1
|
Horowitz JD, Adeghate JO, Karani R, Henriquez DR, Gorroochurn P, Sharma T, Park L, Wang Q, Diamond DF, Harizman N, Auran JD, Maruri SC, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study: (NYC-SIGHT)Tele-Retinal Image Findings and Importance of Photography. Telemed J E Health 2024; 30:664-676. [PMID: 37651209 DOI: 10.1089/tmj.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Purpose: To describe tele-retinal abnormality image findings from the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT), which aims to investigate whether community-based eye health outreach strategies using telemedicine can improve visual outcomes among at-risk populations in Upper Manhattan. Methods: A 5-year prospective, cluster-randomized clinical trial was conducted. Eligible individuals aged 40 years and older were recruited from affordable housing developments and senior centers in New York City. Participants underwent on-site eye health screening (best-corrected visual acuity, intraocular pressure [IOP] measurements, and fundus photography). Fundus images were graded via telemedicine by a retina specialist. Multivariate logistic regression modeling was used to assess the factors associated with abnormal retinal findings requiring referral to ophthalmology. Results: Participants with a retinal abnormality on fundus photography (n = 157) were predominantly older adults, with a mean age of 68.4 ± 11.1 years, female (63.7%), African American (50.3%), and Hispanic (43.3%). A total of 32 participants in our study passed the vision and IOP screening but had an abnormal retinal image and ocular pathology that would have been missed without fundus photography. Individuals who self-identified as having preexisting glaucoma (odds ratio [OR] = 3.749, 95% confidence interval [CI] = 1.741-8.074, p = 0.0001) and had severe vision impairment (OR = 4.1034, 95% CI = 2.0740-8.1186, p = 0.000) at the screening had significantly higher odds of having an abnormal retinal image. Conclusion: This community-based study targeted populations at-risk for eye disease, improved access to eye care, detected a significant number of retinal image abnormalities requiring follow-up by using telemedicine, and provided evidence of the importance of fundus photography during eye health screenings. CTR number: NCT04271709.
Collapse
Affiliation(s)
- Jason D Horowitz
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Jennifer O Adeghate
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Rabia Karani
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Tarun Sharma
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Qing Wang
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Daniel F Diamond
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Noga Harizman
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| |
Collapse
|
2
|
Zeng R, LaMattina KC. Follow-Up Adherence After Community Health Vision Screening Programs: A Review of the Literature. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e223-e231. [PMID: 37795383 PMCID: PMC10547536 DOI: 10.1055/s-0043-1771354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2023] [Indexed: 10/06/2023]
Abstract
Objective Although the purpose of community eye screening programs is to reduce health care disparities, the effectiveness of these programs is limited by the follow-up adherence of their participants. The aim of this review is to investigate factors that may promote or hinder participants from attending follow-up ophthalmological exams after community eye screenings and identify interventions to increase follow-up rates. Methods For literature review, PubMed, Web of Science, Embase, Proquest/Global Health Library, and Google Scholar databases were searched to identify studies of community eye screenings published between January 2000 and May 2023. Data from these articles were analyzed to identify barriers and facilitators of follow-up adherence after community eye screenings in the United States and to examine strategies used to increase follow-up rates. Only published manuscripts were included. We excluded studies of school screenings and clinic-based screenings. Results A total of 28 articles were included. Follow-up rates ranged from 12.5 to 89%. Nineteen articles reviewed facilitators and barriers to follow-up. Eighteen articles were non interventional and seven (see Table 1 and 2 , respectively) articles described interventions that were tested to improve follow-up rates after screening. Interventions included prescheduled appointments, transportation assistance, patient education, and patient navigators. Conclusion Several interventions are promising to increase follow-up adherence in community eye screenings, but more evidence is needed. Future research should focus on randomized trials of isolated interventions to improve follow-up adherence of disadvantaged populations, although this may be limited given ethical considerations and documented lack of follow-up after screening.
