Making the Case for Comprehensive Eye Examination Over Screening

By Daniel L. Mannen, OD, FAAO July 26, 2013

With the reality of healthcare reform squarely before us, the efficacy of many traditional healthcare practices is being challenged. One such consideration is to question whether or not screening adults without symptoms for glaucoma in a primary care setting has a clear benefit. In its new recommendations, the US Preventative Services Task Force (USPSTF) has stated that “there are not enough data showing that (screening) tests for glaucoma are accurate” or that they lead to a change in outcome.

Clearly, the statement above is referring to glaucoma screenings which are being conducted by primary care physicians. I think most eye doctors would agree that glaucoma screening is most appropriate under the purview of the eye doctor and as part of comprehensive examination. After all, glaucoma is a complex problem requiring the evaluation of many risk factors, as well as comparative, sequential examination. It certainly requires comparison to a quantitative baseline.

Dr. Virginia Moyer, chair of the Task Force from Baylor College of Medicine in Houston has stated that “a full-on eye exam that could adequately detect early signs of glaucoma takes a long time and is way too complicated for a primary care appointment.” She further states that glaucoma tests available in primary care offices aren't very accurate and can’t discern when problems are likely to get worse.

Appropriate screening for eye disease and the ocular manifestations of systemic disease should remain within the domain of eye doctors. The virtues of regular comparative eye examination are well documented and early diagnosis and treatment is the name of the game. It is important that we work hard in the area of education to encourage patients to enroll in programs which champion regular preventative care. We should not forget that stand alone vision members are more likely to get regular eye examinations, and therefore, continue to play an important role in early detection.

As I See It, eye related screenings in primary care settings have some, albeit, limited benefit. Comprehensive eye examination provides important data for early detection, diagnosis, and treatment of not only glaucoma but many other eye related problems and systemic manifestations. Regular visits to the eye doctor should be an important part of a patients’ overall health care strategy and are more likely to occur at a desired frequency when patients are involved in programs which encourage regular preventative care.

Evidence lacking on glaucoma screening: panel by Genevra Pittman | July 8, 2013

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