At what age should glaucoma screening begin?

From the Guidelines

Glaucoma screening should begin at age 40 for most adults with no risk factors, but individuals with risk factors such as family history of glaucoma, African American or Hispanic ancestry, history of eye injury, long-term steroid use, or certain medical conditions like diabetes should start screening earlier, typically between ages 20-30. The screening involves measuring intraocular pressure, examining the optic nerve, and assessing peripheral vision 1. Regular screenings are important because glaucoma develops gradually without noticeable symptoms until significant vision loss has occurred. Early detection allows for timely intervention with treatments such as prescription eye drops (like prostaglandin analogs, beta-blockers, or carbonic anhydrase inhibitors), laser procedures, or surgery if necessary. These treatments aim to reduce intraocular pressure to prevent optic nerve damage and preserve vision. After the initial screening, follow-up frequency depends on individual risk factors, but generally occurs every 1-4 years, becoming more frequent with age or if early signs of glaucoma are detected.

Some key points to consider when screening for glaucoma include:

• Measuring intraocular pressure is not an effective method for screening populations for glaucoma, as half of all individuals with POAG have IOP levels below 22 mmHg 1
• Assessing the optic nerve and retinal nerve fiber layer can be done using various techniques, including ophthalmoscopy and optic disc photography, but these methods have poor to moderate diagnostic precision for glaucoma when used for population-based screening 1
• Evaluating the visual field is another method of screening for glaucoma, but it may be nonspecific for glaucoma and may show abnormalities in normal eyes due to various factors 1
• Frequency doubling technology perimetry shows promise as a screening tool to detect moderate to severe glaucomatous damage 1

It's also important to note that the US Preventive Services Task Force (USPSTF) has reviewed evidence on the benefits and harms of screening and treatment for glaucoma, and has considered the accuracy of screening tests for glaucoma 1. However, the most recent and highest quality study, published in 2016, provides the most up-to-date guidance on glaucoma screening 1.

From the Research

Glaucoma Screening Recommendations

• The American Academy of Ophthalmology recommends regular eye examinations for adults, with the interval depending on patient age and risk factors 2.
• The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting 2.
• High-risk adults, such as those with a family history of glaucoma, African-Americans, and Hispanics, may benefit from earlier screening 3, 4.

Age-Related Screening Guidelines

• While there is no specific age recommended for glaucoma screening, regular eye examinations are recommended for adults, especially those over 40 years old 2.
• Adults aged 60 to 80 years may benefit from annual glaucoma screening, especially if they have risk factors such as family history, diabetes, or high blood pressure 3.
• The American Academy of Ophthalmology recommends the following screening intervals:
  • Adults with no risk factors: every 2-3 years between ages 18 and 39, every 1-2 years between ages 40 and 54, and every 1-2 years after age 55 2.
  • Adults with risk factors: more frequent screenings, as determined by an eye care professional 2.

Risk Factors for Glaucoma

• Older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus are risk factors for primary open-angle glaucoma 2, 4, 5.
• Asian descent and female sex are risk factors for primary angle-closure glaucoma 2.
• Other risk factors include high myopia, corticosteroid use, and certain systemic medical conditions 4, 5.