The value of screening for glaucoma with tonometry

Abstract

This paper estimates the value of performing Schiotz tonometry to detect glaucoma in an asymptomatic patient. About 9% of adults over 40 will be found on a single Schiotz tonometry test to have elevated intraocular pressure (IOP). On work-up, about 1 out of 50 of these individuals with high IOP will be found to have glaucoma. Tonometry, however, will miss about half of all patients with glaucoma because they do not have elevated IOPs at the time of the test. Pilocarpine or epinephrine are the most commonly used drugs to treat the disease, but they are not always effective in lowering a patient's IOP or in stopping the progression of field defects. From the available evidence it does not appear that earlier diagnosis makes a substantial difference in the patient's outcome. If all individuals over 40 years of age in a city of 1,000,000 were screened, the total cost of finding and treating about 484 people with chronic simple glaucoma would be on the order of $4,944,866 or about $13,000 per patient potentially benefited. Screening with tonometry does not appear to be warranted.