Cluster-randomised trial of community-based screening for eye disease in adults in Nepal: the Village-Integrated Eye Worker Trial II (VIEW II) trial protocol
Suzanne Gilbert,
Valerie M Stevens,
Raghunandan Byanju,
Ram Prasad Kandel,
Gopal Bhandari,
Sadhan Bhandari,
Jason S Melo,
Prakriti Acharaya,
Manmohan Adhikari,
Shree Kanta Adihikari,
Deepak Bhattarai,
Rabin Bhattarai,
Ajaya Chaudhary,
Bhagiram Chaudhary,
Daya Shankar Chaudhary,
Kishor Chaudhary,
Krishna Raj Dharel,
Maria Gautam,
Shree Krishna Gautam,
Aakriti Ghimire,
Bishwash Ghimire,
Narayan Ghimire,
Ramesh Ghimire,
Gaurav Giri,
Puspa Giri,
Dhanmaya Gurau,
Ramesh Gurung,
Deepak Kandel,
Simanta Khadka,
Benju Lamichhane,
Pappu Mahato,
Pratikshya Neupane,
Ram Janaki Panday,
Sabina Parajuli,
Radhika Devi Poudel,
Susmita Poudel,
Sangita Pradhan,
Suchan Pun,
Bishaka Ranabhat,
Sudha Ranabhat,
Gaurav Rimal,
Gopal Sapkota,
Subit Sapkota,
Ranjeet Shah,
Manisha Shrestha,
Saraswati Silwal,
Amisha Subedi,
Pradeep Subedi,
Alish Tamang,
Dilip Tandukar,
Nischal Sharma Wagle,
Nilam Kumari Yadav,
Sailesh Mishra,
Heidi Chase,
Lauren Jesudason,
Chundak Tenzing,
Shravan Chaudhary,
Parami Dhakwha,
Prasanna Sharma,
Apsara Shrestha,
Jeremy Keenan,
Thomas Lietman,
Jason Melo,
Kieran O’Brien,
Riju Shrestha,
Robert Stamper,
Valerie Stevens
Affiliations
Suzanne Gilbert
6 Innovation & Sight Programs, Seva Foundation, Berkeley, California, USA
Valerie M Stevens
Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
Raghunandan Byanju
Bharatpur Eye Hospital, Bharatpur, Nepal
Ram Prasad Kandel
Seva Foundation, Bharatpur, Nepal
Gopal Bhandari
Bharatpur Eye Hospital, Bharatpur, Nepal
Sadhan Bhandari
Bharatpur Eye Hospital, Bharatpur, Nepal
Jason S Melo
Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
Prakriti Acharaya
Manmohan Adhikari
Shree Kanta Adihikari
Deepak Bhattarai
Rabin Bhattarai
Ajaya Chaudhary
Bhagiram Chaudhary
Daya Shankar Chaudhary
Kishor Chaudhary
Krishna Raj Dharel
Maria Gautam
Shree Krishna Gautam
Aakriti Ghimire
Bishwash Ghimire
Narayan Ghimire
Ramesh Ghimire
Gaurav Giri
Puspa Giri
Dhanmaya Gurau
Ramesh Gurung
Deepak Kandel
Simanta Khadka
Benju Lamichhane
Pappu Mahato
Pratikshya Neupane
Ram Janaki Panday
Sabina Parajuli
Radhika Devi Poudel
Susmita Poudel
Sangita Pradhan
Suchan Pun
Bishaka Ranabhat
Sudha Ranabhat
Gaurav Rimal
Gopal Sapkota
Subit Sapkota
Ranjeet Shah
Manisha Shrestha
Saraswati Silwal
Amisha Subedi
Pradeep Subedi
Alish Tamang
Dilip Tandukar
Nischal Sharma Wagle
Nilam Kumari Yadav
Sailesh Mishra
Heidi Chase
Lauren Jesudason
Chundak Tenzing
Shravan Chaudhary
Parami Dhakwha
Prasanna Sharma
Apsara Shrestha
Jeremy Keenan
Thomas Lietman
Department of Ophthalmology, The Francis I Proctor Foundation, University of California, San Francisco School of Medicine, San Francisco, California, USA
Introduction The majority of blindness worldwide could be prevented or reversed with early diagnosis and treatment, yet identifying at-risk and prevalent cases of eye disease and linking them with care remain important obstacles to addressing this burden. Leading causes of blindness like glaucoma, diabetic retinopathy and age-related macular degeneration have detectable early asymptomatic phases and can cause irreversible vision loss. Mass screening for such diseases could reduce visual impairment at the population level.Methods and analysis This protocol describes a parallel-group cluster-randomised trial designed to determine whether community-based screening for glaucoma, diabetic retinopathy and age-related macular degeneration reduces population-level visual impairment in Nepal. A door-to-door population census is conducted in all study communities. All adults aged ≥60 years have visual acuity tested at the census visit, and those meeting referral criteria are referred to a local eye care facility for further diagnosis and management. Communities are subsequently randomised to a community-based screening programme or to no additional intervention. The intervention consists of a single round of screening including intraocular pressure and optical coherence tomography assessment of all adults ≥60 years old with enhanced linkage to care for participants meeting referral criteria. Four years after implementation of the intervention, masked outcome assessors conduct a repeat census to collect data on the primary outcome, visual acuity. Individuals with incident visual impairment receive a comprehensive ophthalmological examination to determine the cause of visual impairment. Outcomes are compared by treatment arm according to the originally assigned intervention.Ethics and dissemination The trial has received ethical approval from the University of California San Francisco Institutional Review Board, Nepal Netra Jyoti Sangh and the Nepal Health Research Council. Results of this trial will be disseminated through publication in peer-reviewed journals and presentation at local and international meetings.Trial registration number NCT03752840