual impairment, quality of life, and function remains very limited. Fourth, evaluations of publication bias through graphical or statistical methods were limited by small numbers of studies or statistical heterogeneity. However, this review did not identify unpublished studies likely to affect findings. Fifth, non–English-language studies were excluded, which could introduce language bias. However, no relevant non–English-language studies that appeared likely to affect conclusions were identified.
This review found limited direct evidence on glaucoma screening, showing no association with benefits. Screening tests can identify persons with glaucoma and treatment was associated with a lower risk of glaucoma progression, but evidence of improvement in visual outcomes, quality of life, and function remains lacking.
Corresponding Author:Roger Chou, MD, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: BICC, Portland, OR 97239 (chour@ohsu.edu）.
Accepted for Publication:April 4, 2022.
Author Contributions:Dr Chou had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design:Chou, Jonas.
Acquisition, analysis, or interpretation of data:Chou, Selph, Blazina, Bougatsos, Jungbauer, Fu, Grusing, Tehrani.
Drafting of the manuscript:Chou, Selph, Blazina, Bougatsos, Jungbauer, Fu, Grusing.
Critical revision of the manuscript for important intellectual content:Chou, Blazina, Jonas, Tehrani.
Statistical analysis:周,Selph Blazina,傅。
Obtained funding:Chou, Bougatsos, Jonas.
行政、技术或材料支持:Blazina, Bougatsos, Jungbauer, Grusing, Jonas, Tehrani.
Supervision:Chou, Jonas, Tehrani.
Conflict of Interest Disclosures:None reported.
Funding/Support:This research was funded under contract HHSA-290-2015-00011-I, Task Order 75Q80119F32015, from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, under a contract to support the US Preventive Services Task Force (USPSTF).
Role of the Funder/Sponsor:Investigators worked with US Preventive Services Task Force members and AHRQ staff to develop the scope, analytic framework, and key questions for this review. AHRQ had no role in study selection, quality assessment, or synthesis. AHRQ staff provided project oversight, reviewed the report to ensure that the analysis met methodological standards, and distributed the draft for peer review. Otherwise, AHRQ had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript findings. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the US Department of Health and Human Services.
Additional Contributions:We thank the following individuals for their contributions to this project: Pacific Northwest Evidence-based Practice Center Librarian, Tracy Dana, MLS; Agency for Healthcare Research and Quality Medical Officer, Justin Mills, MD, MPH; as well as the US Preventive Services Task Force. We also acknowledge past and current USPSTF members who contributed to topic deliberations. The USPSTF members, external reviewers, and federal partner reviewers did not receive financial compensation for their contributions.
Additional Information:A draft version of this evidence report underwent external peer review from 4 content experts (April Maa, MD, Emory University School of Medicine, Emory Eye Center; Atlanta VA Medical Center; Nancy Weintraub, MD, David Geffen School of Medicine at University of California at Los Angeles; Jennifer Evans, PhD, MSc, London School of Hygiene and Tropical Medicine; and 1 nondisclosed reviewer) and federal partners representing the Centers for Disease Control and Prevention. Comments were presented to the USPSTF during its deliberation of the evidence and were considered in preparing the final evidence report.
Editorial Disclaimer:This evidence report is presented as a document in support of the accompanying USPSTF Recommendation Statement. It did not undergo additional peer review after submission toJAMA.
3.
Kwon M, Huisingh C, Rhodes LA, McGwin G Jr, Wood JM, Owsley C. Association between glaucoma and at-fault motor vehicle collision involvement among older drivers: a population-based study.
Ophthalmology. 2016;123(1):109-116. doi:
10.1016/j.ophtha.2015.08.043
PubMed
Google Scholar
Crossref
5.
Ervin A-M, Boland M, Myrowitz E, et al.筛查Glaucoma: Comparative Effectiveness. Comparative Effectiveness Review No. 59. Agency for Healthcare Research and Quality; 2013. AHRQ publication 12-EHC037-EF.
6.
Boland MV, Ervin AM, Friedman D, et al.Treatment for Glaucoma: Comparative Effectiveness. Comparative Effectiveness Review No. 60. Agency for Healthcare Research and Quality; 2012. AHRQ publication 12-EHC038-EF.
8.
Chou R, Selph SS, Blazina I, et al.筛查Glaucoma in Adults: A Systematic Review for the US Preventive Services Task Force. Evidence Synthesis No. 214. Agency for Healthcare Research and Quality; 2020. AHRQ publication 21-05286-EF-1.
14.
Aptel F, Sayous R, Fortoul V, Beccat S, Denis P. Structure-function relationships using spectral-domain optical coherence tomography: comparison with scanning laser polarimetry.
