It Is Time to Rethink Adult Glaucoma Screening Recommendations.
It Is Time to Rethink Adult Glaucoma Screening Recommendations.
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是时候重新考虑成人青光眼筛查建议了。
DOI：
10.1097/ijg.0000000000002146
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发表时间：
2023
影响因子：
2
通讯作者：
Rhodes,LindsayA
中科院分区：
文献类型：
--
作者：
Newman-Casey,PaulaAnne;Hark,LisaA;Rhodes,LindsayA
虽然青光眼是美国不可逆失明的主要原因之一，并且预计到2050年患病率将从300万增加到630万，美国预防服务工作组（USPSTF）在其2013年和2022年的建议中得出结论，没有足够的证据评估原发性开角型青光眼筛查的受益和危害平衡成人青光眼2-4 USPSTF指出的一个挑战是，由于普通人群中原发性开角型青光眼的患病率相对较低，即使是准确的筛查测试也会产生太多的假阳性转诊，给患者和卫生系统带来负担。这一挑战需要与50%的青光眼患者仍未确诊的现实进行权衡。5该报告还指出，缺乏证据表明如何帮助识别可能从筛查中受益的风险增加的人。然而，在过去的10年中，许多以社区为基础的研究-发生在地理上不同的设置-已发表的证据表明，有针对性的筛查高危人群是高度敏感的，以确定那些早期和晚期青光眼。6-10美国国家科学、工程和医学院建议采取行动，使眼健康成为解决眼保健差异的人口健康当务之急。与白色美国人相比，非洲裔美国人患青光眼失明的可能性高6-8倍，患青光眼视力受损的可能性高15倍。12，13贫困人口、老年人和黑人和/或西班牙裔人口比例较高的社区，青光眼和疑似青光眼的发病率较高，病例检出率为20%，而普通人群的病例检出率为6%-8%。7 USPSTF似乎已经得出结论，在一般人群中，青光眼筛查的证据不足，但未能考虑将青光眼筛查针对高危人群（美国黑人，西班牙裔，有青光眼家族史的人或可能具有高遗传风险评分的人）的必要性。2019年，美国疾病控制和预防中心（CDC）视力健康计划资助了三项为期五年的研究赠款，用于在高危人群中设计创新的青光眼筛查策略，以获得关于如何最好地提供针对性青光眼筛查的证据。15通过远程医疗筛查和干预青光眼和眼睛健康（视力）研究正在密歇根州、纽约市和亚拉巴马进行（视力研究。org）。16
Although glaucoma is one of the leading causes of irreversible blindness in the United States and the prevalence is expected to increase from 3 million to 6.3 million people by 2050, 1 the US Preventive Services Task Force (USPSTF) concluded in both their 2013 and 2022 recommendations that there is insufficient evidence to assess the balance of benefits and harms of screening for primary open angle glaucoma in adults. 2–4 One challenge that the USPSTF points out is that because there is a relatively low prevalence of primary open angle glaucoma in the general population, even accurate screening tests will generate too many false positive referrals, burdening both the patient and the health system. This challenge needs to be weighed against the reality that 50% of people with glaucoma remain undiagnosed. 5 The report also states there is a lack of evidence on ways to help identify persons at increased risk who could benefit from screening. However, numerous community-based studies over the past 10 years—occurring in geographically diverse settings—have been published providing evidence that targeted screening in high-risk populations is highly sensitive in identifying those with both early and later stages of glaucoma. 6–10The National Academy of Science, Engineering and Medicine has recommended a call to action to make eye health a population health imperative to address eye care disparities. 11 African Americans are 6–8 times more likely to experience blindness from glaucoma and 15 times more likely to be visually impaired from glaucoma, as compared with White Americans. 12, 13 Communities with a high proportion of people living in poverty, older adults and those who identify as Black and/or Hispanic, have higher rates of glaucoma and suspected glaucoma—a 20% case detection rate—as opposed to the 6%–8% case detection rate in the general population. 7 The USPSTF seems to have concluded that in the general population, there is insufficient evidence for glaucoma screening, but fails to consider the need to target glaucoma screening to high-risk individuals (Black Americans, Hispanics, those who have a family history of glaucoma or perhaps those with a high genetic risk score). 14 In 2019, the Centers for Disease Control and Prevention (CDC) Vision Health Initiative funded three 5-year research grants to design innovative glaucoma screening strategies among high-risk populations to generate evidence on how to best provide targeted glaucoma screening. 15 The Screening and Interventions for Glaucoma and Eye Health through Telemedicine (SIGHT) Studies are taking place in Michigan, New York City, and Alabama (SIGHTSTUDIES. org). 16