Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Vision and refractive error results

ABSTRACT

Clinical relevance

Optometrists can play a key role in providing access to eye care in underserved populations by organising community-based eye health screenings that include optometric exams to detect vision impairment and uncorrected refractive error.

Background

Community-based eye health screenings and optometric exams were conducted in the NYC-SIGHT Study.

Methods

A sub-analysis of vision impairment and refractive error results within a 5-year prospective, cluster-randomised clinical trial. Eligible individuals (age ≥40 years) were recruited from 10 affordable housing developments in Upper Manhattan. Developments were randomised into usual care (received glasses prescription only) and intervention (free glasses) groups. Participants with 6/12 visual acuity or worse, intraocular pressure 23–29 mmHg, or an unreadable fundus image were scheduled with the study optometrist for refraction and a non-dilated exam. Visual improvement data were obtained by comparing the presenting acuity at screening compared to the best corrected acuity after refraction by the optometrist. Chi-square, two-sample t-tests, and a stepwise multivariate logistic regression model were used to determined factors associated with improvable visual impairment.

Results

Seven hundred and eight participants completed screening, 308 received an optometric exam. Those with improvable vision impairment (n = 251), mean age: 69.8 years, 70.5% female, 53% African American, 39.8% Hispanic, >95% had health insurance. Refractive error diagnosed in 87.8% of the participants; lines of improvement: 2 lines (n = 59), 3 to 5 lines (n = 120), and ≥6 lines (n = 72). Stepwise multivariate logistic regression analysis showed that participants with visual acuity 6/12 or worse (odds ratio 16.041, 95% confidence interval 6.009 to 42.822, p = 0.000) or a normal fundus image (odds ratio 2.783, 95% confidence interval 1.001 to 7.740, p = 0.05) had significantly higher odds of improvable vision impairment.

Conclusion

This innovative, targeted community-based study included an optometrist who detected high rates of refractive error and improvable vision impairment in an underserved population living in New York City.

KEYWORDS:

• Community-based optometrist examination
• eye health screening
• refractive error
• underserved population
• vision impairment

Acknowledgements

The authors thank the CDC for funding the Manhattan Vision Screening and Follow-up Study and project officer, Jinan Saaddine, MD, MPH for her guidance and support for the SIGHTSTUDIES. We thank Columbia University advisors from the Wellness Center (Ojadije Williams, MD), Department of Government and Community Affairs (Ross A. Frommer, Esq.), School of Nursing (Steven Ferrara, DNP, FNP-BC), Mailman School of Public Health (Linda P. Fried, MD, MPH), Internal Medicine (Rafael A. Lantigua, MD), and Occupational Therapy (Phyllis Simon, OTD, OTR/L); New York City community partners: New York City Housing Authority (Marina Oteiza); NYC Department for the Ageing (Lorraine Cortés-Vázquez and Edgar Yu) and DFTA Senior Center Directors; NYC Department of Health and Mental Hygiene Falls Prevention Coalition; New York Academy of Medicine; Lighthouse Guild; Vision Services for the Blind and Visually Impaired; and Volk Optical, Inc. We thank Warby Parker for providing complementary eyeglasses. We thank the Data and Safety Monitoring Board: David S. Friedman, MD, PhD, MPH (Massachusetts Eye and Ear Infirmary), Cynthia Owsley, PhD, MPH (University of Alabama at Birmingham), Jonathan S. Myers, MD (Wills Eye Hospital), Benjamin E. Leiby, PhD (Jefferson Medical College), David Weiss, PhD (Psychology Specialists of Maine), and Tarun Sharma, MD (Columbia University Ophthalmology) for advising us on the study design, clinical decision making, and evaluation of outcomes. We also thank community health educators (Jacqueline Wright and Rachel Wint) for participating in all screenings and Yujia Wang, MPH for supporting the manuscript submission.

Disclosure statement

The author(s) have made the following disclosure(s): JDH: Member Medical Policy Council of Superior Vision. JML.: Research support- NIH/NEI, Heidelberg Engineering, Novartis, Inc.; Consultant- Allergan, Inc., Genentech, Inc., Thea Pharmaceuticals, Inc., Janssen Pharma, Inc.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. All deidentified participant data, study protocol, statistical plan, and informed consent will be made available by the corresponding author upon email request. The data will be made available with investigator support after approval of a proposal and a signed data access agreement is fully executed. Study materials are available at SIGHTSTUDIES.org.

Disclaimer

The findings and conclusions in this report are those of the authors, and do not necessarily represent the official position of the United States Centers for Disease Control and Prevention.

Additional information

Funding

This work was supported by the United States Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion [Grant numbers U01DP006435 and U01DP006436] and Research to Prevent Blindness, Inc., New York, NY.