Collapse
Affiliation(s)
- Rebecca Zeng
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Kara C. LaMattina
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| |
Collapse
|
3
|
Acuff K, Delavar A, Radha Saseendrakumar B, Wu JH, Weinreb RN, Baxter SL. Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program. Ophthalmol Glaucoma 2023; 6:405-412. [PMID: 36746242 PMCID: PMC10400726 DOI: 10.1016/j.ogla.2023.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE To identify socioeconomic factors associated with visit adherence among patients with glaucoma in a nationwide cohort. DESIGN Cross-sectional study. SUBJECTS All subjects were participants in the National Institutes of Health All of Us Research Program. This study cohort consists of participants who were diagnosed with glaucoma and who answered the question on the Health Care Access and Utilization Survey regarding whether they have seen an eye care provider in the last 12 months. METHODS Descriptive analyses were conducted based on participant age, gender, race/ethnicity, insurance status, level of education, and income bracket. Multivariable logistic regression adjusting for these factors was used to generate odds ratios (ORs) for the association between socioeconomic factors and visit adherence. MAIN OUTCOME MEASURE Visit adherence, defined as reporting seeing an eye care provider in the last 12 months. RESULTS Among 4517 patients with glaucoma, 730 (16.3%) indicated that they had not seen or spoken to an eye doctor in the last 12 months. In multivariable models, those with some college education (OR: 1.91; 95% confidence interval [CI]: 1.19-3.04) and those with a college degree or advanced degree (OR: 2.25; 95% CI: 1.39-3.60) and those with the highest annual income of ≥ $200 000 (OR: 1.64; 95% CI: 1.10-2.45) were more likely to have seen an eye doctor in the past year compared with those in the lowest education and income categories, respectively. CONCLUSION Lower income and education levels were significantly associated with lower odds of seeing an eye doctor in the past year among all patients with glaucoma in All of Us. This highlights an important health disparity and may inform subsequent interventions to promote improved adherence to clinical guidelines regarding eye care for glaucoma monitoring and management. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Kaela Acuff
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Arash Delavar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Jo-Hsuan Wu
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Sally L Baxter
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California.
| |
Collapse
|
4
|
Solomon SD, Shoge RY, Ervin AM, Contreras M, Harewood J, Aguwa UT, Olivier MMG. Improving Access to Eye Care: A Systematic Review of the Literature. Ophthalmology 2022; 129:e114-e126. [PMID: 36058739 DOI: 10.1016/j.ophtha.2022.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature. CLINICAL RELEVANCE Health care disparities continue to plague the nation's well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age). METHODS A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms "barriers and facilitators to health care," "access," and "disparities in general and sub-specialty eye care." Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria. RESULTS Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH. CONCLUSIONS The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.
Collapse
Affiliation(s)
- Sharon D Solomon
- School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Ruth Y Shoge
- School of Optometry, University of California Berkeley, Berkeley, California
| | - Ann Margret Ervin
- School of Medicine, Johns Hopkins University, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Melissa Contreras
- College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | | | - Ugochi T Aguwa
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mildred M G Olivier
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| |
Collapse
|
5
|
Cheng D, Babij R, Cabrera D, Yuan M, Port A, Mckenney AS, Zhu J, Van Tassel S, Imperato-McGinley J, Sun G. Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers. Cureus 2022; 14:e28121. [PMID: 35990564 PMCID: PMC9389029 DOI: 10.7759/cureus.28121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Ophthalmologic care is inaccessible to many people due to a variety of factors, including the availability of providers, cost of equipment for ophthalmologic care, and transportation to clinics and appointments. Because many causes of blindness are both highly prevalent and preventable once identified, it is essential to address gaps in care for underserved populations. We developed a novel 3D-printed mobile retinal camera. In this study, we organized recurring student-run screening events around New York City that took place in community centers and churches, at which we utilized our device to take retinal images. Our screening events reached a diverse population of New Yorkers, disproportionately those with lower household income, many of whom had not had recent eye exams. To validate the device for use in telehealth ophthalmologic visits, we transmitted the images to a remote ophthalmologist for evaluation and compared the result with an on-site attending physician’s dilated eye exam. The subjective assessment indicated that 97% of images captured with the mobile retinal camera were acceptable for telehealth analysis. Remote image assessment by achieved 92% sensitivity and 83% specificity in detecting optic disc cupping, compared to the gold-standard on-site dilated eye exam. In addition, the device was portable, affordable, and able to be used by those with relatively little ophthalmologic training. We have demonstrated the utility of this affordable mobile retinal camera for telehealth ophthalmologic evaluation during community screening events that reached an underserved population to detect disease and connect with long-term care.
