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Outreach program yields high rate of glaucoma detection
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The Philadelphia Glaucoma Detection and Treatment Project improved many people’s lives in high-risk areas where there are barriers to care, according to a retrospective study.
The Wills Eye Glaucoma Research Center developed a community outreach initiative to screen the disadvantaged populations of Philadelphia for sight-affecting diseases, specifically glaucoma. The project included five Wills Eye team members who performed free glaucoma examinations 1 week after a Wills Eye community health educator held a glaucoma awareness workshop for at-risk individuals at each community screening site.
“Overall, older people are at risk of developing glaucoma, so it is best to target any intervention where those individuals are living, congregating, working and volunteering,” study co-author Lisa Hark, PhD, told Ocular Surgery News.
The program yielded a high detection rate of glaucoma-related diagnoses in older adults who participated in the project, which spanned 2 years. The project was funded by the Centers for Disease Control and Prevention Vision Health Initiative.
Participants and outreach
A total of 1,649 participants at high risk for glaucoma were screened and treated for sight-affecting diagnoses in 43 community centers in low-income neighborhoods in Philadelphia. Participants deemed to be at high risk were African Americans, Asians and Hispanics/Latinos; anyone with a family history of glaucoma older than 50 years; and any other adults older than 60 years.
The Wills Eye team consisted of five members: an ophthalmologist, an ophthalmic technician, a community health educator, a project manager and a mobile unit coordinator. A typical outreach day began at Wills Eye Hospital, where the team loaded the equipment van and then deployed to the designated site, somewhere within an hour’s drive of the hospital.
“When we arrived, we set up the equipment and began examining patients by 8:30 a.m. There were several stations, including registration, ocular and medical history, visual acuity and visual field testing, fundus photography, pachymetry, slit lamp examination and checkout, where the patients were given their ocular diagnosis and recommended follow-up appointment,” Hark said.
In a 6-hour period, roughly 15 to 20 eye examinations were completed. During the study period, glaucoma was diagnosed in 164 participants (10%), 64 of whom were unaware of their diagnosis. Another 330 participants (20%) were thought to be glaucoma suspects, and 151 (9%) were thought to have narrow angles.
“The most significant outcome of this study was the amount of eye disease that we detected in this high-risk population across 43 community sites,” Hark said.
Participants were offered glaucoma-related treatment during the outreach visit.
“Providing laser treatments, including laser peripheral iridotomy and selective laser trabeculoplasty, was very rewarding since immediate treatment was provided onsite,” Hark said.
Eighty-four participants underwent iridotomy, 13 participants underwent SLT, and 103 participants were prescribed medication to lower IOP. Two follow-up visits were offered at all 43 sites, and participants were invited to follow up at Wills Eye Glaucoma Service 1 year postoperatively, Hark said.
Making a difference
Participants were asked to complete a satisfaction survey upon receiving the initial eye examination. Of the respondents, 99.3% were satisfied or very satisfied with their eye examination and 99.1% said they would recommend the glaucoma detection examination to someone they know.
“The success of this program is that we not only conducted complete eye examinations in the community, we were able to build in two additional follow-up examinations in these same community locations over a 6-month period,” Hark said. “This is the first program of its kind that involved follow-up visits as well as onsite laser treatment.”
The program requires significant funding for the equipment, personnel and transportation necessary to perform community-based eye examinations and follow-up. However, the program is cost-effective because it detected new cases of glaucoma, including narrow angle and open angle, and glaucoma suspect in a high-risk population in which barriers to eye disease detection, treatment and follow-up are involved, she said. – by Kate Sherrer
- Reference:
- Waisbourd M, et al. Am J Ophthalmol. 2016;doi:10.1016/j.ophtha.2016.04.031.
- For more information:
- Lisa Hark, PhD, can be reached at 840 Walnut St., Suite 802, Philadelphia, PA 19107; email: lhark@willseye.org.
Disclosure: Hark reports no relevant financial disclosures.
Perspective
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Jonathan S. Myers, MD
The Philadelphia Glaucoma Detection and Treatment project was an outreach effort to screen and treat people in community centers in underserved areas in Philadelphia. The rate of detection of glaucoma-related conditions in this at-risk population (elderly, largely African American, socioeconomically disadvantaged) was extremely high: 39% of 1,649 participants were found to be glaucoma suspects (20%), have narrow angles (9%) or have glaucoma (10%).
Past screening efforts have been plagued by poor follow-up. In this study, all testing and treatment were completed in the 43 community centers. This led to enhanced follow-up and treatment rates. Trabeculoplasty was chosen by 20% of patients with newly diagnosed open-angle glaucoma and was performed in the community center, as was laser iridotomy when chosen. Most of these procedures were done bilaterally on the day of diagnosis, helping to ensure that the study had some effect on disease treatment. This innovative study showed that there is a significant need for ocular disease detection and treatment programs in this community and that locally based efforts can have an impact.
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