DP24-081 Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) Program: A Pragmatic Randomized Trial

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Abstract

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. Black, Hispanic, Asian, and Native American people and people with lower incomes bear a disproportionate share of the burden of glaucoma and vision impairment. Though glaucoma is treatable, only half of people with the disease are ever diagnosed. Federally qualified health centers (FQHCs) provide primary care for people who live in poverty. Because these people are disproportionately of minority race and ethnicity, FQHCs provide care for people who are at higher risk of: 1) having glaucoma and 2) not getting adequate treatment for glaucoma. There is a critical need to rigorously test the effectiveness and cost effectiveness of innovative strategies to screen for glaucoma in high-risk populations. The scientific premise of this proposal is based on the efficacy of telemedicine-based protocols in identifying glaucoma and other eye disease at higher rates than national averages in high-risk communities when run by academic medical centers. In this proposal, we will empower eye doctors at the FQHC – instead of university physicians – to use telemedicine protocols to review digital, objective ophthalmic data captured by local ophthalmic technicians to triage patients to appropriate in-person care, a 10-minute wellness visit or a 30- minute detailed visit. The telemedicine protocols use advanced technology-based equipment not typically found in FQHCs (e.g. optical coherence tomography, autorefraction). In this proposed telemedicine program, ophthalmic technicians will also act as health care navigators to help people access low-cost glasses from on- line retailers and access recommended medical treatment. Our objective is to test the effectiveness of this comprehensive telemedicine-enhanced care approach compared to usual care (a comprehensive eye exam) in glaucoma and eye disease screening and evaluate implementation and costs. We will conduct a Type 1 effectiveness-implementation hybrid randomized pragmatic clinical trial to test whether telemedicine-enhanced care is more effective than usual care in 1) identifying glaucoma/suspected glaucoma, cataract, diabetic retinopathy and macular degeneration and 2) improving vision-related quality-of-life one month after participation. We will explore the impact of telemedicine-enhanced care on treatment of refractive error, patient satisfaction, and completion of recommended follow-up care. We will use implementation science strategies to identify and prioritize which barriers need to be addressed to implement evidence-based eye care at the local FQHC after the trial. We will create a toolkit for implementation of evidence-based eye care at other FQHCs. We will assess costs and model cost-effectiveness to compare the societal value of telemedicine-based glaucoma and eye disease screening compared to usual care. This work will inform our long-term goal of addressing striking and persistent inequities in eye health outcomes by leveraging the existing network of FQHCs to provide high quality eye care.