The Impact of Routinely Measuring IOP in Younger Adults to Screen for Glaucoma in a Large Eye Hospital.

Abstract

Intraocular pressure (IOP) screening in adults 18 to 40 years of age identified 1 in 535 young adults with or at risk for developing glaucoma in India with a cost of about Indian rupee 596 (USD 8) per patient diagnosed. The purpose of this study was to evaluate the outcomes of routine noncontact tonometry as a screening modality for glaucoma in young adults receiving an eye examination at Aravind Eye Hospital, Pondicherry, India. Retrospective chart review of adults 18 to 40 years of age screened for IOP from November 2017 to June 2018. The diagnoses were determined by a glaucoma specialist using gonioscopy, dilated fundus examination, and occasionally, Humphrey Field Analyzer, and/or optical coherence tomography. Analyses include detection of glaucoma, ocular hypertension (OHT), angle closure, and calculation of the yield of this screening paradigm. A total of 28,369 younger adults were screened and 296 (1.05%) were referred to the glaucoma unit, 84 for an IOP >21 mm Hg and 208 for other reasons. The hypertensive group had a mean screening IOP of 29.3±8.4 mm Hg and the following diagnoses: OHT (19%), secondary raised IOP (14%), glaucoma (26%), angle closure (4%), healthy (11%) and need for further examination (26%). Fifty-five percent of those with glaucoma were previously undiagnosed. In comparison, the normotensive group had a mean IOP of 16±2.5 mm Hg and the following diagnoses: OHT (1%), glaucoma (5%), occludable angles (8%), healthy (47%) and need of further examination (33%). Nearly 40% of these patients with glaucoma were previously undiagnosed. One of every 535 young adults screened had both IOP >21 mm Hg and angle closure, OHT, secondary raised IOP or glaucoma. Given their young age and the potential to treat and delay progression, the benefits seem to outweigh the low cost of this screening.