Manhattan Vision Screening and Follow-up Study (NYC-SIGHT) Cluster-Randomized Clinical Trial: Subanalysis of Glaucoma Suspect Findings

Abstract

Purpose : To describe the glaucoma suspect findings from the Manhattan Vision Screening and Follow-up Study, which aims to investigate whether innovative community-based eye health screening using telemedicine can improve early detection and management of glaucoma and other eye diseases among high-risk populations in New York City.

Methods : A 5-year prospective, cluster-randomized clinical trial. Eligible individuals (≥40 years) were recruited from affordable housing buildings and senior centers (≥60 years) in New York City. Participants underwent eye health screening (visual acuity (Snellen), intraocular pressure measurements (IOP), and fundus photography) in community settings. Fundus images were remotely graded by both glaucoma and retina specialists and those with abnormal images were referred to ophthalmology; those who failed the vision screening (visual acuity 20/40 or worse, IOP 23-29 mmHg, or had an unreadable image) were examined by the study optometrist in the community setting. Multivariate logistic regression analysis determined factors associated with odds of referral to ophthalmology for glaucoma suspect from both the telemedicine image reading results and the optometrist eye exam findings.

Results : A total of 708 participants completed the eye health screening from 3/1/21 to 5/31/22; 189 were referred to ophthalmology for suspected glaucoma (26.7%) (138 participants had an abnormal disc image and 51 participants were referred by the optometrist). Mean age of glaucoma suspects: 68.5 years (SD ±11.7), female (60.3.1%), African American (57.1%), and Hispanic (37%). Mean IOP in the worst eye was significantly higher in those referred for suspected glaucoma compared to those not referred (16.1 mmHg vs. 14.4 mmHg) (p<0.05). Multivariate logistic regression analysis showed that participants who had self-identified with pre-existing glaucoma [OR=6.048, 95% CI=(3.560-10.274), p=0.000], had an IOP ≥23 mmHg at the eye health screening [OR=3.210, 95% CI=(1.407-7.323), p=0.006] or needed assistance with transportation [OR=2.081, 95% CI=(1.136-3.815), p=0.018] had higher odds of suspected glaucoma requiring follow-up.

Conclusions : This community-based study targeted high-risk populations, improved access to eye-care, and detected a significant amount of glaucoma suspects requiring referral to ophthalmology.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.