Collapse
|
6
|
Yuen J, Pike S, Khachikyan S, Nallasamy S. Telehealth in Ophthalmology. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-telehealth-ophthalmology] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
Collapse
Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
| |
Collapse
|
8
|
Robbins CC, Anjum S, Alwreikat AM, Cooper ML, Cotran PR, Roh S, Ramsey DJ. An Initiative to Improve Follow-up of Patients with Glaucoma. OPHTHALMOLOGY SCIENCE 2021; 1:100059. [PMID: 36246940 PMCID: PMC9560565 DOI: 10.1016/j.xops.2021.100059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/14/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
Purpose This study describes the implementation of an electronic medical record (EMR)-based initiative aimed at reducing the number of patients with glaucoma-related diagnoses lost to follow-up (LTF) and reviews its short-term outcomes. Design Retrospective, comparative case series. Participants Patients with glaucoma-related diagnoses seen 1 year prior at the Lahey Medical Center and who had not returned within the 6-month period between January 1, 2020, and June 30, 2020, which spanned the outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic in the United States. Methods An EMR-based tool was designed to identify patients suspected of being LTF with glaucoma-related diagnoses. Providers were enlisted to review the EMR for each of these patients and re-engage them, as appropriate. One month later, the initiative was evaluated by means of a retrospective chart review. Binary logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with being LTF. Main Outcome Measures Patients who completed a telemedicine or in-person appointment, or had a future scheduled or ordered return appointment, were considered re-engaged. Results Of the 3551 patients seen during the study period, 384 patients were identified as LTF (11%), with 60 identifying COVID-19 as the reason for canceling their visit (16%). Patients who lived farther from the eye clinic (P < 0.001) or who had a history of canceling or missing an appointment (P < 0.001) were more likely to be LTF. Patients with open-angle glaucoma (P = 0.042) or who had completed a visual field (P < 0.001) or ophthalmic imaging (P < 0.001) within the past year were less likely to be LTF. One month after the re-engagement initiative, 124 LTF patients (32%) had been re-engaged (40% through telemedicine), 238 patients (62%) had future scheduling orders in place, and 22 patients (6%) had no active plan for future follow-up. Conclusions An EMR-based tool is an effective method for identifying patients at risk of being LTF and provides an opportunity for providers to recall and re-engage patients. Use of telemedicine to recontact LTF patients shows promise of improving the management of glaucoma, enhancing clinical productivity, and documenting treatment plans, thereby potentially reducing medicolegal liability.
Collapse
|
9
|
Hamm LM, Yashadhana A, Burn H, Black J, Grey C, Harwood M, Peiris-John R, Burton MJ, Evans JR, Ramke J. Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review. BMJ Glob Health 2021; 6:e006188. [PMID: 34493531 PMCID: PMC8424858 DOI: 10.1136/bmjgh-2021-006188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries. METHODS We searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis. RESULTS We screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success. CONCLUSION Although research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.
