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Editors Selection IGR 23-2
Screening and Detection: High-Risk Populations
Comment by Rupert Bourne on:
In this article by Sapru et al., each of the three community-based sites involved in the Screening and Intervention for Glaucoma and eye Health through Telemedicine (SIGHT) studies were compared in terms of recruitment of people at greater risk for glaucoma and other eye diseases.
These sites in the USA (public housing in New York city, Federally Qualified Health Centers (FQHC) in rural Alabama, and FQHC and a free clinic in mid-size urban cities of Michigan) involve local health care workers and study staff to obtain basic clinical measures such as visual acuity, intraocular pressure, and retinal photography, and send them to an eye care specialist located remotely for evaluation and recommendations.1-3
By measuring Social Determinants of Heath (SDOH) and high-risk eye disease characteristics among participants, and by interviewing each study's recruitment staff, the authors sought to evaluate what the barriers and enablers to recruitment were, and given the timing of the study (mid-2020 to mid-2021) the undoubtable challenges faced due to the COVID pandemic. The SIGHT studies enrolled much higher proportions of Black Americans, Hispanic Americans, those on low incomes and with diabetes, than would be reflected in the general US population.
A common findings across sites were the lower rate of male enrolment (a concern for glaucoma where global age-standardized rates of blindness exceed that among females)Yet, common findings across sites were the lower rate of male enrolment (a concern for glaucoma where global age-standardized rates of blindness exceed that among females),4 and the much better recruitment that occurred when direct personalized contact was used using culturally sensitive methods, for example by recruiting staff from participants' community or from the same race or ethnicity.5 Providing care within trusted, easy-to-access places in the communities overcame some of the SDOH barriers (e.g., transportation, trust) that can lead to health inequities, and telemedicine meant that participants and medical specialists did not need to be co-located. This paper is particularly interesting at a time when response rates of participants in health surveys in high income countries has been falling,6 and the definition of 'community' or 'community health' is changing. FQHCs in the USA are often the only source of eye care available to underserved populations even though FQHCs are not fully equipped to provide comprehensive eye care. In 2020, there were only 362 full-time equivalents of optometrists and 38 of ophthalmologists across nearly 1,400 health centers with some 13,000 service delivery sites.7 The USA is not alone among high income countries in terms of enormous inequity of health/eye health. For example, the National Study of Eye Disease in 2016 in Australia (currently being repeated) found that 1:5 non-indigenous people surveyed aged 50+ had an undiagnosed eye disease, and this was much higher in the underserved indigenous population.8
Studies such as the Screening to Prevent (SToP) Glaucoma Study have tried to optimize screening for glaucoma in high-risk populations in the USA.9 The SIGHT authors are to be commended for digging deeper into this dilemma, and investigating what drives communities to engage/disengage with eye/healthcare, which can guide current and future interventions.
References
- Hark LA, Kresch YS, De Moraes CG, et al. Manhattan vision screening and follow-up study in vulnerable populations (NYC-SIGHT): design and methodology. J Glaucoma. 2021;30(5):388-394. doi:10.1097/IJG. 0000000000001795.29.
- Newman-Casey PA, Musch DC, Niziol LM, et al. Michigan screening and intervention for glaucoma and eye health through telemedicine (MI-SIGHT): baseline methodology for implementing and assessing a community-based program. J Glaucoma. 2021;30 (5):380-387.
- Rhodes LA, Register S, Asif I, et al. Alabama screening and intervention for glaucoma and eye health through telemedicine (AL-SIGHT): study design and methodology. J Glaucoma. 2021;30(5):371-379.
- Steinmetz J, Bourne RRA, et al. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Global Health 2021. Vol 9(2) e144-e160.
- Kikut A, Vaughn M, Salowe R, et al. Evaluation of a multimedia marketing campaign to engage African American patients in glaucoma screening. Prev Med Rep. 2020;17:101057.
- Mindell JS, et al. Sample selection, recruitment and participation rates in health examination surveys in Europe-experience from seven national surveys. BMC Med Res Methodol. 2015;15:78
- https://www.aoa.org/news/clinical-eye-care/public-health/federally-qualified-health-centers-address-underserved-community-eye-care?sso=y
- Foreman et al. The Prevalence and Causes of Vision Loss in Indigenous and Non-Indigenous Australians The National Eye Health Survey. Ophthalmology 2017;124:1743-1752.
- Zhao D, Guallar E, Gajwani P, et al., on Behalf Of The Stop Glaucoma Study Group. Optimizing Glaucoma Screening in High-Risk Population: Design and 1-Year Findings of the Screening to Prevent (SToP) Glaucoma Study. Am J Ophthalmol 2017;180:18-28.
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