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

Abstract

Purpose : To describe abnormal retinal 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 retinal 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 in community settings (visual acuity (Snellen), intraocular pressure measurements (IOP), and fundus photography). Fundus images were remotely graded by both retina and glaucoma specialists, and those with an abnormal image were referred to ophthalmology for further evaluation. 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 abnormal retinal findings.

Results : A total of 708 participants completed the eye health screening from 3/1/21 to 5/31/22; 157 had an abnormal retinal image and were referred to ophthalmology. These participants were predominantly older adults, (mean age 68.4±11.1 years), female (63.7%), African American (50.3%), and Hispanic (43.3%). Most individuals with a retinal abnormality (n=125, 79.6%) failed the eye health screening. Participants who self-identified as having pre-existing glaucoma [OR=3.750, 95% CI=(1.741, 8.074), p=0.0001] or had severe vision impairment defined as visual acuity 20/200 or worse [OR=1.185, 95% CI=(0.678, 2.066), p=0.000] had significantly higher odds of an abnormal retinal image.

Conclusions : This community-based study targeted populations at high-risk for eye disease, improved access to eye care, and utilized telemedicine, which detected a significant amount of retinal abnormalities requiring referral to ophthalmology. This has been made possible by advances in imaging technology and interpretation of acquired fundus photographs. The results provide insight into the burden of retinal diseases in this underserved population.

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