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Cost-Effectiveness of Screening for Open Angle Glaucoma Compared With Opportunistic Case Finding. J Glaucoma 2023; 32:72-79. [PMID: 36696355 DOI: 10.1097/ijg.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/21/2022] [Indexed: 01/26/2023]
Abstract
PRCIS The manuscript evaluates cost-effectiveness of glaucoma screening with imaging devices and telemedicine based on a screening campaign performed in Spain. The screening strategy implemented in our analysis was cost-effective compared with opportunistic case finding. INTRODUCTION Open angle glaucoma is an asymptomatic ocular disease that represents one of the first causes of blindness. Diagnosis is currently made by opportunistic case finding, usually by community optometrists or general ophthalmologists. The aim of this study was to assess the cost-effectiveness of a screening strategy based on optical coherence tomography and fundus photographs in glaucoma detection. MATERIALS AND METHODS A cost-effectiveness analysis was carried out to compare 2 alternative strategies: opportunistic finding versus screening. A Markov tree model was carried out with 10 health states according to disease progression. Quality-adjusted life years (QALYs) were used as a measure of effectiveness. We included short-term and long-term direct health costs and a discount rate of 3%. We performed a probabilistic sensitivity analysis and several 1-way sensitivity analyses. RESULTS The cohort in the screening program entailed an increase in 0.097 QALYs and additional costs of €1187 versus opportunistic finding, with an incremental cost-effectiveness ratio of about €12.214/QALY. The 1-way sensitivity analysis showed that inputs related to age and screening program (cost and detection rate) were those most strongly influencing the results of the analysis. Probabilistic sensitivity analyses showed that the model was robust to significant changes in the main variables of the analysis. CONCLUSIONS The screening strategy implemented in our analysis was cost-effective compared with opportunistic finding in patients with glaucoma in this Spanish setting.
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Anton A, Nolivos K, Pazos M, Fatti G, Ayala ME, Martínez-Prats E, Peral O, Poposki V, Tsiroukis E, Morilla-Grasa A, Comas M, Castells X. Diagnostic Accuracy and Detection Rate of Glaucoma Screening with Optic Disk Photos, Optical Coherence Tomography Images, and Telemedicine. J Clin Med 2021; 11:jcm11010216. [PMID: 35011957 PMCID: PMC8746039 DOI: 10.3390/jcm11010216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the diagnostic accuracy of optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A population-based sample of 4113 persons was randomly selected. The screening examination included a fundus photograph and OCT images. Images were evaluated on a deferred basis. All participants were then invited to a complete glaucoma examination, including gonioscopy, visual field, and dilated fundus examination. The detection rate, sensitivity, specificity, and positive and negative predictive values were calculated. Results: We screened 1006 persons. Of these, 201 (19.9%) were classified as glaucoma suspects; 20.4% were identified only by retinographs, 11.9% only by OCT images, and 46.3% by both. On ophthalmic examination at the hospital (n = 481), confirmed glaucoma was found in 58 (12.1%), probable glaucoma in 76 (15.8%), and ocular hypertension in 10 (2.1%), and no evidence of glaucoma was found in 337 (70.0%). The detection rate for confirmed or probable glaucoma was 9.2%. Sensitivity ranged from 69.4% to 86.2% and specificity from 82.1% to 97.4%, depending on the definition applied. Conclusions: The combination of OCT images and fundus photographs yielded a detection rate of 9.2% in a population-based screening program with moderate sensitivity, high specificity, and predictive values of 84–96%.
