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PubMed2003

Is digital image compression acceptable within diabetic retinopathy screening?

AIMS: The National Screening Committee (NSC), whilst recommending the use of digital mydriatic retinal photography for diabetic retinopathy screening, has not yet accepted the use of digitally compressed images for grading. By greatly reducing the file size, however, compression of images is invaluable for storage and for its rapid transmission across computer networks. We undertook a study to compare the different levels of JPEG compression with the original bit-mapped image to determine whether there was any loss of clinical detail following compression. METHODS: Three hundred and thirty images were analysed in this study. These images had been captured from 66 eyes consecutively photographed in a diabetic retinopathy screening programme, using a Sony DXC-950 P 3CCD colour video camera mounted on a Canon CR6-45NMf fundus camera. Single 45 degrees macula-centred images were taken from each eye. The images were compressed using the JPEG algorithm within Adobe Photoshop (version 4.0) and then displayed with a Sony Trinitron colour monitor. Four different levels of compression were used, JPEG-1, JPEG-2, JPEG-3, JPEG-4, and an objective analysis was undertaken using 'lesion counts'. The compressed images were assessed separately and blindly and the results compared with their original BMP images. RESULTS: Eight BMP images could not be evaluated (five right eye and three left eye). A total of 290 images were therefore used in the final evaluation. All the JPEG-1 images with file sizes between 16 and 24 kb were found to be 'pixelated', while the JPEG-4 images (66-107 kb) appeared similar to the original BMP (1.3 Mb) images. Both JPEG-2 and JPEG-3 images had significantly lower counted lesions than the BMP images. CONCLUSIONS: From our findings we can conclude that only some degree of image compression (compression ratios of 1 : 20 to 1 : 12) with file sizes of 66-107 kb is permissible using JPEG format, whereas the images obtained after higher compression ratios may not be suitable for diabetic retinopathy screening.

Adult↗
PubMed2003

Screening for diabetic retinopathy in James Bay, Ontario: a cost-effectiveness analysis.

BACKGROUND: Retinopathy is a common complication of diabetes mellitus that if detected early by regular retinal examinations can be treated; thus, blindness can be delayed or prevented. Providing high-quality retinal screening is difficult, especially in rural and remote areas. Canada's First Nations population has a higher prevalence of diabetes and is, in general, more geographically isolated than the broader Canadian population. We modelled the cost-effectiveness of retinopathy screening by travelling retina specialists versus retinal photography with a portable digital camera in an isolated First Nations cohort with diabetes. METHODS: The 2 screening programs were modelled to run concurrently for 5 years, with outcomes evaluated over 10 years. To construct economic models for the population of Cree individuals living in the western James Bay area of northern Ontario, we used available data on the prevalence of diabetes in the area and estimates of the incidence of retinopathy derived from the published literature. We compared the screening models and calculated total costs, visual outcome, costs per sight-year saved and costs per quality-adjusted life year (QALY). We also estimated the costs of implementing a screening program for all First Nations individuals in Ontario with diabetes and no access to an ophthalmologist. RESULTS: From the perspective of the health care system the camera program was preferable to the specialist-based program. Over 10 years, 67 v. 56 sight years were saved, compared with no screening, at costs of 3900 Canadian dollars v. 9800 Canadian dollars per sight year and 15,000 Canadian dollars v. 37,000 Canadian dollars per QALY. Generalizing these results to the province of Ontario, the camera system could allow most isolated First Nations people with diabetes to be screened for 5 years for approximately 1.2 million Canadian dollars. INTERPRETATION: A portable retinal camera is a cost-effective means of screening for diabetic retinopathy in isolated communities of at-risk individuals.

Cost-Benefit Analysis↗
PubMed2004

Utility of red amsler grid screening in a rheumatology clinic.

OBJECTIVE: To ascertain the false positive rate of red Amsler grid screening in an outpatient rheumatologic setting. METHODS: Red Amsler grid screening was performed on 170 consecutive patients presenting with rheumatoid arthritis or systemic lupus erythematosus. Patients with abnormal screening results were referred for ophthalmologic evaluation and formal visual field testing. RESULTS: Nineteen patients identified scotomata on red Amsler grid. Despite numerous recall attempts, only 9 of the 19 patients with scotomata presented for ophthalmologic evaluation. The positive predictive value was 5-58%. Roughly 6-11% of all patients screened had a false positive screening test. CONCLUSION: While red Amsler grid screening may allow rheumatologists to identify patients who are more likely to have hydroxychloroquine ocular toxicity, an abnormal red Amsler grid screening is in itself an unreliable predictor of toxicity.

