Manhattan Vision Screening and Follow-up Study: Ocular Pathology in Telemedicine Images

Abstract

Purpose : To determine the distribution of ocular pathology found in abnormal retina and optic nerve photos from an inner city vision screening program.

Methods : The goal of this study was to conduct vision screenings using in person and telemedicine modalities to improve vision care for residents of 10 New York City Housing Authority buildings in Upper Manhattan. Screening involved obtaining visual acuity, intraocular pressure, offering refraction services, and obtaining fundus and disc photos using a non-mydriatic hand-held fundus camera. Images were read by two ophthalmologists in the specialties of glaucoma and retina. Participants with abnormal image findings as well as those who had failed their screening and saw the on-site optometrist were referred to an ophthalmologist.

Results : A total of 382 participants were screened to date during the first phase of the study from March 2021- December 2021, with 6 months of screening remaining. Of these 382 participants, 110 were found to have failed screening (VA 20/40 or worse, IOP > 23-29 mmHg) and had an abnormal image (as determined by an ophthalmologist).

Participant ages ranged from 42 to 93 years, with mean 69 and median 70. 35 (32%) identified as male, and 75 (68%) as female. 57 (52%) participants identified as Black/African American, 46 (42%) as Latino/Hispanic, and 7 (6%) as American Indian, Asian, White, or Multiracial. 60 participants (55%) were referred as glaucoma suspects, and 73 (67%) were referred for retina findings. Several had overlapping findings. 26 participants (24.3 %) demonstrated non-proliferative diabetic retinopathy (dot blot hemorrhages, macroaneurysms, cotton wool spots), with 7 of these referred for treatment of edema. 1 (.9%) was found to have retinal neovascularization requiring treatment. 3 (2.7%) demonstrated findings consistent with retinal venous occlusion, with 2 of 3 requiring treatment for edema. 3 (2.7%) were found to have hypertensive retinopathy. 15 (13.6%) had findings of age-related macular degeneration. Regarding optic disc photos, 53 (48.2%) were found to have abnormal cup-to- disc ratio, and 13 (11.8%) were found to have peripapillary atrophy.

Conclusions : This study demonstrates that community-based vision screening using non-mydriatic fundus and disc photography detected significant pathology including diabetic retinopathy, age-related macular degeneration, and glaucoma, among the most common causes for blindness.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.