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Bringing Eye Disease Screening and Care to the Underserved
Seven million people live with visual impairment in the U.S., and glaucoma is a leading cause. Though glaucoma is treatable, half of all people with the disease are never diagnosed. Black, Hispanic, and Native American people, people living with low incomes, and people living in medically underserved communities all bear a disproportionate share of the burden of glaucoma and vision impairment.
There is a critical need to expand screening for these at-risk populations, and to help people who test positive access appropriate eye care. Glaucoma specialist and health services researcher Paula Anne Newman-Casey, M.D., M.S., is developing and testing innovative strategies to achieve those goals as successfully and cost-effectively as possible.
In the MISIGHT protocol, eye care technicians were placed in two different community clinic settings to conduct comprehensive screenings and imaging beyond the traditional eye examination. Findings were transmitted via electronic health records to ophthalmologists at Kellogg, whose screening results and recommendations were returned to the technician to review with the patient. MISIGHT’s technology-based protocol was shown to identify significantly higher rates of glaucoma and other eye diseases than national averages.
But while successful, the MISIGHT protocol was administered through an academic medical center and supported by grant funding, which is neither geographically scalable nor economically sustainable.
“In this project, we’re evaluating a more pragmatic approach,” Dr. Newman-Casey says. “We hope to determine how best to achieve a comprehensive screening intervention using infrastructure already in place in underserved communities.”
The clinical infrastructure targeted for this test intervention is the Federally Qualified Health Center, or FQHC. The approximately 1,400 FQHCs in the U.S. provide primary care for people who live in poverty. Their patients are disproportionately of minority race and ethnicity and are therefore at higher risk of both having glaucoma and not receiving adequate treatment for it. Yet, only about a quarter of FQHCs currently offer eye care of any kind, and only two percent of patients receive eyecare through FQHCs.
“Despite the significant challenges faced by FQHCs—chronic underfunding, and insufficient resources and expertise in specialties like ophthalmology—they have the best available foundation on which to build,” notes Dr. Newman-Casey. “They are organized and staffed to meet the specific needs of the communities they serve. Many employ social workers and staff with expertise navigating insurance, assistance programs and transportation resources, as well as interpreters.”
One of the two MISIGHT test sites, the Hamilton Community Health Center, an FQHC in Flint MI, is the site of this trial.
Hamilton patients will be randomized into two groups. One group will receive traditional eye examinations, checking vision and eye pressure and examining the eyes with a slit lamp. In the other group, an FQHC eye doctor will review digital, objective ophthalmic data captured by FQHC ophthalmic technicians, triaging patients to receive appropriate in-person care. Technicians will help patients navigate access to follow up medical treatment and low-cost glasses.
Dr. Newman-Casey’s team will evaluate which approach detects more eye disease and shows greater improvement in vision-related outcomes. They will also identify best practices, conduct resource cost/ value analyses, and develop a ‘toolkit’ for implementing evidence-based eye care in the FQHC setting.
“We hope this work will inform future policies that leverage FQHCs to improve access to quality screening and care to address the striking and persistent inequities in eye health outcomes,” says Dr. Newman-Casey.
