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Lisa A Hark, Yocheved Shira Kresch, C Gustavo De Moraes, Jason David Horowitz, Lisa Park, James Auran, Jeffrey M Liebmann, George A Cioffi; Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Pilot Results. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3490.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers and patient navigators.
Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening (i.e., visual acuity worse than 20/40 in either eye with correction, 2) IOP 23-29 mmHg, or 3) unreadable fundus images, were scheduled with an on-site optometrist for a non-dilated eye exam, either the same day or within two weeks of initial screening; those with ocular pathologies were referred to an ophthalmologist. All images were read and graded by two study ophthalmologists. Participants were also administered the National Eye Institute Visual Function Questionnaire-9 (NEI-VFQ-9) by community health workers.
Results: Participants (n=42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n=33) failed vision screening. Of those who failed, 84.8% (n=28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses. Of the 35 participants who had fundus images taken, 40% (n=14) had a normal image with no significant findings, 37.1% (n=13) had an abnormal image with significant ocular findings, and 22.9% (n=8) had unreadable images. There was 100% agreement between the glaucoma and retinal specialists regarding referral for follow-up eye exam based on the fundus images.
Conclusion: Community-based vision screening using community health workers and optometrist-based eye exams in vulnerable populations may minimize barriers to eye care, improve early detection of eye disease, and patient navigators can link subjects to additional eye care appointments.
This is a 2021 ARVO Annual Meeting abstract.
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