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A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities.

Abstract：

PURPOSE: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.

journal_name

Invest Ophthalmol Vis Sci

journal_title

Investigative ophthalmology & visual science

authors

Blumberg DM,Vaswani R,Nong E,Al-Aswad L,Cioffi GA

doi

10.1167/iovs.14-14014

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

3491-500

issue

eissn

0146-0404

issn

1552-5783

pii

iovs.14-14014

journal_volume

pub_type

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A comparative effectiveness analysis of visual field outcomes after projected glaucoma screening using SD-OCT in African American communities.