Screening for glaucoma in populations at high risk: The eye screening New York project

Abstract

Purpose: To explore the yield and feasibility of glaucoma screening and the prevalence of glaucoma in high risk populations in New York City. Methods: A Community based glaucoma screening study was conducted in a high-risk population in NYC from 2007–2014 using fixed sites and mobile van. Participant underwent visual acuity testing, Tonopen intraocular pressure (IOP), frequency doubling technology (FDT), and optic nerve cup/disk ratio (C/D) by an ophthalmologist or optometrist. Glaucoma suspects (GS) were defined by IOP ≥ 21 mm Hg, abnormal FDT, and cup/disc ≥ 0.5. Results: 8,547 where screened between 2007–2014. 54% were Hispanics and 16% were African Americans. Of the 8,547 screened 2,118 (24.94%) where referred for glaucoma evaluation, 1,243(14.63%) where referred for an ophthalmic evaluation and 5,133(60.43%) where recommended for routine eye exam. 31.96% of our screened population were uninsured and 56.85% never saw an eye doctor in their life. Having IOP ≥ 21 had 36.27fold increase in RRR of being a GS [95% 29.45–44.44, p < 0.001]. Having C/D ratio of ≥ 0.5 had 23.6fold increase in RRR of being a GS [95% 20.65–27, p < 0.001]. Having an abnormal FDT had 2fold increase in RRR of being a GS [95% 1.79–2.19, p < 0.001]. Follow up was available in 610 subjects. Glaucoma was confirmed in 52% of the individuals who followed up. Conclusions: Our data suggests the prevalence of positive screening is substantial in high risk populations. It establishes the feasibility of mobile screening as a method of facilitating access to care. Furthermore, it highlights the importance of an active blindness prevention program in the context of population management.

Keywords

• glaucoma
• glaucoma screening
• access to care
• prevalence of disease
• population health management