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S. H. Hahn, G. Lindhorst, S. Ferlitto, Y. Trigo, H. Koenig, W. E. Sponsel; Project Vision SOS (Saving Our Sight): Post-Screening Follow-Up Analysis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2408.
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To identify common factors that might inhibit adults, who have screened positively and have been confirmed by a clinician as a glaucoma suspect, from seeking clinical follow-up care.
Adults participating in standardized public glaucoma screenings at 8 centers in San Antonio, Texas, underwent frequency doubling technology C-20 (FDT) vision screening. Those missing 2 or more FDT stimuli in either eye underwent Heidelberg Retinal Tomograph (HRT) scanning laser optic disc/NFL tomography, standard perimetry using Humphrey SITA 30-2 visual field (HVF) analysis, and non-contact tonometry. Slit lamp exam and ophthalmoscopy were then performed by an ophthalmologist who made referral arrangements with providers within the same zip code area for follow-up.
Among 1864 participants, 260 (13.94%) screened positively (57% were female; 38% were between ages 40-59 and 36% were over 65; 152 (60%) were Mexican-American; 64% had some form of medical insurance). Glaucoma or suspect glaucoma was confirmed by the ophthalmologist in 172 (9%), who were then referred to a local provider for follow-up care. Among these 172, 106 (61%) did seek care with local ophthalmologists, who confirmed glaucoma in 75.4% of attendees, and commenced therapy in 63%.
Almost 1 in 10 screened participants were referred. Among the fewer than 2/3 who actually attended their follow-up appointment, more than three-quarters were confirmed as being glaucomatous. Lack of medical insurance and fear of cost were the main reasons given for follow-up attrition. Improvements in screening methodology now highlight our greatest ongoing challenge; to ensure that those found to be at risk obtain follow-up care.
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