Gaps in glaucoma care: a systematic review of monoscopic disc photos to screen for glaucoma

Abstract

One important gap in glaucoma care is the lack of an optimized screening protocol for detecting glaucoma on a population level. A systematic review of the literature was conducted to evaluate the effectiveness of monoscopic disc photos as a screening tool for detecting glaucoma. Six studies met inclusion and exclusion criteria out of 221 possible titles. The specificity of monoscopic photos to detect glaucoma compared to clinical exam was excellent (93.6–100%), while the sensitivity was much lower (50–67.4%). Monoscopic disc photos are highly specific in identifying glaucoma, though additional testing, such as perimetry, may be needed to improve their sensitivity. Further research is needed to evaluate whether monoscopic disc photos are a cost–effective way to screen for glaucoma in a primary care setting utilizing new technological advances in ophthalmic imaging such as portable non-mydriatic fundus cameras.

Keywords::

• disc photos
• glaucoma
• monoscopic
• screening
• telemedicine

Financial & conflicts of interest disclosure

The paper was supported by the National Eye Institute K12 award for PA Newman-Casey, K12EY022299. AL Robin has been a consultant for Merck, Medical Monitor for Sucampo, on the Scientific Advisory Board for Aerie Pharmaceuticals, and he has Stock in Glaukos. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• In this systematic review, the specificity of monoscopic photos to detect glaucoma compared to clinical exam was excellent (93.6–100% specificity) and the sensitivity to detect disease was lower (50–67.4%).

• A population-based glaucoma screening program evaluating adults aged 50–79 estimated that the program would be cost–effective if testing was ≥96% specific [23], and from this review, it appears that monoscopic disc photos have the potential to meet this criterion.

• This area of study is limited by the low number of studies that have been carried out and by the lack of reporting of standard deviation or standard error in estimates of sensitivity and specificity, making it difficult to compare results between studies.

• 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.