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Comparative Study
. 2014 May 1;55(6):3491-500.
doi: 10.1167/iovs.14-14014.

A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities

Dana M Blumberg  1 , Reena Vaswani  1 , Eva Nong  2 , Lama Al-Aswad  1 , George A Cioffi  1
Affiliations
Comparative Study

A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities

Dana M Blumberg et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: To assess the impact on visual function of community glaucoma screening in an African American population using spectral-domain optical coherence tomography (SD-OCT).

Methods: Using a Monte Carlo microsimulation model with a 10-year time horizon, we analyzed the efficacy of SD-OCT screening on visual field outcomes in a population of African Americans who are not otherwise seeking office-based care. Outcomes included classification of visual field severity, quality-adjusted life years, and direct health care costs.

Results: Assuming a 60% follow-up rate, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%, and decreased the prevalence of severe visual field loss in patients with glaucoma from 29.1% to 23.9%. Conversely, screening increased the prevalence of mild visual field loss in patients with glaucoma from 9.2% to 18.7%. From initial screening through confirmatory eye examination, the screening program ("screen only") cost $98 per screened individual, and $2561 per new diagnosis of glaucoma. When considering the costs of initial screening though the resultant treatment, the screening program ("screen and treat") had an average annual cost of $79 and $2138, respectively, over a 10-year time period. The cost of one quality-adjusted life year (QALY) gained by screening, including management and treatment, in comparison with opportunistic case finding, ranged from $46,416 to $67,813.

Conclusions: Our findings suggest that community SD-OCT screening in an African American population will minimize glaucoma-related visual morbidity. Ideally, strategies to maximize treatment efficacy through improved medication adherence and improved compliance with follow-up should be identified and implemented before instituting a screening program.

Keywords: Markov model; SD-OCT; comparative effectiveness; glaucoma; screening.

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Figures

Figure 1
Figure 1
Diagram of the Markov model used to evaluate the effect of screening on visual field status. Note that patients who were screened may be either undetected or detected based on their follow-up.
Figure 2
Figure 2
Percentage of patients in each visual field category after 10 years that were screened at 50-years old (blue) and in patients who were not screened (red).
Figure 3
Figure 3
Percentage of patients in each visual field category after 10 years that were screened at 70-years old (blue) and in patients who were not screened (red).
Figure 4
Figure 4
Percentage of patients with visual field outcomes that were mild or severe at 10 years when treatment lowers progression to 30% of untreated rate (blue) and when treatment lowers progression to 70% of untreated rate (red) in screened and unscreened patients.
Figure 5
Figure 5
Percentage of patients with mild and severe visual field loss based on follow-up rate at 10 years of follow-up.
See this image and copyright information in PMC

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