I. Detection of glaucoma
Detection of glaucoma in higher risk individuals is best done through a comprehensive dilated eye exam. Those at an increased risk for glaucoma are African Americans age 40 and older, everyone over age 60 (especially Mexican Americans), and those with a family history of glaucoma. The eye exam should include an appropriate family history, measurement of visual acuity and intraocular pressure, examination of the retina and optic nerve through dilated pupils, and, where indicated, evaluation of the visual field. People thought to have glaucoma should receive appropriate follow-up and management. People at higher risk of glaucoma who do not have the disease should be examined every one to two years. Eye care professionals may recommend more frequent examinations for those considered at sufficient risk for imminent optic nerve damage.
A traditional method of detecting glaucoma is tonometry, which measures intraocular pressure. However, because of individual variations in what constitutes “normal” intraocular pressure, tonometry by itself is not sufficient for an accurate diagnosis of glaucoma. Data collected at several public glaucoma screenings suggest that many people without glaucoma will screen positive with tonometry alone, while many individuals with glaucoma will screen negative. An eye care professional can detect glaucoma during a comprehensive dilated eye examination and may also identify other ocular conditions requiring attention. This exam also provides an opportunity for educating individuals about appropriate eye care.
II. Vision screening in adults
Vision screening programs can be useful in identifying individuals who need appropriate follow-up by an eye care professional for diagnosis and management of their eye problems. They can also provide an important opportunity to educate the public about eye health.
The simplest and most practical screening program should include measurement of visual acuity in each eye separately. People who are found to have visual acuity of 20/40 (6/12) or less, using their current corrective lenses, if any, should be referred to an eye care professional for further evaluation. Also, people with seemingly normal vision should also be referred to an eye care professional, if they fit into any of the following categories:
- People with diabetes who have not had an eye examination through dilated pupils in the past year
- Blacks over age 40 who have not had an eye examination through dilated pupils in the past one to two years
- Anyone over age 60, especially Mexican American, who has not had an eye examination through dilated pupils in the past one to two years
- Anyone with a family history of glaucoma who has not had an eye examination through dilated pupils in the past one to two years
One-on-one health education can increase the value of vision screenings. Staff should provide verbal and written information about eye diseases, such as glaucoma, diabetic retinopathy, age-related macular degeneration, and cataract to screening participants. Staff should make appropriate referrals and stress the importance of early detection and timely treatment.