Glaucoma Screening and Referral Risk Factors in a High-Risk Population: Follow-Up Study of the Manhattan Vision Screening Study.

Abstract

Prcis: Community-based eye health screenings that incorporated fundus photography and optometric exams in a high-risk NYC population effectively identified a higher than average number of participants that required an in-office glaucoma evaluation.

Purpose: To report glaucoma screening rates and risk factors associated with referral for in-office glaucoma evaluation in the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT).

Methods: In this 5-year, cluster-randomized clinical trial, eligible individuals aged 40 and older were recruited from affordable housing developments and senior centers. Visual acuity with correction, intraocular pressure (IOP) measurements, and nonmydriatic fundus photography were conducted. Images were graded by a glaucoma specialist; those with an abnormal image were referred; those who failed the screening or had an unreadable fundus image were examined by the study optometrist. χ 2 tests and stepwise multivariate logistic regression analyses were conducted to determine factors associated with glaucoma referral.

Results: Totally, 708 participants were screened; 189 (26.6%) were referred for an in-office glaucoma evaluation due to an abnormal optic disc image (n=138) or abnormal optometric exam (n=51). Those referred had a mean age 68.5±11.7 years and were 60% female, 57% Black, and 37% Hispanic. Stepwise multivariate logistic regression showed participants with self-reported glaucoma (OR: 8.096, 95% CI: 4.706-13.928, P =0.000), IOP > 23 mm Hg at the screening (OR: 3.944, 95% CI: 1.704-9.128, P =0.001), or wore prescription eyeglasses (OR: 1.601, 95% CI: 1.034-2.48, P =0.035) had higher odds of being referred for an in-office glaucoma evaluation. Of those referred, 106 (56%) attended, 36 participants (34%) were diagnosed with glaucoma and 38 participants (35.8%) as glaucoma suspects.

Conclusion: Our findings support public health approaches that focus on community-based eye health screenings in high-risk populations and prioritize underserved communities.