NIH-Funded Pilot Program Addresses Disparities in Glaucoma Care

Glaucoma is the leading cause of irreversible blindness in Black Americans, who face six times the risk of developing glaucoma than their white counterparts. Because Black Americans are also less likely to see an eye doctor or receive preventive care, their glaucoma is four times more likely to go undiagnosed and untreated.

Angela Elam, M.D., a glaucoma clinician and health services researcher at Kellogg, is preparing to launch the Community Based Treatment for Glaucoma program (ComBaT Glaucoma). This personalized, multi-level intervention funded by the NIH aims to increase eye care utilization among Black residents of Detroit who are at high risk for glaucoma.

To overcome gaps in health awareness and barriers to care commonly observed in the Black community, ComBaT Glaucoma will rely on engagement methods that have proven effective in interventions for conditions like diabetes and cancer, but that, to date, have not been routinely employed for glaucoma.

“A tailored approach has been shown to yield greater engagement and better outcomes than a one-size-fits-all model,” explains Dr. Elam. “Every step of the way, we will be partnering with trusted local influencers to reflect the characteristics and needs of the community.”

Potential program participants will be identified in partnership with Detroit’s Historic King Solomon Missionary Baptist Church (HKSC). HKSC is an established community hub, interfacing with thousands of local residents, both members and non-members, through a host of worship, social and health programs and events.

The goal is to recruit participants who meet one or more of the following criteria: (1) have a personal or family history of glaucoma; (2) are age 40 or older; or (3) have not received an eye exam in more than 2 years.

The input of church and community leaders will also be sought, along with the Detroit Health Department (DHD), to guide the recruitment of the community health workers (CHWs) to administer the intervention. CHWs will receive 126 hours of training in motivational interviewing and glaucoma education, conducted by the Michigan Community Health Worker Alliance, in conjunction with the DHD.

The intervention will consist of a series of discussions with an assigned CHW. During the first session, the CHW will use a web-based application to generate glaucoma educational materials tailored to the participants. Church leaders will assist Dr. Elam with creating the faith-based messaging.

Based on the participant’s specific barriers to care, the CHW will generate a written action plan to increase eye care utilization. The patient will also be referred to an eye care provider.

“Research shows that trust is a significant barrier to eye care utilization in Black Americans,” Dr. Elam explains, “and that seeing a physician of the same race or ethnicity has a positive effect on patient satisfaction. So we are partnering with Dr. Otis Ferguson, a native of Detroit and an ophthalmologist who has practiced in the city for over 20 years, to provide eye care for those who do not already have an eye doctor.”

CHWs will conduct follow-up assessments by phone to monitor progress, reinforce education and revisit individual barriers to care, and the percentage of eye care utilization in the group will be calculated.

“Our goal is to demonstrate the potential of a communitybased, faith-tailored program to overcome barriers to care for those at high risk for glaucoma,” Dr. Elam says. “We hope that our pilot will be shown to be effective, sustainable and scalable for other real-world community settings.”