Am J Ophthalmol. 2010;150(6):825-833. doi:
10.1016/j.ajo.2010.06.011
PubMed
Google Scholar
Crossref
15.
Arnould L, De Lazzer A, Seydou A, Binquet C, Bron AM, Creuzot-Garcher C. Diagnostic ability of spectral-domain optical coherence tomography peripapillary retinal nerve fiber layer thickness to discriminate glaucoma patients from controls in an elderly population (the MONTRACHET study).
Acta Ophthalmol. 2020;98(8):e1009-e1016. doi:
10.1111/aos.14448
PubMed
Google Scholar
Crossref
16.
Asrani S, Bacharach J, Holland E, et al. Fixed-dose combination of netarsudil and latanoprost in ocular hypertension and open-angle glaucoma: pooled efficacy/safety analysis of phase 3 MERCURY-1 and -2.
Adv Ther. 2020;37(4):1620-1631. doi:
10.1007/s12325-020-01277-2
PubMed
Google Scholar
Crossref
17.
Asrani S, Robin AL, Serle JB, et al; MERCURY-1 Study Group. Netarsudil/latanoprost fixed-dose combination for elevated intraocular pressure: three-month data from a randomized phase 3 trial.
Am J Ophthalmol. 2019;207:248-257. doi:
10.1016/j.ajo.2019.06.016
PubMed
Google Scholar
Crossref
18.
Azuara-Blanco A, Banister K, Boachie C, et al. Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study).
Health Technol Assess. 2016;20(8):1-168. doi:
10.3310/hta20080
PubMed
Google Scholar
Crossref
24.
Bonomi L, Marchini G, Marraffa M, Morbio R. The relationship between intraocular pressure and glaucoma in a defined population: data from the Egna-Neumarkt Glaucoma Study.
Ophthalmologica. 2001;215(1):34-38. doi:
10.1159/000050823
PubMed
Google Scholar
Crossref
25.
Brubaker JW, Teymoorian S, Lewis RA, et al. One year of netarsudil and latanoprost fixed-dose combination for elevated intraocular pressure: phase 3, randomized MERCURY-1 study.
Ophthalmol Glaucoma. 2020;3(5):327-338. doi:
10.1016/j.ogla.2020.05.008
PubMed
Google Scholar
Crossref
26.
Casado A, Cerveró A, López-de-Eguileta A, et al. Topographic correlation and asymmetry analysis of ganglion cell layer thinning and the retinal nerve fiber layer with localized visual field defects.
PLoS One. 2019;14(9):e0222347. doi:
10.1371/journal.pone.0222347
PubMed
Google Scholar
Crossref
30.
Cifuentes-Canorea P, Ruiz-Medrano J, Gutierrez-Bonet R, et al. Analysis of inner and outer retinal layers using spectral domain optical coherence tomography automated segmentation software in ocular hypertensive and glaucoma patients.
PLoS One. 2018;13(4):e0196112. doi:
10.1371/journal.pone.0196112
PubMed
Google Scholar
Crossref
33.
Danesh-Meyer HV, Gaskin BJ, Jayusundera T, Donaldson M, Gamble GD. Comparison of disc damage likelihood scale, cup to disc ratio, and Heidelberg retina tomograph in the diagnosis of glaucoma.
Br J Ophthalmol. 2006;90(4):437-441. doi:
10.1136/bjo.2005.077131
PubMed
Google Scholar
Crossref
39.
Francis BA, Varma R, Vigen C, et al; Los Angeles Latino Eye Study Group. Population and high-risk group screening for glaucoma: the Los Angeles Latino Eye Study.
Invest Ophthalmol Vis Sci. 2011;52(9):6257-6264. doi:
10.1167/iovs.09-5126
PubMed
Google Scholar
Crossref
40.
Garas A, Vargha P, Holló G. Diagnostic accuracy of nerve fibre layer, macular thickness and optic disc measurements made with the RTVue-100 optical coherence tomograph to detect glaucoma.
Eye (Lond). 2011;25(1):57-65. doi:
10.1038/eye.2010.139
PubMed
Google Scholar
Crossref
42.
Gazzard G, Konstantakopoulou E, Garway-Heath D, et al; LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial.
Lancet. 2019;393(10180):1505-1516. doi:
10.1016/S0140-6736(18)32213-X
PubMed
Google Scholar
Crossref
43.
Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT.
Health Technol Assess. 2019;23(31):1-102. doi:
10.3310/hta23310
PubMed
Google Scholar
Crossref
51.
Jones L, Garway-Heath DF, Azuara-Blanco A, Crabb DP; United Kingdom Glaucoma Treatment Study Investigators. Are patient self-reported outcome measures sensitive enough to be used as end points in clinical trials? evidence from the United Kingdom Glaucoma Treatment Study.
