Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Visit 1 Results

Abstract

Purpose : To describe methods and preliminary Visit 1 results from an innovative, practice-based screening study for glaucoma that incorporates telemedicine imaging to improve access and utilization of eye care to detect, treat, and manage high-risk individuals with previously undiagnosed eye pathology.

Methods : Up to 1,250 individuals at high-risk for glaucoma are being recruited at 7 primary care offices and 4 Federally Qualified Health Centers for this prospective, randomized clinical trial. Visit 1 consists of telemedicine eye screening of the retina and optic nerve, 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 are invited to return to the same location for a comprehensive eye exam by a glaucoma specialist in the same setting within several months (Visit 2). Recruitment is targeting 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. Participants who attend Visit 2 and agree to enroll are randomized to either the Intervention or the Usual Care group for follow-up eye exams with a community ophthalmologist (Visit 3). The Intervention consists of using patient navigators and a social worker to reduce barriers to eye care utilization over a 3-year period (Visits 4-8).

Results : From 4/1/15 to 11/4/16, 779 individuals consented and attended Visit 1. Participants were predominately female (61.4%) and African American (70.7%), with a mean age of 59 +10.6 years (range 39-100). A total of 446 (57.3%) participants had diabetes, 538 (68.9%) had hypertension, and 188 (24.1%) had a family history of glaucoma. During Visit 1, 306 (47.3%) participants were considered normal. Using image data from the worse eye, 44.5% (n=288) were abnormal and 19.9% (n=132) images were unreadable. Of the 288 participants with abnormal images, 211 (32.6%) were diagnosed as glaucoma suspect; 61 (9.4%) with diabetic retinopathy; 55 (8.5%) with other retinal abnormalities, and 53 (8.2%) with ocular hypertension.

Conclusions : Conducting eye screenings in primary care physician offices and Federally Qualified Health Centers likely holds promise to improve eye care and prevent vision loss in high-risk populations.

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