Chapter 4.B.3 and 4.B.4--Res Ipsa, Negligence per se, the Helling Case and Defensive Medicine


For additional discussion of the advisability of screening for glaucoma, see http://www.annfammed.org/cgi/content/full/3/2/171:

The U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against screening adults for glaucoma.  The USPSTF found good evidence that screening can detect increased intraocular pressure (IOP) and early primary open-angle glaucoma (POAG) in adults. The USPSTF also found good evidence that early treatment of adults with increased IOP detected by screening reduces the number of persons who develop small, visual field defects, and that early treatment of those with early, asymptomatic POAG decreases the number of those whose visual field defects progress. The evidence, however, is insufficient to determine the extent to which screening—leading to the earlier detection and treatment of people with IOP or POAG—would reduce impairment in vision-related function or quality of life.  The USPSTF found good evidence that treatment of increased IOP and early POAG result in a number of harms, including local eye irritation and an increased risk for cataracts. Given the uncertainty of the magnitude of benefit from early treatment and the known harms of screening and early treatment, the USPSTF could not determine the balance between the benefits and harms of screening for glaucoma.




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