Ophthalmology. 2019;126(5):682-689. doi:
10.1016/j.ophtha.2018.09.034
PubMed
Google Scholar
Crossref
52.
Kahook MY, Serle JB, Mah FS, et al; ROCKET-2 Study Group. Long-term safety and ocular hypotensive efficacy evaluation of netarsudil ophthalmic solution: rho kinase elevated IOP treatment trial (ROCKET-2).
Am J Ophthalmol. 2019;200(200):130-137. doi:
10.1016/j.ajo.2019.01.003
PubMed
Google Scholar
Crossref
56.
Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma.
Arch Ophthalmol. 2002;120(6):701-713. doi:
10.1001/archopht.120.6.701
PubMed
Google Scholar
Crossref
57.
Katz J, Tielsch JM, Quigley HA, Javitt J, Witt K, Sommer A. Automated suprathreshold screening for glaucoma: the Baltimore Eye Survey.
Invest Ophthalmol Vis Sci. 1993;34(12):3271-3277.
PubMed
Google Scholar
58.
Kaushik S, Kataria P, Jain V, et al. Evaluation of macular ganglion cell analysis compared to retinal nerve fiber layer thickness for preperimetric glaucoma diagnosi s.
Indian J Ophthalmol. 2018;66(4):511-516. doi:
10.4103/ijo.IJO_1039_17
PubMed
Google Scholar
Crossref
59.
Kaushik S, Singh Pandav S, Ichhpujani P, Gupta A, Gupta P. Retinal nerve fiber layer measurement and diagnostic capability of spectral-domain versus time-domain optical coherence tomography.
Eur J Ophthalmol. 2011;21(5):566-572. doi:
10.5301/EJO.2011.6289
PubMed
Google Scholar
Crossref
60.
Khouri AS, Serle JB, Bacharach J, et al; Rocket-4 Study Group. Once-daily netarsudil versus twice-daily timolol in patients with elevated intraocular pressure: the randomized phase 3 ROCKET-4 study.
Am J Ophthalmol. 2019;204:97-104. doi:
10.1016/j.ajo.2019.03.002
PubMed
Google Scholar
Crossref
61.
Kiddee W, Tantisarasart T, Wangsupadilok B. Performance of optical coherence tomography for distinguishing between normal eyes, glaucoma suspect and glaucomatous eyes.
J Med Assoc Thai. 2013;96(6):689-695.
PubMed
Google Scholar
62.
Kim SY, Park HY, Park CK. The effects of peripapillary atrophy on the diagnostic ability of Stratus and Cirrus OCT in the analysis of optic nerve head parameters and disc size.
Invest Ophthalmol Vis Sci. 2012;53(8):4475-4484. doi:
10.1167/iovs.12-9682
PubMed
Google Scholar
Crossref
63.
Koh V, Tham YC, Cheung CY, et al. Diagnostic accuracy of macular ganglion cell-inner plexiform layer thickness for glaucoma detection in a population-based study: comparison with optic nerve head imaging parameters.
PLoS One. 2018;13(6):e0199134. doi:
10.1371/journal.pone.0199134
PubMed
Google Scholar
Crossref
67.
Lee WJ, Na KI, Kim YK, Jeoung JW, Park KH. Diagnostic ability of wide-field retinal nerve fiber layer maps using swept-source optical coherence tomography for detection of preperimetric and early perimetric glaucoma.
J Glaucoma. 2017;26(6):577-585. doi:
10.1097/IJG.0000000000000662
PubMed
Google Scholar
Crossref
69.
Leibowitz HM, Krueger DE, Maunder LR, et al. The Framingham Eye Study monograph: an ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975.
Surv Ophthalmol. 1980;24(suppl):335-610.
PubMed
Google Scholar
70.
Liu S, Lam S, Weinreb RN, et al. Comparison of standard automated perimetry, frequency-doubling technology perimetry, and short-wavelength automated perimetry for detection of glaucoma.
Invest Ophthalmol Vis Sci. 2011;52(10):7325-7331. doi:
10.1167/iovs.11-7795
PubMed
Google Scholar
Crossref
72.
Maa AY, McCord S, Lu X, et al. The impact of OCT on diagnostic accuracy of the technology-based eye care services protocol: part II of the Technology-Based Eye Care Services Compare Trial.
Ophthalmology. 2020;127(4):544-549. doi:
10.1016/j.ophtha.2019.10.025
PubMed
Google Scholar
Crossref
74.
Marraffa M, Marchini G, Albertini R, Bonomi L. Comparison of different screening methods for the detection of visual field defects in early glaucoma.
