Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results

ABSTRACT

Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care.

Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers.

Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses.

Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes.

KEYWORDS:

• Glaucoma detection
• community-based
• access to eye care
• vulnerable populations
• vision screening

Acknowledgments

The authors would like to thank the U.S. Centers for Disease Control and Prevention for funding the development of the Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations and reviewing the manuscript. We thank the New York City Department for the Aging (Edgar Yu) and New York City Housing Authority (NYCHA) (Marina Oteiza) for facilitating the partnership and use of the Riverstone Senior Center for recruitment. We thank our Advisory Board members for providing valuable input on the study design, vision screening procedures, and manuscript preparation and submission. We thank Warby Parker® for providing complimentary eyeglasses and Volk Optical, Inc. for providing the Pictor Plus hand-held camera. We thank our Data Safety Monitoring Board members: David S. Friedman, MD, PhD, MPH, Cynthia Owsley, PhD, MPH, Jonathan S. Myers, MD, Tarun Sharma, MD, and David Weiss, PhD.

Helsinki declaration of interest statement

The study was approved by the Columbia University Institutional Review Board and was conducted in accordance with the Declaration of Helsinki (CUIMC IRB #AAAR9162). Written informed consent was obtained from all participants. The study is registered with ClinicalTrials.gov (NCT04271709).

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion Cooperative Agreements: U01DP006435 and U01DP006436. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.