Balancing Glaucoma Care: Tackling Overdiagnosis and Overtreatment to Preserve Patient Quality of Life

The Science behind the Tip

In contrast to underdiagnosis, which has been described in population-based studies as affecting 50% or more of glaucoma cases (1, 2), there is little data on overdiagnosis and overtreatment in OAG. Recently, overdiagnosis and overtreatment have been increasingly acknowledged as critical health issues in multiple medical fields.(3) The Thessaloniki Eye Study revealed a significant rate of overdiagnosis among elderly Caucasian individuals, highlighting the importance of precise diagnostics to prevent unnecessary treatment and associated risks (4). Rapid technological advancements have increased diagnostic sensitivity and improved risk prediction, which should help ophthalmologists with the prognosis, diagnosis, and treatment of glaucoma. However, initiating therapy that might not be necessary could potentially cause problems, especially in patients with low-risk disease. According to the EGS Guidelines, the quality of life of glaucoma patients should always be a primary focus of our treatment. This quality of life should be maintained not only through the effective treatment of existing glaucoma but also by avoiding unnecessary treatment or misdiagnosis of non-existent glaucoma.

References

1. Topouzis F, Coleman AL, Harris A, Koskosas A, Founti P, Gong G, et al. Factors associated with undiagnosed open-angle glaucoma: the Thessaloniki Eye Study. Am J Ophthalmol. 2008;145(2):327-35.
2. Chua J, Baskaran M, Ong PG, Zheng Y, Wong TY, Aung T, et al. Prevalence, Risk Factors, and Visual Features of Undiagnosed Glaucoma: The Singapore Epidemiology of Eye Diseases Study. JAMA Ophthalmol. 2015;133(8):938-46.
3. Moynihan R, Henry D, Moons KG. Using evidence to combat overdiagnosis and overtreatment: evaluating treatments, tests, and disease definitions in the time of too much. PLoS Med. 2014;11(7):e1001655.
4. Founti P, Coleman AL, Wilson MR, Yu F, Anastasopoulos E, Harris A, et al. Overdiagnosis of open-angle glaucoma in the general population: the Thessaloniki Eye Study. Acta Ophthalmol. 2018;96(7):e859-e64.

Contributor: Nikolaus Hommer MD; Department of Ophthalmology, Hanusch Hospital, 1140 Vienna, Austria

Tip of the Month manager: Karin Öyo-Szerenyi
Tip of the Month editors in chief: Manuele Michelessi, Francesco Oddone