Community-Based Glaucoma Detection

WRITER John Nguyen

Eye care practitioners needn’t work alone to detect glaucoma. In this article, optometrist John Nguyen explains how he has worked with a pharmacy and a GP clinic – and now developed a screening app for home use – to help identify people at risk. His early learnings from pilot programs could support your own practical, community-based identification model.

A few months ago, I was sitting in a medical centre waiting room, watching people move through their GP appointments. I must have been there for about 15 minutes before being called in. Afterwards, I walked next door to the pharmacy and spent another 10 minutes waiting to pick up a prescription. In those 25 minutes, surrounded by people in their 40s, 50s, and 60s, the optometrist in me suddenly asked a question. “How many of these people might be living with undiagnosed glaucoma?”

I do not know why that thought popped into my head at that moment, but it did. I like solving problems and putting theory into practice, so I decided to explore the problem, and look for a solution.

In Australia, we know that around 50% of glaucoma cases are undiagnosed.1,2 We also know that eye care practitioners are generally very good at detecting glaucoma once the patient is in the clinic. The challenge is that many at-risk people are simply not engaging with eye care when they should be. Yet here they were, committed enough to see their GP and visit the pharmacy for other health concerns. So, I wondered, if they’re already showing up for healthcare, why not meet them where they are? I decided to speak about it with glaucoma specialists I knew.

SPECIALIST PERSPECTIVES

The first glaucoma specialist I approached, with my concept of integrating glaucoma risk detection into pharmacies and GP clinics, gave me one piece of advice.

“Mass screening does not work. If you are going to do this, make sure you focus on getting a worthwhile yield.”

Reviewing the literature helped clarify what makes a screening approach workable outside traditional clinics. And it reinforced the surgeon’s perspective that the highest-yield opportunities are in primary care settings, where people are already present for other health concerns.3,4

I then shared the idea with a couple of other glaucoma specialists. Our discussions helped refine my thinking.

“New portable, scalable technologies, such as AI-assisted fundus imaging and mobile visual field testing, are improving the speed and accuracy of glaucoma risk assessment,” Associate Professor George Kong, from GLANCE Optical, told me. “They offer promising tools for targeted community glaucoma screening and, importantly, help prompt individuals to obtain formal testing from their eye care providers.”

My objective was now defined. I was not creating a clinical trial. I was building a local community initiative that engaged stakeholders outside the traditional glaucoma detection pathway. My aim was to create a proof of concept and generate real-world insights to work toward a scalable, sustainable, and meaningful model for early disease identification.

My method for project work is simple. Form a theory; conduct research; consult others; test the concept; prepare for challenges; learn from results; then refine and test again. With that mindset, the next step was to see how this idea might work in practice.

TURNING THEORY INTO A PILOT

I approached Warren Best, a pharmacist at Best Pharmacy I had known for years, and shared my justification report. After working through it, he felt the idea was sound and worth trialling. “Anything we can do to help patient health, is us doing our job better,” he noted.

He agreed to pilot the concept. The experience was insightful. One of the clearest learnings was that a pharmacist’s personal recommendation makes a significant difference to screening uptake. When the pharmacist personally introduced the idea to patients, engagement was notably higher than when materials were simply displayed.

With these lessons in hand, the next step was to approach a GP medical centre to explore whether the model could translate into a primary care environment.

BRINGING THE MODEL INTO GENERAL PRACTICE

I knew that for this collaborative model to succeed in a GP setting, a foundation of professional trust would be essential. GPs are already managing multiple chronic conditions under significant time constraints and will be understandably reluctant to integrate any new service that increases their administrative or clinical burden. Therefore, education and reassurance around a minimal, structured, and low-impact process were paramount for securing their buy-in. I was fortunate to have a medical practice nearby where we had productive and collaborative discussions about building a model that works for everyone. We agreed that in this setting, a visiting glaucoma clinic made the most sense.

The screening workflow for the GP was intentionally simple and based on two key questions, as suggested by Glaucoma Australia:5

• Is there a first-degree family history of glaucoma? If yes, book into the glaucoma clinic.

