Personal Views

A surfeit of screening?

BMJ 1997; 315 doi: (Published 02 August 1997) Cite this as: BMJ 1997;315:318
  1. Philip G Griffiths
  1. consultant ophthalmologist, Newcastle upon Tyne

    It is now Wednesday. So far this week I have attended three planned eye clinics and a eye casualty session. I do not normally work in eye casualty, but there have been dark rumours about the pressure of work, and our ophthalmic senior house officers seem to be wilting under the strain. It is clearly time to investigate the problem.

    The outpatient sessions have included one adult clinic in a teaching hospital, one outreach clinic in a rural area, and a children's clinic back at base. Relatively few patients have symptoms. Most have been referred following screening programmes or opportunistic case finding (a euphemism for limited screening which evades the normal considerations of sensitivity, specificity, ethics, and cost).

    In my adult clinic the commonest indication for referral is raised intraocular pressure indicating possible glaucoma. But pressure alone is a poor way of screening for glaucoma and a recent meta-analysis of medical treatment of glaucoma failed to show any beneficial effect of screening in terms of preserving vision. …

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