Antirheumatic Agents↗
PubMedDate not supplied

Barriers to vision care for nursing home residents.

OBJECTIVE: To describe the prevalence of periodic eye examinations by eye professionals and to examine nursing facility resident characteristics associated with lack of periodic screening. DESIGN: Retrospective chart review. SETTING: Two Midwestern nursing facilities. PARTICIPANTS: Between 1995 and 1997, 134 subjects aged 60 and older were recruited from two metropolitan nursing facilities. MEASUREMENTS: Nursing home charts were reviewed for: demographics, length of stay, date of eye examination, eye diagnosis,visual acuity. Nursing assessments were used to obtain information about cognition, function, behavior, and the presence of Do Not Resuscitate or Do Not Hospitalize orders. The chart was reviewed for visual acuity, intraocular pressures, and the presence of eye pathology. Individuals who had not had eye examinations in the previous 2 years were screened by an ophthalmologist. This examination included external examination of the eye, fundoscopic examination, tonometry,visual acuity with correction. RESULTS: Only 62 (46%) of the subjects had been seen by an eye care professional in the previous 2 years. Visual acuity information was available for 37/64 previously examined subjects. Of those with no eye examination in the previous 2 years (n = 72), visual acuity was obtained in 32 (44%) of subjects. New eye diagnoses were made in 64% (41/64). Logistic regression models with "eye examination within the past 2 years" as the dependent variable show that residents who do not desire hospital transfer are 80% less likely to have had an eye examination than those without this designation. Sex, age, length of stay, functional status, presence of severe dementia, behavior problems, or DNR orders do not change the likelihood that a resident would have been examined. Logistic regression models with "visual acuity measured" as the dependent variable show that residents with severe dementia are 12.6 times less likely to have acuity measured than those without dementia. Those with a length of stay in the facility less than 6 months are 10% less likely to have visual acuity measured. CONCLUSIONS: This study does not confirm that barriers still exist in the provision of eye care to all nursing home residents, but the prevalence of such assessments remains low. Additional screening results in a substantial increase in the identification of treatable eye diseases. Contrary to the original hypotheses that patient characteristics that make testing difficult would provide a barrier or disincentive to vision testing, this study did not show statistical differences in the rates of vision screening for those with dementia, behavior problems, or severe functional impairment. Severe dementia does seem to affect the ability of the eye care specialist to gather subjective data such as visual acuity. It also demonstrates that vision screening does take place on nursing home residents with a broad range of cognitive and functional abilities, and this screening results in the diagnosis of many treatable eye conditions. Future efforts should be made to increase vision screening and treatment in the nursing home.

Journal Article↗
PubMed2003

Glaucoma screening by primary care physicians in southern Alberta: patterns, methods and deficiencies.

BACKGROUND: This study was undertaken to determine the proportion of primary care physicians who routinely assess their patients for risk factors associated with glaucoma as well as the elements that underlie whether these physicians screen for glaucoma. METHODS: A brief, confidential questionnaire was distributed to primary care physicians on 3 occasions. The survey asked about the physicians' background, their glaucoma screening habits, reasons for not doing routine screening and measures that would help the physician begin to do screening. Responses were categorized and percentages calculated. RESULTS: Of the 161 questionnaires distributed, 49 (30.4%) were returned. Of the respondents, 53% claimed that they routinely screened for glaucoma; more urban than rural physicians did so (57% vs. 44%). Some of the screening methods documented were inappropriate. The reasons most often given for not screening were lack of equipment and skills, cited by 48% and 30%, respectively, of the physicians who claimed not to be currently screening. Most (85%) of the respondents who claimed to routinely screen for glaucoma said they would refer the patient to an ophthalmologist or optometrist if they suspected the condition. Among the measures that would help physicians currently not screening to begin doing so, training and access to equipment and facilities were most often suggested by those not currently screening as well as those routinely doing so. INTERPRETATION: If family physicians are an appropriate group to screen for glaucoma, and if mass screening for this condition is worth while, education and access to equipment are critical.

Attitude of Health Personnel↗
PubMed1998

Evaluation of screening schemes for eye disease in a primary care setting.

