DP24-081 Novel telehealth technologies to detect and manage glaucoma and vision-threatening eye diseases in high-risk populations

University Of California, San Francisco, San Francisco CA

Investigators

Linked publications, trials & patents

Abstract

PROJECT SUMMARY/ABSTRACT Most glaucoma in the United States goes undetected, and hence, untreated until late stages of disease. Open angle glaucoma is a progressive disease that is asymptomatic in its early to moderate stages and thus may be amenable to screening. Eye disease screening of the general population is not currently recommended given low-cost effectiveness and insufficient evidence of improved health outcomes. However, screening in higher-risk groups, including Black and Latino individuals, could be more cost-effective. This randomized trial will assess the feasibility and effectiveness of telemedicine-based glaucoma screening for high-risk populations. The specific aims of the proposal are (1) to determine the effectiveness of a telemedicine-based glaucoma screening program for detecting glaucoma, (2) to determine if a telemedicine- based glaucoma screening program provides ancillary benefits besides detection of glaucoma, such as detection of cataract or refractive error, and (3) to determine the cost-effectiveness of a telemedicine-based glaucoma screening program. The trial will be conducted at Federally Qualified Health Centers (FQHCs) in northern California since the burden of undiagnosed glaucoma is expected to be high in this population—both due to poor access to care and because most patients seen at California FQHCs are Black or Latino. We will randomize patients to one of three groups: telemedicine screening, direct mail educational brochure, or a delayed intervention. In the screening arm, a community health worker (CHW) will call patients to schedule a screening visit. The CHW will operate a mobile telemedicine screening unit that drives from clinic to clinic to perform screenings. The CHW will perform all screening tests, including optical coherence tomography (OCT), virtual reality visual field testing, and tonometry, and will upload the results to the existing telemedicine platform EyePACS. Participants in the education arm will be mailed a brochure about the importance of glaucoma screening with a phone number to schedule a screening visit. The delayed treatment arm will be mailed a brochure at the end of the study. The primary outcome will be a self-reported diagnosis of glaucoma, assessed by phone at 3 months. This research uses novel portable tests, and it has been designed to be financially sustainable in the real world. Leveraging the existing EyePACS telemedicine platform reduces barriers for FQHCs to participate, simplifying the administrative and logistical burden for FQHCs and improving the potential for easy scalability. The trial focuses on detecting new cases of glaucoma, since this is the crucial first step in establishing whether glaucoma screening of high-risk populations leads to improved health outcomes.