Public health approaches that focus community-based eye health screenings on high-risk populations and prioritize underserved communities can help decrease glaucoma burden and reduce eye health disparities. Photo: Getty Images.

In 2019, the Centers for Disease Control and Prevention (CDC) Vision Health Initiative funded three five-year research grants to develop innovative screening strategies for high-risk populations to help address how to best identify high-risk individuals and provide eye health screenings to detect glaucoma. One of them is the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT), which is what the authors of a recent study evaluated—specifically the glaucoma screening rate and risk factors associate with referral for in-office glaucoma evaluation. They found that those with pre-existing glaucoma, an IOP >23mm Hg or wearing prescription eyeglasses had higher odds of being referred. The team’s paper on the work was recently published in Journal of Glaucoma.

In this five-year, cluster-randomized clinical trial, a total of 708 participants aged 40 and older were recruited from affordable housing developments and senior centers in upper Manhattan. 138 were referred due to abnormal glaucoma findings on fundus photography and 51 were referred for an abnormal optometric exam.

The authors efficiently identified glaucoma suspects while reducing cost. They found 74 participants were identified as glaucoma suspects and referred for in-office eye care, which represents a significantly higher detection rate compared to that reported for the general population or in other high-risk populations. Participants with pre-existing glaucoma, an IOP >23mm Hg at the screening or wearing prescription eyeglasses had higher odds of being referred for glaucoma evaluation. This is consistent with prior studies and suggests that in community-based settings, assessing medical and ocular history, combined with checking visual acuity, IOP and taking a fundus photo resulted in early detection of glaucoma pathology warranting referral for an in-office eye exam.

The combined glaucoma and glaucoma suspect findings of 26% are higher than these national averages from the CDC’s 2019 annual prevalence estimates from Medicare data—8% for glaucoma and 5.27% for glaucoma suspect (combined 13.27%). Medicaid data rates were 3.9% for glaucoma and 2.13% for glaucoma suspect (combined 6.03%).

“While Medicare and Medicaid rates for glaucoma and glaucoma suspect by race and ethnicity are higher for Black adults (18.97% Medicare/8.76% Medicaid) and Hispanic/Latino adults (13.64% Medicare/6.42% Medicaid) compared to non-Hispanic White adults, our study findings remain higher than all of these data from 2019,” the authors wrote. “This difference is likely due to NYC-SIGHT studies being conducted in high-risk, underserved populations with lack of access to eye care and poor utilization rates. The recruitment approaches and community-based eye health screening settings in the NYC-SIGHT recruited adults and senior residents in neighborhoods where large populations of Black and Hispanic adults are living at or below the NYC poverty level.”

Of the 189 participants with abnormal glaucoma findings, 98% had Medicare or Medicaid, which reduced the insurance barrier for attending in-office eye exam appointments. However, 68.3% did not have an eye doctor despite having insurance. All were assisted in making an initial eye exam appointment.

“Previously reported community-based studies from the CDC have shown that this additional assistance helped improve utilization of eye care,” the authors wrote. “The majority of participants also indicated they did not need transportation assistance, most likely because we implemented the community-based eye health screenings in dense urban settings where public transportation is accessible. Participants who wore prescription glasses were also more likely to be referred, indicating that refractive error is an important consideration when screening high-risk populations for glaucoma, as myopia and hyperopia are known risk factors for glaucoma.”

The authors noted that 56.1% of the 189 participants referred for glaucoma evaluation attended the in-office visit after screening. They added that ongoing research about glaucoma screening methods provide evidence that hand-held imaging devices, remote image interpretation and AI can be integrated into routine eye care and public health settings.

“We can impact population health by detecting glaucoma in earlier stages, particularly in high-risk groups, and initiating earlier treatment to decrease disease burden and reduce eye health disparities,” the authors concluded.