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Edmund Tsui, Andrew N Siedlecki, Jie Deng, Margaret J Chowaniec, Sandolsam Cha, Susan M Pepin, Erin M Salcone; Implementation of a vision-screening program in rural northeastern United States. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1444.
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Rural populations face unique barriers in receiving health care. Although the utility of vision screening has been evaluated in urban settings, there have been limited investigations within rural communities in the United States. We aim to evaluate the efficacy of a medical student-run free vision-screening clinic as a strategy to overcome barriers to accessing eye care in New Hampshire and Vermont.
Medical students were trained by an ophthalmologist to administer screening eye examinations. Patients (n=103) from New Hampshire and Vermont were prospectively enrolled through a free community clinic. Screening included a medical history questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, and diagnoses were recorded and analyzed. Dartmouth College IRB approval was obtained.
Of 103 patients (45.5±12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmological exam findings were found in 58/66 (88%) of patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal disease (8%), cataract (6%), other (14%), and normal exam (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancelled appointment, work conflicts, or forgetfulness. Patients travelled a mean of 16.6 miles (range 0-50 miles) to attend appointments. Mean time from patients’ last effort to seek eye care was 7.1 years (range 1-54 years).
This study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, we demonstrate that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting.
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