BACKGROUND AND PURPOSE: Screening in a primary care setting could be an effective method for detection of eye disease. This study was designed to evaluate a questionnaire and a battery of tests for their performance in eye disease screening at a primary care clinic. METHODS: 405 patients aged 40 years or older were interviewed and received a comprehensive eye examination including visual acuity and visual field testing, tonometry, slit-lamp examination, dilated fundus examination and photography. Sensitivity and specificity for the identification of eye disease were calculated for each test and various combinations of tests. RESULTS: A questionnaire-based algorithm for detection of overall eye disease was sufficiently sensitive (90%) but less specific (44%) than an ideal screening test. Distance visual acuity with presenting correction of < or = 20/40 had a sensitivity of 61% and specificity of 72%. A dilated fundus examination had a sensitivity of 79% and specificity of 82%. In screening for glaucoma, tonometry was ineffective (sensitivity = 27% and specificity = 96%), while visual field testing by suprathreshold screening had a sensitivity of 70% and specificity of 67%. Among a variety of combinations, a two-stage strategy with the questionnaire as a first-stage and visual acuity and ophthalmoscopy as second-stage tests provided the best balance of sensitivity (83%) and specificity (76%). CONCLUSION: Among currently available ophthalmic tests, an eye examination including a thorough fundus examination is critical in detection of eye disease. A five-item questionnaire may be useful to identify patients at high risk in primary care practice. More effective tests are needed to improve performance of eye disease screening.

Adult↗
PubMed2006

Establishing ongoing quality assurance in a retinal screening programme.

AIM: To establish a clinically efficient, cost-effective quality assurance programme as part of a routine retinopathy screening service. METHODS: The operation of a quality assurance system as part of an ongoing retinal screening service is described. A random selection of 12% of images of all people reported to have retinopathy and of 2% reported to have no retinopathy are re-graded by a consultant ophthalmologist. Entry of the two sets of data into a purpose-designed excel spreadsheet allows automated calculation of sensitivity and specificity. RESULTS: The results of quality assurance from August 2001 to July 2003 are reported. Out of 8351 screening episodes, 498 were re-examined. Of the 62 cases identified by the ophthalmologist as having referable retinopathy, four false negatives for detection were identified. Three of these had been assigned to early re-screening by the retinal screener but were still regarded as false negative by the parameters of the quality assurance system. The sensitivity and specificity for detection of sight-threatening retinopathy were 93.5% (95% CI = 84.3-98.2%) and 97.8% (95% CI = 95.8-98.9%), respectively. CONCLUSION: A robust and cost-effective system has been developed to allow monitoring of performance of routine retinal screening which may be extended to meet current national recommendations.

Diabetic Retinopathy↗
PubMed2001

[A pilot study on rapid glaucoma screening].

OBJECTIVE: To screen glaucoma effectively and rapidly and evaluate the specificity and sensitivity of the method. METHODS: 734 subjects were screened in 4 weekend days. All subjects underwent intraocular pressure (IOP) examination with Tonopen, anterior chamber depth measurement with Van Herick method, fundus photography without pupil dilatation and supra-threshold perimetry with Frequency Doubling Perimeter (FDP), Octopus and Humphery automatic perimeter. The cases with positive results in the above examinations should undertake threshold perimetry and fundus stereo photography for the evaluation of the retinal nerve fiber layer (RNFL). RESULTS: Of the 734 subjects with complete data, there were 55 cases with open angle glaucoma (7.5%), 59 angle-closure glaucoma (8.4%) and 98 glaucoma suspects (13.4%). The IOP of 34 patients was > 21 mm Hg in all the glaucomatous patients (29.8%). The abnormal rates of optic nerve and visual field were 94.5% and 67.3% respectively in the patients with open-angle glaucoma. The abnormal rates of anterior chamber, visual field and optic nerve were 89.8%, 72.9% and 45.8% respectively. CONCLUSIONS: The most efficient method for screening open-angle glaucoma is fundus stereo photography with evaluation by an expert. Anterior chamber evaluation is necessary in screening glaucoma. Supra-threshold perimetry has limited specificity, and FDP might be a promising method in screening glaucoma with relatively good specificity.

Adolescent↗
PubMed1990

Screening for glaucoma in the community by non-ophthalmologically trained staff using semi automated equipment.

