Visual Impairment from Uncorrected and Undercorrected Refractive Error in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) Program

Abstract

Purpose : Uncorrected/Undercorrected refractive error (URE) is the leading cause of visual impairment (VI) and the second leading cause of blindness worldwide. There are only a few programs targeting optical dispensing for adults. We investigated the prevalence and risk factors for VI from URE among adults presenting to the MI-SIGHT program in two clinics serving low-income communities.

Methods : Information from the first-year cohort of participants enrolled in the MI-SIGHT program was analyzed.¹ Trained technicians obtained presenting visual acuity (VA) and best corrected visual acuity (BCVA), which were then reviewed by University of Michigan ophthalmologists. Visual acuities were compared to create 4 refractive error groups: (1) VI from pathology (VA & BCVA ≤20/50), (2) VI from URE (VA ≤20/50 & BCVA ≥20/40), (3) URE without VI (VA ≥20/40 & 2+ lines of improvement of BCVA), and (4) no or minor refractive error (VA ≥20/40 & <2 lines of improvement of BCVA). Technicians also facilitated the internet purchase and fitting of low-cost glasses, and assessed participant satisfaction with the program. Participants’ characteristics and satisfaction were summarized by refractive error group and compared using analysis of variance, Kruskal-Wallis, Chi-square, and Fisher exact testing. Holm adjustment was used for multiple comparisons.

Results : 1166 of 1171 participants (99.6%) had both VA and BCVA measured. 24 participants had VI due to pathology (2.1%), 96 had VI due to URE (8.2%), 168 had URE without VI (14.4%), and the remaining had no or minor change in refractive error. Lower education and household income were significantly associated with VI due to URE (p<0.0001), but not age, race, sex, ethnicity, employment, and health insurance (all p>0.05). A larger percentage of participants who reported their last eye exam was ≥1 year ago had VI due to URE (85.2%, p=0.0039) and URE without VI (78.3%), compared to those with no or minor refractive error (67.1%, p=0.0100). 97.7% of program participants were satisfied with their glasses, 1.3% were dissatisfied, and 1.0% required a glasses revision.

Conclusions : URE is an important cause of preventable vision loss. Novel programs are needed to treat URE especially among populations with high level of poverty. 1.Newman-Casey et al. J Glau 2021

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