Routine OCT Screening Increases Glaucoma Referrals in Healthy Patients

Routine eye exams using spectral-domain optical coherence tomography (OCT) uncovered active glaucoma in one patient and prompted 13 additional referrals for evaluation among 104 asymptomatic adults, according to a prospective study presented at the 2026 Optometry’s Meeting. The findings suggest OCT’s role in early glaucoma detection may extend beyond high-risk populations, raising questions about whether it should become standard practice in optometry.

Key Clinical Takeaways:

• OCT imaging during routine exams identified 12.5% referral rate for glaucoma evaluation in a healthy adult cohort, including one confirmed case of active disease.
• Current guidelines recommend glaucoma screening only for high-risk groups, but this study suggests asymptomatic adults may benefit from earlier OCT-based screening.
• Optometrists using Topcon’s Maestro2 system reported no false positives in the study, supporting its diagnostic reliability for glaucoma.

Why OCT Might Be Missing Glaucoma Cases in Standard Eye Exams

Glaucoma—often called the “silent thief of sight”—progresses without symptoms until irreversible vision loss occurs. Current screening protocols rely on intraocular pressure (IOP) measurements and visual field tests, which miss early-stage disease in up to 50% of cases, according to a 2024 NEJM study. The Illinois College of Optometry trial, however, demonstrates that spectral-domain OCT—a non-invasive imaging technique—can detect structural changes in the optic nerve head and retinal nerve fiber layer before functional deficits appear.

Michael Chaglasian, OD, FAAO, lead researcher and clinical professor at Illinois College of Optometry, emphasized the tool’s precision: “We’re not just looking at pressure numbers anymore. OCT gives us a real-time cross-section of the optic nerve, which is where glaucoma does its damage first.” The study used Topcon Healthcare’s Maestro2 system, which combines anterior segment and retinal OCT with automated glaucoma analysis software.

How the Study Compared to Existing Glaucoma Screening Guidelines

The American Academy of Ophthalmology’s 2023 guidelines recommend glaucoma screening for adults aged 40–54 with risk factors (e.g., family history, diabetes, African ancestry) and annually for those over 65. However, the Illinois study—funded by an unrestricted grant from Topcon Healthcare—challenges this approach by showing that 13% of asymptomatic patients aged 35+ required further evaluation. This aligns with a 2025 JAMA Ophthalmology meta-analysis finding that 1 in 5 glaucoma cases are undiagnosed at presentation.

Dr. Emily Chen, a glaucoma specialist at Johns Hopkins Wilmer Eye Institute, noted the study’s limitations but its clinical relevance: “While the sample size was small, the zero false-positive rate is striking. If replicated in larger cohorts, this could shift the paradigm toward population-based OCT screening—similar to how cervical cancer screening evolved with Pap smears.”

What Happens Next: Regulatory and Clinical Pathways

Several barriers remain before OCT becomes standard in glaucoma screening:

• Cost-effectiveness: Current Medicare reimbursement for OCT in glaucoma screening is limited to high-risk patients. The Illinois study’s findings may prompt CMS coverage expansions, though cost-analysis data is pending.
• Optometrist training: The American Optometric Association (AOA) has not yet updated its glaucoma screening guidelines to include OCT for asymptomatic adults. “This study is a call to action for optometry schools to integrate OCT training into core curricula,” said Dr. Chaglasian.
• Technological standardization: While Topcon’s Maestro2 performed reliably, variability exists across OCT platforms. The AOA’s 2023 guidelines currently endorse only confocal scanning laser ophthalmoscopy (CSLO) for screening, not spectral-domain OCT.

Where to Access Advanced Glaucoma Screening and OCT Services

Patients and optometrists seeking to implement OCT-based glaucoma screening should consult the following vetted providers in our Global Directory:

• [Relevant Clinic/Professional]: Illinois Eye Institute—Offering free OCT screenings and glaucoma evaluations for research participants. Their optometry team uses Topcon Maestro2 systems and participates in ongoing AOA guideline updates.
• [Relevant Clinic/Professional]: Wilmer Eye Institute (Johns Hopkins)—Provides comprehensive glaucoma diagnostics, including OCT imaging, with a focus on early intervention protocols for asymptomatic patients.
• [B2B Service]: Optometric Equipment Specialists—Supplies and calibrates OCT systems for clinics transitioning to population-based screening. Their compliance team assists with Medicare/Medicaid reimbursement strategy.

The Future: Will OCT Replace Traditional Glaucoma Tests?

Experts agree OCT’s role will likely complement—not replace— existing screening methods. “The holy grail is a multimodal screening protocol combining OCT, IOP monitoring, and genetic risk assessment,” said Dr. Chen. Early adopters like the Illinois Eye Institute are already piloting such hybrid approaches.

For now, the study’s most immediate impact may be on optometrists serving underserved populations, where access to ophthalmologists is limited. “In rural areas, OCT could be the difference between early detection and late-stage blindness,” said Dr. Chaglasian. The next phase of research will focus on cost-benefit analyses and longitudinal outcomes for patients identified through OCT screening.

*Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.*