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Affiliation(s)
- Alfonso Anton
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
- Medical School, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
- Correspondence: ; Tel.: +34-93-254-0565 (ext. 4000-4002); Fax: +34-93-254-0567
| | - Karen Nolivos
- Department of Medicine, Institut Mar d’Investigacions Mèdiques (IMIM), 08005 Barcelona, Spain;
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
| | - Marta Pazos
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic de Barcelona, Institut d’Investigacions Mèdiques, 08036 Barcelona, Spain;
| | - Gianluca Fatti
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
| | - Miriam Eleonora Ayala
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | | | | | - Vladimir Poposki
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
| | - Evangelos Tsiroukis
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | - Antonio Morilla-Grasa
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | - Merce Comas
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Wu Y, Szymanska M, Hu Y, Fazal MI, Jiang N, Yetisen AK, Cordeiro MF. Measures of disease activity in glaucoma. Biosens Bioelectron 2021; 196:113700. [PMID: 34653715 DOI: 10.1016/j.bios.2021.113700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness globally which significantly affects the quality of life and has a substantial economic impact. Effective detective methods are necessary to identify glaucoma as early as possible. Regular eye examinations are important for detecting the disease early and preventing deterioration of vision and quality of life. Current methods of measuring disease activity are powerful in describing the functional and structural changes in glaucomatous eyes. However, there is still a need for a novel tool to detect glaucoma earlier and more accurately. Tear fluid biomarker analysis and new imaging technology provide novel surrogate endpoints of glaucoma. Artificial intelligence is a post-diagnostic tool that can analyse ophthalmic test results. A detail review of currently used clinical tests in glaucoma include intraocular pressure test, visual field test and optical coherence tomography are presented. The advanced technologies for glaucoma measurement which can identify specific disease characteristics, as well as the mechanism, performance and future perspectives of these devices are highlighted. Applications of AI in diagnosis and prediction in glaucoma are mentioned. With the development in imaging tools, sensor technologies and artificial intelligence, diagnostic evaluation of glaucoma must assess more variables to facilitate earlier diagnosis and management in the future.
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Affiliation(s)
- Yue Wu
- Department of Surgery and Cancer, Imperial College London, South Kensington, London, United Kingdom; Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom.
| | - M Ihsan Fazal
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - M Francesca Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom; The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom; Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom.
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P. S, J. R, R. P. An automatic recognition of glaucoma in fundus images using deep learning and random forest classifier. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Hamid S, Desai P, Hysi P, Burr JM, Khawaja AP. Population screening for glaucoma in UK: current recommendations and future directions. Eye (Lond) 2021; 36:504-509. [PMID: 34345031 PMCID: PMC8873198 DOI: 10.1038/s41433-021-01687-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
Effective population screening for glaucoma would enable earlier diagnosis and prevention of irreversible vision loss. The UK National Screening Committee (NSC) recently published a review that examined the viability, effectiveness and appropriateness of a population-based screening programme for primary open-angle glaucoma (POAG). In our article, we summarise the results of the review and discuss some future directions that may enable effective population screening for glaucoma in the future. Two key questions were addressed by the UK NSC review; is there a valid, accurate screening test for POAG, and does evidence exist that screening reduces morbidity from POAG compared with standard care. Six new studies were identified since the previous 2015 review. The review concluded that screening for glaucoma in adults is not recommended because there is no clear evidence for a sufficiently accurate screening test or for better outcomes with screening compared to current care. The next UK NSC review is due to be conducted in 2023. One challenge for POAG screening is that the relatively low disease prevalence results in too many false-positive referrals, even with an accurate test. In the future, targeted screening of a population subset with a higher prevalence of glaucoma may be effective. Recent developments in POAG polygenic risk prediction and deep learning image analysis offer potential avenues to identifying glaucoma-enriched sub-populations. Until such time, opportunistic case finding through General Ophthalmic Services remains the primary route for identification of glaucoma in the UK and greater public awareness of the service would be of benefit.
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Affiliation(s)
- Sana Hamid
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Parul Desai
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Pirro Hysi
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK.,Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jennifer M Burr
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK.
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Interobserver and Intertest Agreement in Telemedicine Glaucoma Screening with Optic Disk Photos and Optical Coherence Tomography. J Clin Med 2021; 10:jcm10153337. [PMID: 34362120 PMCID: PMC8347319 DOI: 10.3390/jcm10153337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose: To evaluate interobserver and intertest agreement between optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A stratified sample of 4113 individuals was randomly selected, and those who accepted underwent examination including visual acuity, intraocular pressure (IOP), non-mydriatic retinography, and imaging using a portable OCT device. Participants’ data and images were uploaded and assessed by 16 ophthalmologists on a deferred basis. Two independent evaluations were performed for all participants. Agreement between methods was assessed using the kappa coefficient and the prevalence-adjusted bias-adjusted kappa (PABAK). We analyzed potential factors possibly influencing the level of agreement. Results: The final sample comprised 1006 participants. Of all suspected glaucoma cases (n = 201), 20.4% were identified in retinographs only, 11.9% in OCT images only, 46.3% in both, and 21.4% were diagnosed based on other data. Overall interobserver agreement outcomes were moderate to good with a kappa coefficient of 0.37 and a PABAK index of 0.58. Higher values were obtained by experienced evaluators (kappa = 0.61; PABAK = 0.82). Kappa and PABAK values between OCT and photographs were 0.52 and 0.82 for the first evaluation. Conclusion: In a telemedicine screening setting, interobserver agreement on diagnosis was moderate but improved with greater evaluator expertise.
