Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Comparison of Ocular Outcomes at Two Health Centers

Abstract

Purpose : To describe preliminary data from a practice-based telemedicine screening program for glaucoma in two health centers.

Methods : The Philadelphia Department of Public Health (PDPH) Health Center 5 (HC5) and the Mary Howard Health Center (MHHC) for the homeless and underserved were the recruitment sites for this study because they provide on-site eye care by an optometrist (MHHC) and an ophthalmologist (HC5). Visit 1 consisted of a telemedicine eye screening of the fundus, testing visual acuity, measuring intraocular pressure, and assessing family history of glaucoma. Glaucoma and retina specialists remotely read images and clinical data, and participants with abnormal findings or unreadable images were invited to return to the same location for an eye exam by a glaucoma specialist (Visit 2). African Americans, Hispanics, and Asians over 40; adults over 65 of any ethnicity; adults over 40 with a family history of glaucoma; or adults over 40 with diabetes were recruited.

Results : From 4/1/15 to 9/30/16, 161 individuals consented and attended Visit 1 (HC5 n=118; MHHC n=43). Participants were predominantly African American (87%), male (56.5%), with a mean age=58.2 +8.1 years (range 41 to 85). A total of 61 (37.9%) participants had diabetes, 103 (64%) had hypertension, and 28 (17.4%) had a family history of glaucoma, and 53 (32.9%) were smokers. During Visit 1, 63 (39.1%) participants were considered normal. Using image data from the worse eye, 34.8% (n=56) were abnormal and 19.3% (n=31) had unreadable images. Of these, 54 (33.5%) were diagnosed as glaucoma suspect; 5 (3.1%) with diabetic retinopathy; 13 (8.1%) with other retinal abnormalities, and 27 (16.8%) with OHTN. Of the 63 participants who returned for Visit 2 (HC5 n=43; MHHC n=20), 6 (9.5%) were diagnosed with glaucoma, 26 (41.3%) as glaucoma suspect, 8 (12.7%) with diabetic retinopathy, 2 (3.2%) with other retinal disease, 4 (6.3%) with cataract, 6 (9.5%) with OHTN, and 36 (54%) with other pathology. All participants were referred to the on-site eye care provider for follow-up care.

Conclusions : This project demonstrates how using telemedicine screening in primary care offices and health centers that provide care to underserved and homeless populations, can improve access, detection, and management of glaucoma and other eye diseases in a high risk population, reducing future health care costs.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.