- When to consider referring for low-vision rehabilitation
- The role of sex hormones and aging in dry eye disease
- 3 reasons to read AOA’s newest clinical practice guideline
- Identifying reading difficulties in children
- Mobilizing against myopia
- New AOA clinical guideline puts focus on elevating care of glaucoma patients
- Tips for reinforcing optometry’s role in the broader health care system
- Vision loss makes list of 14 risk factors for dementia
- The ‘gatekeepers of primary eye care’
- Myopia report calls for disease classification, new federal policies
- High-tech solutions for low vision
- Optometrists play an integral role in assessing and treating patients with traumatic brain injuries.
- Primary care of the stroke patient
- Research on eye aberrations not abstract to award-winning scientists
- AOA, CooperVision mobilize to ‘disrupt the status quo,’ advance new standard of care for children with myopia
- What do the experts say on genetic testing for IRDs?
- Pediatric keratoconus prevalence higher than believed, may change care approach
- Making blurry vision clear
- Unblurring the lines
- Appreciating optometry’s value to patients with diabetes and their primary care physicians
- 9 benefits of introducing laser procedures into your practice
- 5 considerations if you’re thinking about adding laser procedures to your practice
- Optometrist-performed YAG capsulotomies shown effective, safe and beneficial for patients
- Proof not positive yet on low-dose atropine for myopia in children
- For 128 million U.S. presbyopes, doctors of optometry can provide treatment options
- What’s up, doc? Can a dietary supplement reverse patient cataracts?
- Legal blindness in America
- AOA webinar addresses concerns about myopia management
- AOA serving patients through research in optometry
- Marijuana sensibilities changing fast: Are you ready for patients’ questions?
- Buzz builds for AOA virtual ePosters event
- New AOA adult eye guideline
- New technology for the advanced AMD patient
- Interprofessional communication for diabetic eye care
- Contact lens experts weigh in on gaps in consumer knowledge
- Align your team on binocular vision disorders
- How to better manage dry eye disease
- eyes the brain and learning
- Can vision intervention slow onset of dementia
- Gene therapy vision rehabilitation for IRDs
- 2022 contact lens controversies
- The latest research from AOA members
- Caring for patients with special needs
- New discoveries aid understanding of the visual system
- Don’t let the pressure get to you or your patients
- How technology has changed recommendations for visually impaired children
- 12 ways to provide better care for patients with prediabetes and diabetes
- Alzheimers and eyes
- Level up your diabetes care with specialists, services collaboration
- Behind the lens
- Contact lens developments regarding keratoconus
- Managing the care of patients with contact lens-related dry eye
- Lens-based strategies to address reading issues due to mild, disease-related vision loss
- Study shines light on optogenetics in retinitis pigmentosa
- surgical procedures courses
- Genetic Testing and Gene Therapy
- low vision in your practice
- Low percentage of patients with diabetes adhere to key self-care practices
- EBO to produce new glaucoma clinical practice guideline
- details of visual functions immediately following marijuana use
- Understanding Photophobia in mTBI
- New myopia management guidance released
- The challenges of maintaining a healthy tear film
- Integrating models of diabetic eye care
- Dry Eye and Productivity
- Contact lens innovation delivers opportunity
- How face masks affect the eyes
- Marijuana dispensaries still blow smoke over glaucoma effects
- Conjunctival Lymphangiectasia and Fabry
- Techniques to enhance contrast
- Americans remain at high risk for vision loss
- Stimulating eye and vision research
- Allergic conjunctivitis in a COVID-19 world
- Atropine in myopia control
- sleep patients ocular health
- CDC US coronavirus spread expected
- Demystifying dizziness
- Optometry and Glaucoma patients
- 5 reasons why doctors should use AOA diabetes guideline
- Growing epidemic of adolescents and young adults with prediabetes
- Improving scanning efficiency of individuals with homonymous hemianopia
- second edition of diabetes clinical practice guideline
- Pupil patterns in youth a phenomenon
- Study high school sports concussions underscores optometry role in care
- Prototype imager of tear film sublayers opens eyes on dry eye