Int Ophthalmol. 1989;13(1-2):43-45. doi:
10.1007/BF02028636
PubMed
Google Scholar
Crossref
75.
Medeiros FA, Martin KR, Peace J, Scassellati Sforzolini B, Vittitow JL, Weinreb RN. Comparison of latanoprostene bunod 0.024% and timolol maleate 0.5% in open-angle glaucoma or ocular hypertension: the LUNAR Study.
Am J Ophthalmol. 2016;168:250-259. doi:
10.1016/j.ajo.2016.05.012
PubMed
Google Scholar
Crossref
77.
Miglior S, Zeyen T, Pfeiffer N, Cunha-Vaz J, Torri V, Adamsons I; European Glaucoma Prevention Study Group. The European Glaucoma Prevention Study design and baseline description of the participants.
Ophthalmology. 2002;109(9):1612-1621. doi:
10.1016/S0161-6420(02)01167-3
PubMed
Google Scholar
Crossref
78.
Morejon A, Mayo-Iscar A, Martin R, Ussa F. Development of a new algorithm based on FDT Matrix perimetry and SD-OCT to improve early glaucoma detection in primary care.
Clin Ophthalmol. 2018;13:33-42. doi:
10.2147/OPTH.S177581
PubMed
Google Scholar
Crossref
81.
Nagar M, Ogunyomade A, O’Brart DP, Howes F, Marshall J. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma.
Br J Ophthalmol. 2005;89(11):1413-1417. doi:
10.1136/bjo.2004.052795
PubMed
Google Scholar
Crossref
86.
Ravalico G, Salvetat L, Toffoli G, et al. Ocular hypertension: a follow-up study in treated and untreated patients.
New Trends Ophthalmol. 1994;9(2):97-101.
Google Scholar
87.
Sall K; Brinzolamide Primary Therapy Study Group. The efficacy and safety of brinzolamide 1% ophthalmic suspension (Azopt) as a primary therapy in patients with open-angle glaucoma or ocular hypertension.
Surv Ophthalmol. 2000;44(suppl 2):S155-S162. doi:
10.1016/S0039-6257(99)00107-1
PubMed
Google Scholar
Crossref
91.
Schweitzer C, Korobelnik JF, Le Goff M, et al. Diagnostic performance of peripapillary retinal nerve fiber layer thickness for detection of glaucoma in an elderly population: the ALIENOR Study.
Invest Ophthalmol Vis Sci. 2016;57(14):5882-5891. doi:
10.1167/iovs.16-20104
PubMed
Google Scholar
Crossref
92.
Serle JB, Katz LJ, McLaurin E, et al; ROCKET-1 and ROCKET-2 Study Groups. Two phase 3 clinical trials comparing the safety and efficacy of netarsudil to timolol in patients with elevated intraocular pressure: rho kinase elevated IOP treatment trial 1 and 2 (ROCKET-1 and ROCKET-2).
Am J Ophthalmol. 2018;186:116-127. doi:
10.1016/j.ajo.2017.11.019
PubMed
Google Scholar
Crossref
93.
Soh ZD, Chee ML, Thakur S, et al. Asian-specific vertical cup-to-disc ratio cut-off for glaucoma screening: an evidence-based recommendation from a multi-ethnic Asian population.
Clin Exp Ophthalmol. 2020;48(9):1210-1218. doi:
10.1111/ceo.13836
PubMed
Google Scholar
Crossref
102.
Wahl J, Barleon L, Morfeld P, Lichtmeß A, Haas-Brähler S, Pfeiffer N. The Evonik-Mainz Eye Care Study (EMECS): development of an expert system for glaucoma risk detection in a working population.
PLoS One. 2016;11(8):e0158824. doi:
10.1371/journal.pone.0158824
PubMed
Google Scholar
Crossref
104.
Weinreb RN, Ong T, Scassellati Sforzolini B, Vittitow JL, Singh K, Kaufman PL; VOYAGER Study Group. A randomised, controlled comparison of latanoprostene bunod and latanoprost 0.005% in the treatment of ocular hypertension and open angle glaucoma: the VOYAGER study.
Br J Ophthalmol. 2015;99(6):738-745. doi:
10.1136/bjophthalmol-2014-305908
PubMed
Google Scholar
Crossref
105.
Weinreb RN, Scassellati Sforzolini B, Vittitow J, Liebmann J. Latanoprostene bunod 0.024% versus timolol maleate 0.5% in subjects with open-angle glaucoma or ocular hypertension: the APOLLO Study.
Ophthalmology. 2016;123(5):965-973. doi:
10.1016/j.ophtha.2016.01.019
PubMed
Google Scholar
Crossref