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Free, community-based glaucoma detection, treatment has high compliance
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A program for detection and follow-up of glaucoma aimed at individuals living in underserved urban communities, including senior housing residences, showed success in improving adherence to monitoring appointments and therapy.
In 2012, the Willis Eye Hospital Glaucoma Research Center launched the Philadelphia Glaucoma Detection and Treatment Project, offering free glaucoma detection exams, regular monitoring, medications, laser therapy and surgery when needed. Retrospective analysis of 531 participants – 91 of whom had glaucoma, 154 who had anatomic narrow angle and 286 who were glaucoma suspects – investigated adherence to follow-up exam appointments.
The highest rate of adherence (73.6%) was reported among participants with a diagnosis of glaucoma. Men were more likely to adhere than women, as were patients who were prescribed glaucoma medications or other therapies, who were older and had higher IOP.
The rate of adherence among patients with a diagnosis of anatomic narrow angle was 64.9%. Glaucoma suspects who did not receive on-site treatment or were not prescribed medications were less likely to attend further appointments, in spite of receiving counseling and educational materials. Their adherence rate, although lower, was still 55.2%. The overall adherence rate was more than 60%.
“Bringing the glaucoma specialist and all ophthalmic equipment directly to the patient minimized many of the barriers, including transportation, copay costs, insurance and lack of time,” the authors noted. “This community-based approach improved follow-up adherence rates for eye exams compared to previous studies.”
This study demonstrates that underserved communities would benefit from on-site, free programs of glaucoma detection, follow-up monitoring and treatment, they concluded. – by Michela Cimberle
Disclosure: The authors reported no conflict of interest.
Perspective
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Carl H. Jacobsen, OD, FAAO
African American patients are about eight times more likely to experience glaucoma-related blindness than white Americans. Although this is thought to be largely due to genetic predisposition, other factors such as lack of affordable health care and lower socioeconomic status may also play a role.
All told, it is estimated that up to 75% of African American patients with glaucoma are undiagnosed. As recent events indicate, it’s not easy being black in America, and this fact unfortunately extends to glaucoma care.
In order to address this complex problem, Hark and colleagues investigate the effect of a community-based glaucoma detection and treatment program on appointment adherence. Their findings are encouraging. They were able to achieve a 61% appointment adherence rate, where previous studies in more traditional settings suggest appointment adherence rates of 25%.
As optometrists, we are in a position to improve access to glaucoma care. Optometric offices are numerous, widely distributed and offer relative ease of access to underserved patients. Just as community-based clinics can make a difference, community-based optometric practices can play an important role. There is no simple solution to our current health care predicament, but let’s do our part by offering affordable, comprehensive glaucoma care to everyone.
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