- Retinal measurements hold clues to Alzheimers disease
- reversing prediabetes to normoglycemia can lessen microvascular complication risk
- Detecting the signs of autism at earlier age using visual cues
- Eye disorder CRISPR technology
- Addressing elderly vision impairment
- The AMD aspirin balancing act
- Study looks at what patients understand about their glaucoma diagnoses
- Vision Rehabilitation Clinical Pearls Lens Rx Prescribing for the Patient with Traumatic Brain Injury
- Real partners in diabetes care
- Amblyopia More than meets the eye
- New mild TBI guideline for children provides opportunity for doctors of optometry
- Reading corneal signs
- Eyes on Alzheimers disease
- Study looks at potential of suppressing ocular cancer in children
- Doctors of optometry are members of post-concussion team
- Glaucoma & Exercise
- The ABCs of MGD
- When T-cells go bad
- Study opens eyes to Alzheimers disease risk
- Understanding MGD
- Sjogren’s dry eye disease and depression
- Are patches the answer to amblyopia
- Oranges may allay AMD risk Pulp fact or fiction
- myopiatech
- Cognitive Decline
- Myopia Genes Discovered
- Link between diabetes and MGD
- alzheimers clues could be found using eye scan
- Genetic markers may help predict elevated IOP
- Ebola vector-borne diseases rear ugly heads again
- Blue lights link to prostate and breast cancers
- Can dyed contact lenses help color perception in CVD patients
- Omega 3 and Dry Eyes
- Glaucoma-Cannabinoid NP Drop
- Genetic Testing for AMD
- Premature Babies Low Birthweight Eyes
- ASD & Accommodative Function
- Stem Cells and Wet AMD
- Sjogren Awareness
- Brain Injury Awareness
- Sleep apneas interplay with corneal hysteresis
- New blood pressure guideline
- Low vision patient future
- Retinoblastoma-detecting ocular cancer in children
- Winter Dry Eye
- Low Vision and Blindness to Double
- New guidelines detecting retinoblastoma in children
- Glaucoma protein biomarker
- Risk for normal-tension glaucoma rises
- Peripheral reaction time faster in deaf adults
- New therapeutic target could reduce diabetic retinopathy
- diabetes on the rise among the young
- Trabeculoplasty Commentary
- Seniors near vision loss dementia risk linked
- Can frequent anti VEGF injections increase glaucoma surgery risk
- Study stresses stress test in treating patients with AMD
- Contact lens helps predict speed of glaucoma progression
- Unique retinal cell dysfunction triggers myopia
- Preeclampsia years later still takes toll
- How tilted optic discs may affect myopic eyes
- New eye test is early detector of diabetes
- Anti VEGF injections may not work for allglaucoma sooner
- New technique could diagnose glaucoma sooner
- Myopia incidence piques control efforts initiatives
- Study links visual impairment to physical and cognitive function declines
- Benefits unfamiliarity proves barrier to diabetes care
- Eyes on Alzheimers
- Association found between TBI and neurodegenerative conditions
- Spotting the link between vision problems and ADHD
- Treating the digital eye
- Statins show continued potential as treatment for dry AMD
- How doctors of optometry can diagnose a rare disorder
- Could eye drops be an alternative treatment to cataract surgery
- Researchers zero in on potential dry AMD treatment
- Ranibizumab proves effective to treat proliferative diabetic retinopathy
- Study shows some drivers with glaucoma naturally adapt
- Doctors of optometry a crucial component in cataract care
- Be part of the national dialogue about diabetes
- Under pressure addressing hypertension
- Gene therapy successful in treating rare retinal disorder
- The lowdown on treating low vision patients
- New study calls attention to importance of carotenoids
- 5 things doctors of optometry should know about concussions
- Can a supplement fight diabetic retinopathy
- Outdoor activity may reduce risk for myopia in children
- 3 reasons comprehensive exams matter for diabetes
- Diabetes and Prediabetes
- Vitamin C may slow progress of cataracts
- Multifocal contact lens effective at treating myopia in kids
- New tool educates and motivates patients with diabetes related eye disease
- Myopia Its in your genes too
- Out of the box thinking leads to potential glaucoma treatment
- Doctors of optometry have big role in catching giant cell arteritis before blindness
- Cataract surgery lessens death risk
- Novel glaucoma therapy One ring to help them all
- Common glaucoma drugs may affect IOP measurements
- Gene mutation uncovers potential treatment for rare form of pediatric glaucoma
- How astigmatism affects reading fluency
