DESIGN OF LOW-COST GLAUCOMA SCREENING

In 1991 the Netherlands Glaucoma Patient Association organized a glauc oma screening survey. This survey was designed to evaluate the effecti veness of a low cost, screening setting. During a screening period of 8 days, 1259 subjects over the age of 49 years were examined by a team of non-ophthalmologically trained students. The following screening m ethods were used: visual field analysis (Henson CFS3000 perimeter), re tinal nerve fiber layer photography (Canon non-mydriatic camera), intr aocular pressure measurement (Pulsair non-contact tonometer) and deter mination of the peripheral anterior chamber depth (slitlamp biomicrosc ope, the van Herick method). In a later stage, subjects with glaucomat ous abnormalities in the visual field and/or the photograph were re-ex amined by a glaucoma specialist using applanation tonometry, gonioscop y, ophthalmoscopy and Humphrey 30-2 visual field analysis. The time ta ken to conduct the individual screening tests in a subject varied from 1 to 5 min: perimetry took 5 min, photography 2 min, tonometry 3 min and angle-width determination 1 min. Fifty-six (4.4%) subjects showed glaucomatous defects in perimetry and/or photography. Thirty-seven cou ld be re-examined and glaucoma was diagnosed in 16 subjects. Visual fi eld defects and glaucomatous abnormalities in the photograph were conf irmed by Humphrey perimetry in 72.7% and 35.7% respectively. Sixty-sev en (5.3%) subjects had an intraocular pressure above 21 mm Hg, while n o cases of angle closure glaucoma were found in this population. The c osts of this screening setting were estimated at Fl. 48,60 per screen. A future low cost screening survey might be limited to non-contact to nometry and visual field analysis with the Henson CFS3000 perimeter or a similar device, using suprathreshold testing with a limited number of points. Screening might be performed by non-medically trained emplo yees. The costs of such a screening program may be estimated at Fl. 16 ,- per screen and Fl. 1.989,- per glaucoma case using a mobile screeni ng unit (addendum).