WGA Consensus Series 5: Glaucoma Screening

This is the fifth glaucoma World Glaucoma Association Consensus. As with other consensus topics, the discussion and conclusions of Glaucoma Screening, the subject for the 2008 consensus, will have broad impact. The global faculty, consisting of leading authorities on various aspects of glaucoma screening, met in Fort Lauderdale on April 26, 2008 to discuss the reports and refine the consensus statements. The Consensus Panel also met at that time, as well as electronically during the subsequent four weeks.

Obtaining consensus on how best to conduct glaucoma screening is quite a challenge, especially since the epidemiology and testing paradigms are so different for open-angle and angle-closure glaucoma. As with the previous WGA consensuses, the Glaucoma Screening consensus was based on the published literature and expert experience. Although consensus does not replace and is not a surrogate for scientific investigation, it does provide considerable value, especially when the desired evidence is lacking. The goal of this consensus was to establish the best practice for glaucoma screening, as well as to identify those areas for which we have little evidence and, therefore, need additional research. We hope that this consensus will serve as a benchmark of our understanding, and that it will be revised and improved with the emergence of new evidence.

Robert N. Weinreb
Paul R. Healey
Fotis Topouzis
Anne Coleman
Ningli WangSee also:

International Glaucoma Review

World Glaucoma Association

For the World Glaucoma Association Consensus V, our topic was Glaucoma Screening, both for open-angle glaucoma and angle-closure glaucoma. Global experts were assembled beginning in January 2008 to participate in the Project Forum E-Room, a unique aspect to facilitate discussion of each of the consensus meetings.

With each of the prior meetings, arriving at the consensus was circuitous and filled with compromises, and this meeting had a similar path. The consensus process provided an excellent opportunity to critically assess the evidence relating to glaucoma screening and develop consensus statements. As with previous ones, the entire process was stimulating, educational, and thought-provoking for all participants and attendees.

Robert N. Weinreb
Erik L. Greve

Preface
Welcome
SCREENING FOR OPEN-ANGLE GLAUCOMA (OAG)

Is OAG an important health problem?
Co-chairs: Anders Heijl, Paul Lee

Is there an accepted and effective treatment for patients with the disease that is more effective at preventing morbidity when initiated in the early, asymptomatic stage than when begun in the later, symptomatic stages?
Co-chairs: Makoto Araie, Linda Zangwill

Are facilities for diagnosis and treatment available?
Co-chairs: Paul R. Healey, Ramanjit Sihota

Is there an appropriate, acceptable, and reasonably accurate screening test?
Co-chairs: Augusto Azuara Blanco, Linda Zangwill

Is the natural history of the condition, including development from latent to manifest disease, adequately understood?
Co-chairs: Anders Heijl, Harry Quigley

Is the cost of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditure on medical care as a whole?
Co-chairs: Paul R. Healey, Anja Tuulonen

SCREENING FOR PRIMARY ANGLE CLOSURE AND
PRIMARY ANGLE-CLOSURE GLAUCOMA

Are angle closure (AC) and angle-closure glaucoma (ACG) important health problems?
Co-chairs: Paul Foster, Mingguang He

Is there an accepted and effective treatment for patients with angle-closure glaucoma (ACG) that is more effective at preventing morbidity when initiated in the early, asymptomatic stage than when begun in the later, symptomatic stages?
Co-chairs: Robert Ritch, Clement Tham

Are facilities for diagnosis and treatment available?
Co-chairs: Robert Ritch, Jim Standefer

Is there an appropriate, acceptable, and reasonably accurate screening test?
Co-chairs: Tin Aung, Winnie Nolan

Is the natural history of the condition, including development from latent to manifest disease, adequately understood?
Co-chairs: Paul Foster, Ravi Thomas

Is the cost of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditure on medical care as a whole?
Co-chairs: David Friedman, Steve Kymes

Photo Section
Index of Authors
Summary of Consensus Points