Free trial streammate

Instead, a reasonable balance is sought between sensitivity and specificity. Chauhan BC, Mc Cormick TA, Nicolela MT, Le Blanc RP.

Definition of the reasonable balance may be arbitrary—achieved through consensus over time—or based on empirical analyses of test performance (e.g., receiver operating characteristic curves) and associated costs of screening and cost per true case identified.[4] To be a practical reality, screening tests must be simple to perform, need the assistance of lay people or less costly midlevel or technician-level providers (or none at all), and be quick enough to be done on otherwise asymptomatic people in the community setting (i.e., on a population basis).[5] [6] [7] Prior Glaucoma Screening Efforts In the past, glaucoma screening has relied upon intraocular pressure (IOP) measurements, based on a case definition of glaucoma that required the presence of visual field defects, optic nerve or nerve fiber layer defects, and elevated IOP (except in the “normal tension” variant, in which elevated IOP was not required). Optic disc and visual field changes in a prospective longitudinal study of patients with glaucoma: comparison of scanning laser tomography with conventional perimetry and optic disc photography.

Both studies also provide important information on the risk factors for progression. Incidence of visual field loss in 20,000 eyes and its relationship to driving performance.

Further, results from the AGIS show that low IOP is associated with a reduction in the progression of visual field defects.[17] Evidence from the Collaborative Normal Tension Glaucoma Study Group shows that IOP plays a role in the pathogenesis of normal-tension glaucoma as well.[19] Although more complete answers to the questions addressed in these studies are expected in the next few years, the evidence now available strongly supports the notion that treatment can retard the rate of vision loss due to glaucoma. Finally, our ability to understand the effect of less than optimal vision on patients’ function has increased considerably in the past few years.

Both the OHTS and EMGT clearly demonstrate that lowering intraocular pressure significantly reduces the rate of progression of disease compared with no treatment.[15] [16] In the OHTS results, treatment to lower IOP halved the rate of progression from 9.5% to 4.4% over 5 years. Influence of glaucomatous visual field loss on health-related quality of life.

HISTORICAL REVIEW Screening Programs From a societal perspective, screening should ideally identify every patient who has a disease (100% sensitivity) while clearing every individual who does not (100% specificity). Preperimetric glaucoma diagnosis by confocal scanning laser tomography of the optic disc.

In reality, no test has these technical performance characteristics.

(3) At what point does loss of nerve fibers cause functional loss of significance to patients, and what degree of visual field loss (or any other physiological or psychometric measure), if any, is required before patients notice a decrease in their visual functioning or their general quality of life?

The answers are essential because they address key concepts that were presupposed in prior screening efforts—that even early loss adversely affects patients (or that later loss is harder to control), that treatment is effective in at least slowing down the rate of both anatomic and functional loss, and that a sufficiently high number of patients progress without treatment to make it worthwhile to screen for even early stages prior to any functional or field loss.

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The current definition raises at least three questions: (1) What are the likelihood and rate of progressive loss from early glaucoma, in which there is only optic nerve or retinal nerve fiber layer loss?

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