Eighty-nine and a half per cent of the population of a general practice over the age of 49 years were screened for glaucoma and high risk ocular hypertension requiring treatment. Screening took place using semi-automated intraocular pressure and visual field equipment operated by non-ophthalmologically trained staff. An experienced ophthalmologist examined all patients in a single blind manner to reduce false negatives to a minimum. Patients suspected of requiring treatment on the grounds of raised intraocular pressure, abnormal visual fields or suspicious optic discs were subsequently examined in a hospital clinic. Treatment criteria, as commonly practiced, were carefully defined and the sensitivities and specificities of the methods of screening used were calculated. One and three tenths per cent of the practice population were known to be receiving treatment prior to the study and a further 1.4% were found to require treatment after screening. The sensitivity and specificity of the non-contact tonometer were 91.7% and 95.6% respectively with a predictive power of 22.5% for a positive result. The mean time taken to perform the test in both eyes was two minutes. Seventy per cent of the patients with pressures over 22 mmHg in both eyes on screening were found to require treatment. The routine use of the field screener did not increase either the sensitivity or specificity of the screening process but its use in cases with raised intraocular pressure is advised to indicate the degree of urgency of the referral. An algorithm based on the results of the study is suggested when planning the use of semi-automated equipment to screen for ocular disease related to raised intraocular pressure.

Aged↗
PubMed1999

Glaucoma awareness and screening uptake in relatives of people with glaucoma.

PURPOSE: To assess glaucoma awareness and screening uptake in relatives of people with glaucoma. METHODS: A questionnaire was administered to 52 patients with primary open-angle glaucoma. They were asked about their awareness of glaucoma clustering within families, and the need for glaucoma screening in relatives of glaucoma patients. Patients were asked to identify one or more first-degree relatives, aged over 40 years and thus eligible for free glaucoma screening in the United Kingdom. These relatives were mailed a similar questionnaire. In performing the statistical analysis we corrected for possible clustering within families. The study was approved in advance by our local ethics committee, and all participants were informed of the United Kingdom's free screening service afterwards. RESULTS: Ninety relatives were identified, of whom 70 (78%) returned questionnaires. Only 53% of responding relatives thought they were at increased lifetime risk of developing glaucoma. Though 81% of relatives had been screened, many were screened infrequently. We compared the responses of patients' siblings and patients' offspring. Perceived lifetime glaucoma risk was similar in the two groups, but the (older) siblings had a significantly lower awareness of the free screening service (p = 0.03) and attended for screening less frequently (p = 0.07). Uptake of regular, free glaucoma screening at least every 2 years was 57% among offspring and 30% among siblings (p = 0.005). Because of selection bias (good communicators were more likely to be invited to participate) the true rates of glaucoma awareness and screening uptake are almost certainly lower than this. CONCLUSIONS: Relatives of people with glaucoma should be made more aware of the need for glaucoma screening and encouraged to use the free screening service. Older relatives should be particularly targeted.

Aged↗
PubMed1989

[Detection of latent disorders of visual function during ambulatory care of children].

For the purpose to select tests for diagnosis of latent disturbances of visual functions, dynamic observation was conducted over 88 healthy school children within 5 years (from the 3d to the 8th form). Once a year, the children underwent examination of visual acuity for far and near, the state of binocular vision on a synoptophore and a color test, the volume of relative and absolute accommodation, muscular balance of eyes for far and near, contrast sensibility, the time of perception of the negative successive contrast, refraction. For the period of 5 years, 7 children developed myopia of low degree, 32 showed transitory or lasting reduction of visual acuity due to spasm of accommodation. The authors believe that the most rapid and informative tests for diagnosis of latent disturbances in accommodation-convergence system are visual acuity for near, the volume of absolute accommodation, the threshold of remote vision, muscular balance of eyes for near. It is recommended to use these tests widely when conducting ophthalmologic thorough prophylactic examinations of children.

Ambulatory Care↗
PubMed2004

Isoametropic amblyopia due to high hyperopia in children.