- FDA approves first corneal cross linking system for treatment
- Cataracts and UV exposure in driver-side windows
- Virtual model aids diabetic retinopathy progression understanding
- doctors of optometry AMD assessments comparable to ophthalmologistsoutcomes
- Parkinsons detectable through eye exam
- Are sleep apnea and asthma linked to keratoconus
- Not a dry eye
- Eye on head injuries
- Risk for macular degeneration linked to low levels of vitamin D
- Tears now fears Zika persists in eyes
- Myopia Controlling the heretofore uncontrollable
- advancing keratoconus care
- visual dysfunction after brain injury
- Study detects early biomarkers for risk of developing diabetic retinopathy
- Prevalence of Undiagnosed AMD
- Daily use of steroid drops increases risk for ocular hypertension
- Zikababy
- New study dry eye disease
- Encyclopedia of dry eye disease released
- Clinical Pearls for Seasonal Allergies
- Doctors of optometry less likely to prescribe seldom needed antibiotics for conjunctivitis
- T cells hold promise of treatment for preemies born with eye condition
- Youth Concussions
- New imaging techniques detect earlystage Alzheimer’s disease
New independent task force recommendation on glaucoma screening underwhelms
June 15, 2022
Doctors of optometry say recommendation for screenings in primary care offices casts doubt and clouds public awareness.
Doctors of optometry are taking issue with a new recommendation by the U.S. Preventive Services Task Force (USPSTF) regarding screening for primary open-angle glaucoma, saying it can potentially cause care providers and patients to disregard the dangers of glaucoma, which has been called the “silent thief of sight.”
Glaucoma refers to a group of diseases, which are predominately chronic in nature (there are acute forms of the disease) and characterized by progressive damage to the optic nerve. The loss of nerve tissue results in vision loss and affects about 2.7 million people in the U.S. The task force’s recommendation focuses on primary open-angle glaucoma (POAG), the most common form of the group’s disorders, and applies to adults 40 years or older who present in primary care settings and are not showing signs or symptoms of open-angle glaucoma. Onset is often mid-late adulthood.
The May 24 task force statement on glaucoma screening by primary care physicians is neither a recommendation for nor against screening. The USPSTF is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine working to improve the health of people nationwide.
“The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for glaucoma in adults,” the report reads. “The benefits and harms of screening for glaucoma in adults are uncertain. More research is needed.”
Dismaying is how Murray Fingeret, O.D., and Andrew Morgenstern, O.D., characterized the task force’s neutral recommendation. Eye doctors, Dr. Fingeret knows, threw up their hands in frustration after the task force released its recommendation. Dr. Fingeret is a clinical professor at SUNY College of Optometry. He also is a member of the American Glaucoma Society and founding member and past president of the Optometric Glaucoma Society.
Dr. Morgenstern is a clinician in Bethesda, Maryland, and director of the AOA Evidence-Based Optometry (EBO) Committee.
The EBO is currently developing the evidence-based clinical practice guideline titled Care of the Patient with Primary Open Angle Glaucoma. This guideline, for which over 1,600 high-quality journal articles and landmark studies were read and graded, will report that glaucoma is a serious and significant public health concern and a leading cause of vision loss in the U.S. Specifically, it will show that glaucoma is a silent thief of vision and commonly there are no warning signs. Glaucoma often presents symptom- and pain-free in its early phases. The EBO Committee stresses the need for the public to seek out an annual, comprehensive eye examination for all age populations as to identify the earliest evidence of these common (and in some cases preventable) eye diseases.
“It’s disappointing and shocking,” Dr. Morgenstern says of the task force statement. “It goes against what the National Eye Institute [NEI] (under the National Institutes of Health) says and what we know as doctors of optometry. Unfortunately, while the USPSTF is an organization whose intentions are largely good for the public, it got this wrong. We live the medical era of prevention. Every medical professional knows that the easiest way to improve prevention is with early detection.”
