The Philadelphia Glaucoma Detection and Treatment Project

Abstract

Purpose To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. Design Retrospective analysis. Participants A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. Methods Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. Main Outcome Measures Detection rates of glaucoma-related diagnoses and types of treatments administered. Results Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. Conclusions Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations.

Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project

“…Our detection rates were comparable with prior screening programmes that focused on high-risk populations 27. However, a high number of narrow angle cases was detected.…”

“…PGDTP programme sites were located in neighbourhoods with high rates of poverty as compared with the national average because the low-income older minority population is at high risk for glaucoma and is typically underserved in eyecare 26. Inclusion was based on meeting one of the following criteria: (1) African–American ≥50 years, (2) ≥60 years of age and of any race or (3) family history of glaucoma 27. The educational workshops aimed to increase awareness about glaucoma and its symptoms, warning signs and risks.…”

Chronic angle closure glaucoma: presentation and outcomes at a tertiary eye hospital of Saudi Arabia

“…19 In contrast, an American reported that 65% of glaucoma patients had hypertension. 20 Authors are at a loss to explain the lower rate of hypertension noted in our study.…”

Telemedicine for Glaucoma: Guidelines and Recommendations

“…29 However, subsequent studies have suggested that screening in populations at high risk for glaucoma is effective. 30,31 A systematic review of teleglaucoma screening estimated its sensitivity as 83.2% and specificity as 79.0%. 28 Diagnostic consultation.…”