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Edwards LA, Taylor DJ, Campbell P, Shah R, Edgar DF, Crabb DP. Feeling the pressure: a cross-sectional study exploring feasibility of a healthcare Pop-Up for intraocular pressure measurements in shopping centres in England. BMJ Open 2019; 9:e030523. [PMID: 31748291 PMCID: PMC6887061 DOI: 10.1136/bmjopen-2019-030523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To test the hypothesis that a shopping centre Pop-Up health check combining an intraocular pressure (IOP) check with a general health check (blood pressure (BP)) is more readily accepted by the general public than an IOP check only. We investigate public awareness of IOP compared with BP and the feasibility of measuring IOP in large numbers in a Pop-Up. DESIGN A cross-sectional study using a tailor-made healthcare Pop-Up. SETTING The 'Feeling the Pressure' Pop-Up was sited in eight regionally-different shopping centres in England. PARTICIPANTS Adult members of the public in shopping centres. METHODS On one day we measured IOP only and on another measured BP and IOP. IOP was measured by Icare IC100 tonometer (Helsinki, Finland). Potential participants were asked about their awareness of IOP and BP and when they last visited their optometrist. RESULTS More people attended the combined BP + IOP days (461; 60%; 95% CI 56% to 64%) than IOP-only days (307; 40%, 95% CI 37% to 43%) over 16 days of testing. We recorded IOP in 652 participants (median (IQR) age and IOP of 54 (42 to 68) years and 13 (11 to 15) mm Hg, respectively). Fewer people reported awareness about IOP (19%, 95% CI 16% to 23%) compared with BP (71%, 95% CI 66% to 75%). Of 768 participants, 60 (8%) reported no previous optometric eye examination and 185 (24%) reported >2 years since their most recent examination. CONCLUSIONS Measuring IOP in large numbers of the public via a shopping centre Pop-Up is feasible. Public engagement was greater when a BP check was offered alongside an IOP check, suggesting unfamiliar health checks can be promoted by aligning them with a more familiar check. Our findings hint at strategies for public health schemes that engage the public with their eye health.
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Affiliation(s)
- Laura A Edwards
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Peter Campbell
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - Rakhee Shah
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - David F Edgar
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City University London, London, UK
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Zhang S, Sun J, Liu S, Liang Y, Hu Y, Congdon N, Pang CP, Wang H. Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study. Clin Exp Ophthalmol 2019; 47:1000-1008. [PMID: 31152490 DOI: 10.1111/ceo.13564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Shaodan Zhang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityGlaucoma Research Institute of Wenzhou Medical University Zhejiang China
- Department of Ophthalmology, the Fourth Peoples' Hospital of ShenyangShenyang Key Lab of Ophthalmology Liaoning China
| | - Jing Sun
- Department of Ophthalmology, the Fourth Peoples' Hospital of ShenyangShenyang Key Lab of Ophthalmology Liaoning China
| | - Shanshan Liu
- Department of Ophthalmology, the Fourth Peoples' Hospital of ShenyangShenyang Key Lab of Ophthalmology Liaoning China
| | - Yuanbo Liang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical UniversityGlaucoma Research Institute of Wenzhou Medical University Zhejiang China
| | - Ying Hu
- Department of Ophthalmology, the Fourth Peoples' Hospital of ShenyangShenyang Key Lab of Ophthalmology Liaoning China
| | - Nathan Congdon
- Centre for Public HealthQueen's University Belfast Belfast UK
- Zhongshan Ophthalmic CenterSun Yat‐sen University Guangzhou China
- Orbis International New York New York
| | - Chi Pui Pang
- Department of Ophthalmology and Visual SciencesThe Chinese University of Hong Kong Hong Kong Hong Kong
| | - Hailin Wang
- Department of Ophthalmology, the Fourth Peoples' Hospital of ShenyangShenyang Key Lab of Ophthalmology Liaoning China
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