GLAUCOMA SCREENING CLINIC IN GENERAL-PRACTICE - PREVALENCE OF OCCULT DISEASE, AND RESOURCE IMPLICATIONS

Background. Previous studies have shown that for every known case of g laucoma there is another case of occult disease, Most cases of glaucom a are detected by optometrists. Aim. This study set out to determine t he prevalence of occult glaucoma in a practice population and assess t he likely resource implications of introducing a glaucoma screening pr ogramme into a general practice setting. Method. The 1153 patients reg istered with one practice in Leicester who were aged 55-69 years on 1 January 1992 and who were not known to have glaucoma prior to screenin g were invited to a screening clinic. Prior to screening there were 11 known cases of glaucoma in this age group. Screening was carried out by a practice nurse. Patients who failed the screening tests were refe rred according to the study protocol to the ophthalmology department o f the Leicester Royal Infirmary and examined by one ophthalmologist. T he number of cases of occult glaucoma and other eye disease detected, the cost per case screened and case defected, and the number of referr als generated were evaluated. Results. Nine hundred and fifty people ( 82%) accepted the invitation and attended for glaucoma screening. Of t hose screened 115 (12%) were referred for ophthalmic assessment. Glauc oma was confirmed in 14 of the referred patients (12%) while a further 15 (13%) were found to have ocular hypertension. All but one of those people diagnosed as having glaucoma recalled having been examined by their optician within the last five years; for 50% the period was less than two years. Nineteen of the patients referred (17%) had other ocu lar pathology detected by the ophthalmologist and no abnormality was d etected in 65 patients referred (57%). The estimated cost to the pract ice (excluding hospital outpatient costs) per case screened using the study protocol was pound 6 and the cost per case detected was pound 40 8. Conclusion. Glaucoma screening may be successfully undertaken in a general practice setting by non-ophthalmically trained staff who have received tuition in the use of the equipment. It is well received by t he population served but the capital cost of equipment is likely to be too high for most practices to afford. The reaffirmation of at least one occult case of glaucoma for every known case is particularly alarm ing in the absence of a national screening programme and the asymptoma tic course of this treatable, blinding disease. Closer cooperation bet ween general practitioners and optometrists will be the practical way ahead for most practices.