PURPOSE: To identify children with isoametropic amblyopia due to moderate to high hyperopia and evaluate associated findings and visual acuity outcome. METHODS: Charts from two university's pediatric ophthalmology clinics were reviewed retrospectively. Healthy children with > or = +4.5 D spherical equivalent who did not have anisometropia > or = 1.5 D were selected for data collection. The charts of qualifying children with bilateral amblyopia (visual acuity of 20/40 or less) were further analyzed. RESULTS: Identified were 418 children with the above set of criteria for hyperopia; 36 of these children had isoametropic amblyopia (bilateral amblyopia). This gives an estimated prevalence of isoametropic amblyopia of 8.6% in children with at least 4.5 D of hyperopia in one or both eyes. The children with isoametropic amblyopia presented at a later age (5 years, 1 month) than the overall group of hyperopes (3 years, 5 months). Strabismus was less prevalent in this group (64%) than in the entire population of children with high hyperopia (81%). These children's amblyopia responded well to treatment with glasses, and patching in 13 (36%) cases. Surgical intervention for residual strabismus was necessary in very few cases (2 of 36, 5.5%). CONCLUSION: Children with hyperopia > or = 4.5 D have an increased risk of amblyopia and strabismus that further threatens their future visual function. Isoametropic amblyopia is a real risk in these children. Based on these results, hyperopic correction should be prescribed for children with > or = 4.5 D of hyperopia even if no strabismus or fixation preference is detected, to reduce this risk. Screening programs should also be in place to identify these children at an early age.

Amblyopia↗
PubMed2003

Incidence of sight-threatening retinopathy in Type 1 diabetes in a systematic screening programme.

AIM: To measure the cumulative incidence of any retinopathy, maculopathy and sight-threatening diabetic retinopathy (STDR), and calculate optimal screening intervals by retinopathy grade at baseline for patients with Type 1 diabetes attending an established systematic retinal screening programme. METHODS: All patients with Type 1 diabetes registered with enrolled general practitioners, excluding only those attending an ophthalmologist, were studied if retinopathy data was available at baseline and at least one further screen event. Screening utilized non-stereoscopic 3-field mydriatic photography and modified Wisconsin grading. STDR was defined as moderate pre-proliferative retinopathy or greater and/or significant maculopathy in any eye. RESULTS: Patients (n=501) underwent 2742 screen events. Cumulative incidence of STDR in patients without baseline retinopathy was 0.3% (95% CI 0.0-0.9) at 1 year, rising to 3.9% (1.4-5.4) at 5 years. Rates of progression to STDR in patients with background and mild pre-proliferative retinopathy at 1 year were 3.6% (0.5-6.6) and 13.5% (4.2-22.7), respectively. Progression to STDR was greater in patients with a higher grade of baseline retinopathy (P=0.001) or a longer disease duration (P=0.003). For a 95% likelihood of remaining free of STDR, mean screening intervals by baseline status were: no retinopathy 5.7 (95% CI 3.5-7.6) years, background 1.3 (0.4-2.0) years and mild pre-proliferative 0.4 (0-0.8) years. CONCLUSIONS: Screening at 2-3 year intervals, rather than annually, for patients without retinopathy in Type 1 diabetes is feasible because of the low risk of progression to STDR, and may result in significant cost savings for a screening programme. Patients with higher grades of retinopathy require screening at least annually or more frequent.

Adult↗
PubMed1988

Screening for glaucomatous visual field defects: the relationship between sensitivity, specificity and the number of test locations.

The visual field results from 104 eyes with early glaucomatous loss and 1860 normal eyes have been used to derive the relationship between sensitivity, specificity and the number of test locations in a visual field screening test. A logarithmic relationship was found between sensitivity and the number of test locations and a linear relationship between specificity and the number of test locations. The results indicate that large numbers of test locations are not required to reach high levels of sensitivity and that clinically it might be better to screen all patients with a few stimuli quickly than to examine carefully those patients who meet a precondition such as raised intraocular pressure or abnormal disc appearance.

Computers↗
PubMed1998

Screening for abnormal levels of hyperopia in children: a non-cycloplegic method with a hand held refractor.

