Leveraging technology to enhance eye disease detection: a pragmatic randomized trial

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Abstract

Abstract Text In the United States, seven million people live with visual impairment and one million live with blindness; glaucoma is a leading cause of this visual disability. Though glaucoma is treatable, only half of people with the disease are ever diagnosed. Federally qualified health centers (FQHCs) provide medical care for people who are publicly insured but only 3% of patients at FQHCs receive eye care. FQHCs provide care for people who are more likely to: 1) have glaucoma and 2) receive inadequate treatment for glaucoma. There is a critical need to rigorously test the effectiveness and cost effectiveness of innovative, holistic strategies to screen for glaucoma and other eye disease in the national network of FQHCs. The scientific premise of this proposal is based on the efficacy of our technology-based protocols that identified glaucoma and other eye disease at higher rates than national averages at an FQHC when run by our academic medical center. In this proposal, eye doctors at the FQHC – instead of university physicians – will use technology-based protocols to review digital, objective ophthalmic data captured by FQHC ophthalmic technicians to triage patients to appropriate inperson care, a 30-minute detailed visit or a 10-minute wellness visit, to increase clinical efficiency. The ophthalmic technicians act as health care navigators to help people access affordable glasses from on-line retailers and recommended medical treatment. Our objective is to test the effectiveness of this comprehensive technology-based approach to glaucoma and eye disease screening compared to usual care (a comprehensive eye exam) and evaluate implementation and costs. We will conduct a Type 1 effectivenessimplementation hybrid randomized pragmatic clinical trial to test whether technology-based screening is more effective than usual care in 1) identifying glaucoma/suspected glaucoma, visually significant cataract, and diabetic retinopathy, and 2) improving vision-related quality-of-life six weeks after participation. We will explore the impact of our technology-based screening program on treatment of refractive error, satisfaction with glasses and care, and completion of recommended follow-up care. We will assess the sensitivity and specificity of protocol-based and standard optometric exam to gold standard glaucoma specialist evaluation to identify areas for improvement. (Aim 1). We will use implementation science strategies to identify best strategies to implement whichever glaucoma and eye disease screening protocol is most effective at the local FQHC after the trial. We will create a toolkit of how to implement evidence-based eye care for other FQHCs (Aim 2). Due to the need for advanced technology-based equipment, we will assess costs and model costeffectiveness to compare the societal value of technology-based glaucoma screening versus usual care (Aim 3). This work will inform our long-term goal to leverage the existing network of FQHCs to provide high quality eye disease screening and care.