Screening for glaucoma in populations at high risk: The eye screening New York project

It was submitted to two journals: Ophthalmology: The Journal requested the follow up data which we intend to publish in a subsequent manuscript JAMA Ophthalmology: The Journal’s response was the manuscript simply did not meet their current priorities for publication

Abstract

Purpose: To explore the yield and feasibility of glaucoma screening and the prevalence of glaucoma in high risk populations in New York City. Methods: A Community based glaucoma screening study was conducted in a high-risk population in NYC from 2007–2014 using fixed sites and mobile van. Participant underwent visual acuity testing, Tonopen intraocular pressure (IOP), frequency doubling technology (FDT), and optic nerve cup/disk ratio (C/D) by an ophthalmologist or optometrist. Glaucoma suspects (GS) were defined by IOP ≥ 21 mm Hg, abnormal FDT, and cup/disc ≥ 0.5. Results: 8,547 where screened between 2007–2014. 54% were Hispanics and 16% were African Americans. Of the 8,547 screened 2,118 (24.94%) where referred for glaucoma evaluation, 1,243(14.63%) where referred for an ophthalmic evaluation and 5,133(60.43%) where recommended for routine eye exam. 31.96% of our screened population were uninsured and 56.85% never saw an eye doctor in their life. Having IOP ≥ 21 had 36.27fold increase in RRR of being a GS [95% 29.45–44.44, p < 0.001]. Having C/D ratio of ≥ 0.5 had 23.6fold increase in RRR of being a GS [95% 20.65–27, p < 0.001]. Having an abnormal FDT had 2fold increase in RRR of being a GS [95% 1.79–2.19, p < 0.001]. Follow up was available in 610 subjects. Glaucoma was confirmed in 52% of the individuals who followed up. Conclusions: Our data suggests the prevalence of positive screening is substantial in high risk populations. It establishes the feasibility of mobile screening as a method of facilitating access to care. Furthermore, it highlights the importance of an active blindness prevention program in the context of population management.

Keywords:

• glaucoma
• glaucoma screening
• access to care
• prevalence of disease
• population health management

Public Interest Statement

To study glaucoma screening in high risk populations, a study was conducted 2007–2014 in New York City, using multiple eye tests. 8,547 where screened. 54% were Hispanics and 16% were African Americans. Of the 8,547 screened 2,118 (24.94%) had suspicions of glaucoma diagnosis. Of those who were followed up, glaucoma was confirmed in 52%. Our study suggests that glaucoma screening in high risk populations is feasible and has high positive yield. Furthermore, it highlights the importance of an active blindness prevention program in the context of population management.

Competing Interests

The authors declare no competing interest.

Acknowledgements

The authors thank George Cioffi, MD and Stanley Chang, MD for their outstanding academic guidance and support of this project, Ridwan Shabsigh, MD for his valuable input and advice in this project, specifically as it relates to population health management, Vipul Patel and Maribel Rodriguez for their t help with the data management, the residents, the fellows of the Harkness Eye Institute and Vipul Patel for their help with conducting the screening, Joseph H Lee DrPH for his valuable input and advice on the genetics of aging and age-related disease and Faith Reidenbach, BA of Caley-Reidenbach Consulting, LLP provided medical writing assistance that was funded by the Friends of the Congressional Glaucoma Caucus Foundation.

Notes

It was submitted to two journals: Ophthalmology: The Journal requested the follow up data which we intend to publish in a subsequent manuscript JAMA Ophthalmology: The Journal’s response was the manuscript simply did not meet their current priorities for publication

Additional information

Notes on contributors

Lama A. Al-Aswad

Lama A. Al-Aswad is a glaucoma subspecialty a strong interest in disease prevention and population health management. She is an Associate Professor of Ophthalmology at Columbia fellowship director, Chair of quality assurance of the Eye Institute and the Director of the Tele-ophthalmology initiative. She received her medical degree from Damascus University Medical School and a Glaucoma research fellowship from Mass Eye and Ear infirmary Harvard Medical School. She completed her Residency in ophthalmology at SUNY Downstate and her Glaucoma fellowship at UT Memphis. Dr. Al-Aswad is the past president of the NY Glaucoma Society and the president elect for WIO. In 2015, she received her MPH in healthcare policy and management from Columbia University, Mailman School of Public Health.

Al-Aswad is a believer in blindness prevention as evident from her large-scale screening project in NYC where she screened 8,547 individuals for glaucoma. She recently launched the tele-ophthalmology screening project for the 4 leading causes of blindness utilizing cutting edge technology.