AIMS: High hyperopia constitutes the majority of refractive errors in large scale visual screening at preschool ages. The authors aimed to assess the validity of the Retinomax hand held refractor to detect high hyperopia in a refractive screening performed without cycloplegia and carried out on children aged 9-36 months. They considered +1.5 D of manifest hyperopia to be the threshold value and abnormal absolute hyperopia to be above +3.5 D. METHODS: Of the 897 children screened without cycloplegia, 220 were refracted with cycloplegia. The validity of several thresholds of manifest hyperopia was estimated by receiver operating characteristic (ROC) curves using cycloplegic measures as a reference. The reproducibility of Retinomax measurements was assessed. Normal and quick mode measurements were compared using the Wilcoxon test. RESULTS: The manifest threshold of +1.5 D offered the best combination of sensitivity (70.2%), specificity (94.6%), positive predictive value (78.6%), and negative predictive value (91.9%) to disclose abnormal absolute hyperopia. A good agreement was obtained between the various measurements using Retinomax on the same subject. In the results of this survey, there is no evidence that accommodation is minimised in the normal mode of measurement compared with the quick mode. CONCLUSION: The Retinomax hand held infrared autorefractor is a suitable instrument to diagnose abnormal hyperopia (manifest hyperopia > +1.5 D) in noncycloplegic refractive screening at preschool ages. It is suggested as the quick mode of measurement as it is more feasible in children (success rate 98.5%).

Age Distribution↗
PubMed2001

Non-cycloplegic screening for refractive errors in children with the hand-held autorefractor Retinomax: final results and comparison with non-cycloplegic photoscreening.

AIMS: To establish the results of refractive screening of preschool children with the hand-held autorefractor Retinomax under non-cycloplegic conditions, and to compare these results with those of photoscreening. METHODS: Among 1218 children undergoing non-cycloplegic refractive screening, 302 (25%) were also refracted under cycloplegia using the same refractor and were used as controls. Our criteria for a positive screening test were based on the spherical or cylinder values and were: myopia over 3D, astigmatism > or = 2D, spherical or cylindrical anisometropia > or = 1.5D, and hyperopia > or = 1.5D. Absolute myopia over 3D, absolute astigmatism > or = 2D, absolute anisometropia > or = 1.5D and absolute hyperopia > 3.5D were considered as true positives. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated within the group of controls for each refractive anomaly. On the basis of Bayes' theorem, these figures were then corrected to yield the true screening results that would be expected in a population without verification and selection bias. To determine the usefulness of this screening technique, the likelihood ratios for positive test results (+LR) were also calculated. The results of this screening in terms of sensitivity, specificity and predictive values were then compared with those of photoscreening. RESULTS: The basic results of screening with the hand-held autorefractor were as follows: -EHyperopia: sensitivity 46%, specificity 97%, PPV 55%, NPV 96%, +LR 15; -EAstigmatism: sensitivity 37%, specificity 99%, PPV 69%, NPV 96%, +LR 37; -EAnisometropia: sensitivity 66%, specificity 93%, PPV 19%, NPV 99%, +LR 9; -EMyopia: sensitivity 87%, specificity 99%, PPV 33%, NPV 100%, +LR 87. The comparison with photoscreening revealed a similar performance when screening for hyperopia, but the hand-held autorefractor yielded much better figures when screening for astigmatism. In the case of myopia and anisometropia, the lack of consistent information concerning photoscreening invalidates any comparison. CONCLUSION: The hand-held autorefractor Retinomax appears to have potential as a screening device. Our experience with the non-cycloplegic screening of preschool children for refractive anomalies indicates definite usefulness and reasonable accuracy of the Retinomax for detecting myopia, astigmatism and hyperopia. The weak point of this screening technique is the diagnosis of anisometropia, with only moderate utility and poor accuracy.

Bayes Theorem↗
PubMed2006

Glaucoma screening during regular optician visits: can the population at risk of developing glaucoma be reached?

AIM: To determine the percentage of the population at risk of developing glaucoma, which can potentially be reached by conducting glaucoma screening during regular optician visits. METHODS: 1,200 inhabitants aged >40 years were randomly selected from Dutch community population databases. A questionnaire was mailed to these inhabitants with questions on their latest optician visit and risk factors for glaucoma. A second questionnaire was sent to their opticians, who were asked about their willingness to conduct an additional glaucoma screening programme in the future. RESULTS: The questionnaire was returned by 959 of 1,200 inhabitants and 37 of 50 opticians. The percentage of inhabitants who visited an optician during a 5-year period was 83% (95% confidence interval (CI) 80% to 85%). This percentage was adjusted for the presence of risk factors for glaucoma to obtain the percentage of the population at risk of developing glaucoma. The percentage of opticians willing to cooperate in a glaucoma screening programme extended beyond a non-contact tonometry measurement alone was 91% (95% CI 77% to 98%). CONCLUSION: By conducting glaucoma screening during regular optician visits, a large section of the population at risk of developing glaucoma can be reached.

Aged↗