A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities.
OBJECTIVE
To assess the impact on visual function of community glaucoma screening in an African American population using spectral-domain optical coherence tomography (SD-OCT).


METHODS
Using a Monte Carlo microsimulation model with a 10-year time horizon, we analyzed the efficacy of SD-OCT screening on visual field outcomes in a population of African Americans who are not otherwise seeking office-based care. Outcomes included classification of visual field severity, quality-adjusted life years, and direct health care costs.


RESULTS
Assuming a 60% follow-up rate, screening decreased the prevalence of undiagnosed glaucoma from 75% to 38%, and decreased the prevalence of severe visual field loss in patients with glaucoma from 29.1% to 23.9%. Conversely, screening increased the prevalence of mild visual field loss in patients with glaucoma from 9.2% to 18.7%. From initial screening through confirmatory eye examination, the screening program ("screen only") cost $98 per screened individual, and $2561 per new diagnosis of glaucoma. When considering the costs of initial screening though the resultant treatment, the screening program ("screen and treat") had an average annual cost of $79 and $2138, respectively, over a 10-year time period. The cost of one quality-adjusted life year (QALY) gained by screening, including management and treatment, in comparison with opportunistic case finding, ranged from $46,416 to $67,813.


CONCLUSIONS
Our findings suggest that community SD-OCT screening in an African American population will minimize glaucoma-related visual morbidity. Ideally, strategies to maximize treatment efficacy through improved medication adherence and improved compliance with follow-up should be identified and implemented before instituting a screening program.
Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.
Dana M
DM
Blumberg
Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.
Reena
R
Vaswani
Columbia University College of Physicians and Surgeons, New York, New York, United States.
Eva
E
Nong
Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.
Lama
L
Al-Aswad
Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.
George A
GA
Cioffi
D001741:Black or African American; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis* / Q000208:ethnology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009010:Monte Carlo Method; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012607:Scotoma / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D014481:United States / Q000453:epidemiology; D014794:Visual Fields
Markov model; SD-OCT; comparative effectiveness; glaucoma; screening