Cost-effective evaluation of the glaucoma suspect.

PURPOSE OF REVIEW: The number of glaucoma patients nationwide will increase appreciably over the coming years reflecting the increased number of elderly people. This increase will require efficient allocation of available healthcare resources for management of the entire spectrum of disease from glaucoma suspect to advanced glaucoma. This review considers the cost-effective management of glaucoma suspects.

RECENT FINDINGS: Medications account for the majority of costs of managing glaucoma suspects while the cost of clinical evaluations has remained stable. Early disease recognition limits both direct and indirect costs. Risk stratification of glaucoma suspects can identify those who would benefit most from therapy. Newer structural modalities can be as predictive of early disease progression as stereo disk photography. Short-wavelength automated perimetry and frequency doubling technology may be more appropriate in confirming field changes in this patient population.

SUMMARY: Overall costs of managing glaucoma can be limited by preventing early disease progression. Identification and monitoring of glaucoma suspects would help minimize overall costs if intraocular pressure lowering therapy is reserved for high-risk glaucoma suspects or those with early disease. Yet, since the rate of progression to blindness for a particular patient is not known, the most cost-effective time to begin intraocular pressure lowering therapy remains unclear.