Unintended consequences?
Key to the task force’s decision to withhold an endorsement to primary care physicians was the lack of evidence to demonstrate the benefits or harms of screening. Said task force member Katrina Donahue, M.D., M.P.H: “In the absence of this evidence, primary care clinicians should use their judgment when deciding whether or not to screen.”
“The Task Force wanted to see if there was an opportunity for primary care clinicians to play a greater role in helping to prevent vision loss from glaucoma, especially among those who are disproportionately affected,” says Task Force Chair Carol Mangione, M.D., M.S.P.H. “However, there is not enough evidence to inform what primary care clinicians can do, so we are calling for more research.”
The data-driven task force partly has only itself to blame for lack of evidence for making a recommendation, Dr. Fingeret says. Nine years ago, it made a similar recommendation—that there was not enough evidence to make a recommendation—which might have discouraged screenings and the evidence to study.
“It’s a Catch-22,” Dr. Fingeret says.
Further, more concerning was that primary care doctors might interpret the lack of an endorsement as reflecting a lack of priority in their practice setting, Dr. Fingeret says. And with a lack of recommendation or referral from primary care doctors to eye doctors, glaucoma awareness among patients might suffer never mind the disorder not being detected at all by primary care doctors, he says.
Dr. Morgenstern pointed out content on the NEI website: glaucoma’s “symptoms can start so slowly that you may not notice them. The only way to find out if you have glaucoma is to get a comprehensive dilated eye exam.”
“Early detection is the only way to slow its progression,” Dr. Morgenstern says. “Prevention and early detection are the rule today, not the exception. What is even more perplexing is that ‘Preventive Services’ is part of its name.”
A related concern is an opinion shared by many doctors of optometry.
“Screenings are extremely limited,” Dr. Fingeret says. “They are not a comprehensive eye exam. A comprehensive eye exam would be far better. We include the history, intraocular pressure, assessment of the back of the eye and an assessment of the visual field to really make that diagnosis.”
He also cited an editorial by Henry Jampel, M.D., MHS, and Aakriti Garg Shukla, M.D., in JAMA online from May 2022:
“The day may come when images of the optic nerve and retina could routinely be obtained in a primary care office or other settings and when such images could be accurately categorized by an artificial intelligence algorithm as normal or demonstrating disease. This is unlikely to be a glaucoma-only tool but rather could possibly be used to detect other eye diseases, such as diabetic retinopathy and age-related macular degeneration. Until that time, and until additional evidence on screening for glaucoma is available, primary care clinicians should not necessarily conclude that there is no utility in screening for glaucoma, but rather may attempt to determine which patients are at highest risk through history-taking, and direct them to an eye care specialist.”
Screening no substitute for eye examination
The AOA has previously expressed concerns to the task force in response to a draft research plan on the topic of impaired visual acuity and glaucoma screening in adults.
The AOA discouraged the generic use of the term “vision screening” in the draft plan, and instead recommended more precise wording, such as “glaucoma screening” or “visual acuity screening.” It also made the point that screenings are no substitute for comprehensive eye exams, as noted in AOA’s Evidence-Based Clinical Practice Guideline: Comprehensive Adult Eye and Vision Examination.
“Screenings should be used solely to refer patients for a comprehensive eye exam, and all adults, regardless of the presence or lack of symptoms, should be receiving an annual comprehensive eye exam,” the March 2020 letter read. “The comprehensive adult eye and vision examination provides the means to evaluate the structure, function, and health of the eyes and visual system.
“It involves collecting subjective data directly from the patient and obtaining objective data by observation, examination, and testing,” it continued. “During the exam, the doctor obtains information to understand and explain symptoms reported by the patient, and to diagnose the cause of signs noted by the eye doctor. It also provides the means to identify the presence of other ocular or systemic conditions that may exist without symptoms.”
Interested in being nominated to the task force?
The AOA continues to work on getting representation on the 16-member USPSTF. If you are interested in being nominated to the task force, contact the AOA at president@aoa.org.