Should We Add Screening of Age-Related Macular Degeneration to Current Screening Programs for Diabetic Retinopathy?

The report by Chan et al 1 in the current issue (p. 2278) details how screening for both diabetic retinopathy and age-related macular degeneration (AMD) can be conducted using fundus photographs obtained with nonmydriatic cameras. Exactly how cost-effective is such a screening? Could this be a recommendation for the future? Herein, we explore the potential for such a model for the management of 2 of the leading causes of blindness worldwide. Criteria for effective screening for diseases include strategies that have good sensitivity and specificity. Ideally, the screening is effective if it results in detecting disease while the patient is asymptomatic and in initiation of an efficacious therapy that could prevent or retard progression of disease to reduce vision loss. Screening for diabetic retinopathy long has been demonstrated to be cost-effective. 2,3 Persons with proliferative diabetic retinopathy may be asymptomatic, and timely delivery of scatter laser photocoagulation (panretinal photocoagulation) is 95% effective in reducing the risk of

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