• If the patient is over 40, when was their last eye check? If it has been more than two years, book into the glaucoma clinic.

Could GPs simply refer these patients to an optometrist? Sure. But in practice, eye health rarely comes up in routine appointments unless the patient mentions it first. These two easy prompts made the discussion systematic rather than accidental, and having a visiting screening service onsite at their trusted GP removed the usual barriers to follow through.

Many GP practices and pharmacies already have underutilised consultation rooms available for use by colleagues and allied health practitioners, such as podiatry and dietitian services. It is a model that GPs are comfortable and familiar with, which makes a visiting glaucoma service a natural extension rather than a disruption.

To set up our clinic, all we needed was to take in equipment to facilitate vision, slit lamp assessment, intraocular pressure measurement, dilated fundus examination, and visual field testing as needed. Patients requiring further care would be referred on appropriately.

TECHNOLOGY AS AN ENABLER

Mobile clinics with portable equipment are commonplace in eye care. However, two critical pieces of equipment for glaucoma assessment have never fitted neatly into the model: visual fields and optical coherence tomography (OCT). These limitations have traditionally made it difficult to maintain the level of specificity and sensitivity needed for meaningful glaucoma detection outside a full clinical setting. However, we now have technology that can achieve more with less.

Melbourne Rapid Fields (MRF) brings validated visual field testing into a truly portable workflow that can be easily set up in a co-located consultation room or pharmacy space.6 Similarly, Eyeonic’s cloud-based AI-powered visual field testing platform is available to use on a computer or tablet. Additionally, Eyetelligence provides artificial intelligence (AI)-assisted optic nerve evaluation to help distinguish between healthy and glaucomatous discs,7 which is especially useful in cases where OCT is not available.

These three pieces of technology – all developed in Australia – enable more consistent and informative assessments in community environments that previously could not support them.

THE HUMAN SIDE OF EARLY DETECTION

The comments we have received during our pilot programs have been heartwarming and encouraging. One woman who was screened at a pharmacy told us, “My mother had glaucoma. I am glad you are here to remind me to have it checked.”

A GP colleague affirmed our collaborative ambition, stating, “Early detection and treatment are vital. Working together, we could prevent a leading cause of irreversible blindness.”

FULFILLING THE VISION

While developing my pilot program, my thinking was that we could build a framework to fit comfortably within GP practices that would become part of routine, systematic care. A visiting optometrist, with patients prebooked on the advice of their GP, felt like the most practical and sustainable approach.

To scale up pharmacy screenings, I had reached out to a global provider of health kiosks, widely used in pharmacies, to explore whether glaucoma risk questions could be added to its system.

But as my work progressed, a bigger opportunity came into focus.

FROM PILOT TO PLATFORM

The technology for early glaucoma detection exists, but our community approach to finding at-risk people hasn’t modernised to match. Through these pilots, it became clear that taking the screening into people’s homes was the fastest way to extend our reach beyond traditional clinic settings.

The result is G-Screen (g-screen.online) – a web-based glaucoma risk assessment app that is accessible by anyone around the world with an internet connection and a computer or tablet. It assesses glaucoma risk based on age, ethnicity, family history, and eye care history, then screens visual acuity and visual fields using Melbourne Rapid Fields before advising on follow-up care.

It is an exciting evolution. The principle is still true to the one that started this whole project: meet people where they are. G-Screen simply takes that to another level of magnitude, one that seems so obvious in hindsight.

My vision started with one thought in a waiting room. Five years from now, when I am sitting in another one, I hope the question isn’t “How many of these people might be living with undiagnosed glaucoma?” but instead “How many cases did we manage to catch early today?”

Have I cracked the code? No, not yet. But I am hopeful that this work, in whatever form it evolves, will help close the gap in finding the missing 50%.

John Nguyen BOptom is an optometrist and founder of Zoom Optics in Sydney and creator of G-Screen (g-screen.online), an online glaucoma screening platform. He works at the intersection of clinical care and health innovation, with collaborative models that improve early detection of preventable eye diseases and reduce avoidable vision loss. He is committed to developing practical, community-based approaches that expand access to timely eye care.

References available at mivision.com.au.