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Y. Trigo, J. Hendricks, H. Koenig, W.E. Sponsel; Clinical Follow–Up Return Rates Among Those Screening Postively for Sight–Threatening Disease in Bexar County, Texas . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3439.
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To compare return rate of those screening postively for glaucoma or other sight–threatening eye disorders at glaucoma screenings in Bexar County, Texas.
Four–day screenings for glaucoma were held monthly at different sites using a 60–foot Lion's Mobile Eye Screening Unit. Screening was carried out in two stages: initial screening by a trained technician who performed history, BP, acuity, and FDT C20–2. Those screening postively with >1 FDT misses underwent HVF SITA 30–2, HRT–II scanning laser, tonometry, and a full examination by an ophthalmlogist on days 1 or 4. Screenees testing postively on days 2 or 3 were given the option of returning to be seen by the ophthalmologist at the same site on day 4 or go to a different site the following month on days 1 or 4.
Among 4550 individuals screened over the past 23 months at the glaucoma screenings, 407 failed the FDT and of those that failed, 235 were clinically confirmed as having glaucoma or other sight–threatening eye disorders on comprehensive examination by an ophthalmologist. Among these 235, 90 were immediately examined by the on–site MD on days 1 or 4 of each 4–day screening period. The remainder (145) returned to see the ophthalmologist on day 4 at the same site, or, if they preferred, at the subsequent month's site. Fifty–eight of the 407 FDT failures made appointments to come back on Day 4, but failed to return and 172 FDT failures chose not to stay for further evaluation. It is not known if they would have tested positive for glaucoma or other disorders because they were not evaluated by the doctor. During Month 9 when no ophthalmologist was available to perform Day 4 evaluations, the no–show rate for ophthalmologic assessments at a different site one month later was 5 times worse than the mean no–show rate for the other 23 months.
Follow–up compliance among those at high risk for sight–threatening ocular disease is a critical problem that must be addressed, particularly with screening methods now attaining very high levels of diagnostic sensitivity and specificity. The proportion of those screening positively for glaucoma who actually make it back to see the ophthalmolgoist has been low in meticulous screening settings, despite well–directed efforts (the return rate data frrom Baltimore, Los Angeles, and Philadelophia studies were similar). Time and distance beween the screening and clinical follow–up site appear to be factors.
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