Methodological quality of the review: Medium confidence
Authors: Paula Anne Newman-Casey, Angela J. Verkade, Gale Oren, and Alan L. Robin.
Geographical coverage: USA, Australia
Sub-sector: Glaucoma care
Equity focus: No
Review type: Other review
Quantitative synthesis method: Narrative review
Qualitative synthesis method: Not applicable
Glaucoma continues to be the third leading cause of blindness in the United States despite proven treatments that can minimize vision loss, indicating that our medical interventions are not impacting disease burden for many Americans in a meaningful way. Glaucoma is also the second leading cause of blindness worldwide and this progression poses a serious economic burden. In order to address this gap in glaucoma care, there is a need to develop and implement improved methods for glaucoma screening. is one important arena in which our system for delivering glaucoma care is limiting our impact on the societal burden of vision-threatening disease. A more efficient, sensitive and specific screening process is necessary to facilitate the early diagnosis and treatment of primary open angle glaucoma.
This review aims to gather and analyze the effectiveness of screening for glaucoma using non-stereoscopic disc photos.
Six studies were identified that met all of the inclusion and exclusion criteria.
Inclusion criteria: evaluation of single-field, monoscopic photographs for the screening and diagnosis of glaucoma in comparison to standard diagnosis via stereoscopic disc photographs or clinical exam.
Exclusion criteria: any study in which all patients were not screened with both an imaging protocol and a gold standard exam. The gold standard was defined as either a clinical exam by an ophthalmologist or stereoscopic disc photographs evaluated by an ophthalmologist. outline of search:
This study used a systematic approach to searching the published literature using Pubmed and Embase. Final searches were conducted on June 27, 2014. Two searches were run on each database, the first including terms and medical subject headlines (MeSH) mapping to “telemedicine” and “glaucoma,” and the second search including terms mapping to “non-stereoscopic” and “glaucoma.” Articles chosen were restricted to the English language and only included published articles; abstracts were excluded.
Two independent researchers (PANC and AJV) evaluated the titles and agreed upon reading 77 abstracts of these references to determine their eligibility based on pre-determined inclusion criteria. After the criteria were applied, the two researchers screened the abstracts and determined that 29 full-length papers should be screened further. The references of the 29 papers were screened to ensure that the original search criteria had not missed any relevant citations, and no new relevant citations were found. (including population, intervention, study design (for example, RCTs and Quasi-experimental studies), outcomes and contexts), (including main databases and time period of search, data collection and synthesis).
The review focuses on studies from USA and Australia where the health service available for glaucoma is very high. The results of this study might be different in other settings. Despite this, the authors acknowledged that further research is needed to validate the use of monoscopic non-mydriatic photos taken with portable fundus cameras in identifying individuals at high-risk for glaucoma, both in the controlled setting of an eye clinic and in the real-world setting of a population-based study.
The review was focused specifically on high-income countries USA and Australia.
Summary of quality assessment:
Medium confidence was attributed in the conclusions of the review as the authors included published studies only in the review. In addition, the authors did conduct a thorough search of the literature to ensure that all relevant studies were included in the review. These limitations may impact on the overall findings of the review.
Newman-Casey PA, Verkade AJ, Oren G, Robin AL (2014) Gaps in Glaucoma care: A systematic review of monoscopic disc photos to screen for glaucoma. Expert Rev Ophthalmol. 2014;9(6):467‐474. doi:10.1586/17469899.2014.967218.