Collapse
Affiliation(s)
- Lisa M Hamm
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Aryati Yashadhana
- Centre for Health Equity Training Research & Evaluation, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Burn
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Black
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Performance Improvement, Auckland District Health Board, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Roshini Peiris-John
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
10
|
Abstract
Purpose of Review The field of teleglaucoma has expanded rapidly in recent years with several large-scale teleglaucoma screening programs in existence throughout the world. Additionally, teleglaucoma programs for use in disease management are under study. The limited access to care that resulted from the COVID-19 pandemic highlighted the need for expansion of such programs. This article reviews the literature on teleglaucoma for screening and management of glaucoma, discussing considerations for incorporating teleglaucoma into clinical practice. Recent Findings Teleglaucoma screening reduces the rate of false-positive referrals and can accurately screen at-risk populations with accuracy similar to in-person screening. The use of teleglaucoma for the management of glaucoma shows promise for low-risk patients with early disease. Furthermore, teleglaucoma is cost-effective and reduces travel burden for patients resulting in high patient satisfaction. Summary Teleglaucoma offers potential for improving access to glaucoma care, reducing the burden on patients and health care systems.
Collapse
|
11
|
Barbosa W, Zhou K, Waddell E, Myers T, Dorsey ER. Improving Access to Care: Telemedicine Across Medical Domains. Annu Rev Public Health 2021; 42:463-481. [PMID: 33798406 DOI: 10.1146/annurev-publhealth-090519-093711] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that (a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; (b) telemedicine in select circumstances has demonstrated improved health outcomes; and (c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.
Collapse
Affiliation(s)
- William Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA;
| | - Kina Zhou
- School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA
| | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA; .,Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| |
Collapse
|
12
|
Hark LA, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Stidham EM, Banks AZ, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology. J Glaucoma 2021; 30:388-394. [PMID: 33492894 DOI: 10.1097/ijg.0000000000001795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
PRCIS The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. PURPOSE To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. MATERIALS AND METHODS This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. CONCLUSION This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.
Collapse
Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Yocheved S Kresch
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Carlos Gustavo De Moraes
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jason D Horowitz
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Lisa Park
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - James D Auran
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | | | - Aisha Z Banks
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | | | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ
| | - Saloni Sapru
- Westat, Public Health and Epidemiology Practice, Rockville, MD
| | - Simani Price
- Westat, Public Health and Epidemiology Practice, Rockville, MD
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, Columbia University
| | - George A Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| |
Collapse
|
13
|
Lam PY, Chow SC, Lai JSM, Choy BNK. A review on the use of telemedicine in glaucoma and possible roles in COVID-19 outbreak. Surv Ophthalmol 2021; 66:999-1008. [PMID: 33811912 PMCID: PMC8011321 DOI: 10.1016/j.survophthal.2021.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/31/2022]
Abstract
We review the use of telemedicine in glaucoma and its possible roles in the COVID-19 outbreak. We performed a literature search of published human studies on teleglaucoma on May 12, 2020, using search terms including “telemedicine” and “glaucoma” that were in English and published over the prior 10 years. This search strategy yielded a total of 14 relevant articles after manual curation. Of the 14 articles, 4 were from the same randomized control trial, 7 were prospective studies, 2 were retrospective studies, 1 was descriptive analysis, and 1 was cost-effective analysis. Seven discussed the common ophthalmologic measurements used in teleglaucoma. Four demonstrated the cost effectiveness of the use of teleglaucoma, and 3 articles investigated patient satisfaction with the use of teleglaucoma. Three articles investigated the correlation between teleglaucoma and face-to-face clinics. Five articles discussed the current use and opportunities of teleglaucoma. When compared to in-person care, teleglaucoma is more time and cost-effective, shows high patient satisfaction and fair to good agreement with in-person care; however, there is great variation in the reported sensitivity of glaucoma screening, warranting further studies to establish its efficacy. For glaucoma management, both the sensitivity and specificity must be further improved before it could be put into extensive use. Nevertheless, it is worthwhile to explore the possible extensive application of teleglaucoma in monitoring “glaucoma suspects” and maintaining glaucoma follow-up during a pandemic outbreak to reduce the risk of transmission of infection.
Collapse
Affiliation(s)
- Pun Yuet Lam
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Jimmy Shiu Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| |
Collapse
|