BMJ Open (Oct 2020)

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

  • ,
  • Thomas M Lietman,
  • Jeremy D Keenan,
  • Kieran S O'Brien,
  • Travis Porco,
  • Daniel Schwartz,
  • Travis C Porco,
  • 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

DOI
https://doi.org/10.1136/bmjopen-2020-040219
Journal volume & issue
Vol. 10, no. 10

Abstract

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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