What are the recommended screening guidelines for glaucoma in high-risk populations?

In the UK, recommended guidelines for identifying individuals at risk of glaucoma, often referred to as case-finding, focus on specific tests performed by primary eye care professionals before referral for diagnosis of chronic open angle glaucoma (COAG) and related conditions ¹. These guidelines do not outline specific screening programs for broadly defined 'high-risk populations' but rather detail the assessment and referral process for individuals where glaucoma is suspected ¹.

• Recommended Tests for Case-Finding: Before referral, primary eye care professionals should offer the following tests:
  • Central visual field assessment using standard automated perimetry (full threshold or supra-threshold) ¹.
  • Optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy (with pupil dilatation if necessary), and optical coherence tomography (OCT) or optic nerve head image if available ¹.
  • Intraocular pressure (IOP) measurement using Goldmann-type applanation tonometry ¹.
  • Peripheral anterior chamber configuration and depth assessments using gonioscopy or, if not available or preferred, the van Herick test or OCT ¹.
• Important Considerations for Referral:
  • A decision to refer should not be based solely on IOP measurement using non-contact tonometry ¹.
  • Consider repeating visual field assessment and IOP measurement on another occasion to confirm a visual field defect or an IOP of 24 mmHg or more, unless urgent referral is clinically indicated ¹.
  • For individuals with an IOP below 24 mmHg, advise them to continue regular visits to their primary eye care professional ¹.
• Criteria for Referral: Referral for further investigation and diagnosis of COAG and related conditions is recommended if, after considering repeat measures, any of the following are present:
  • Optic nerve head damage observed on stereoscopic slit lamp biomicroscopy ¹.
  • A visual field defect consistent with glaucoma ¹.
  • Intraocular pressure (IOP) of 24 mmHg or more using Goldmann-type applanation tonometry ¹.
• Factors Influencing Referral: Referral criteria are largely based on the person's age, their intraocular pressure (IOP), their central corneal thickness, and if signs of glaucoma develop ².