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David S Friedman, Di Zhao, Lucy I Mudie, Bonnielin K Swenor, Eliseo Guallar; Optimizing approaches to identify glaucoma among at-risk population: the SToP Glaucoma study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1558.
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© 2017 Association for Research in Vision and Ophthalmology.
To develop, implement and evaluate replicable community-based interventions designed to improve eye disease detection and follow-up care in high-risk populations.
This is an ongoing study of a screening program using trained personnel to identify individuals with vision needs in inner-city communities, focusing on African Americans and Hispanics at multiple community sites in Baltimore, MD. The screening examination includes presenting visual acuity (VA), best-corrected VA (for those with VA worse than 20/40) using autorefraction, digital fundus imaging, visual field, and intraocular pressure using a sequential referral approach (Figure 1). Field personnel determine referral status, and a glaucoma specialist reviews all fundus images to confirm appropriate referral. Participants are classified into 3 categories: no referral, referral for possible eye disease, or referral for refraction only. Those referred were seen at no cost for a definitive exam at the Wilmer Eye Institute.
901 individuals were screened and were mostly African Americans (94.9%) with a mean (SD) age of 64.3 (9.9) and BMI of 30.6 (7.7) (Table 1). 356 (39.5%) and 107 (11.9%) participants were referred for a definitive eye exam and refraction, respectively. 47 (7.2%) individuals had cup:disc ratio ≥ 0.7, 38 (5.8%) had macula abnormalities, 56 (6.4%) had an IOP ≥ 23 mmHg and 172 (19.1%) needed glasses. The most common reason for referral was refraction without other ocular issues (23.1%), followed by ungradable fundus image (22.3%), BCVA < 20/40 (11.2%) and ungradable autorefraction (9.1%) (Figure 2). Referred participants were older and less well educated (p < 0.05).
A large proportion of individuals 50 years of age and older screened for eye problems require ophthalmic services, particularly those who are older and less well educated. Programs will have to focus on encouraging these individuals to attend screening exams as they are more likely to have treatable conditions.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Flow of screening in the SToP Glaucoma Study
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