Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): Subanalysis of Referral to Ophthalmology

AbstractPurpose The Manhattan Vision Screening and Follow-up Study aims to provide access to eye care for underserved populations, detect native rates of ocular pathology, and refer participants with eye disease to ophthalmology. This subanalysis describes the reasons for referral to ophthalmology and identifies risk factors associated with being referred.Methods Enrolled participants were aged ≥40 years, living independently in public housing developments and able to provide consent for eye health screenings. Those with habitual visual acuity 20/40 or worse, intraocular pressure (IOP) 23-29 mmHg, or an unreadable fundus image failed and were scheduled with the on-site optometrist. The optometric exam determined whether further referral to ophthalmology for a clinic exam was warranted. Those with an abnormal image or IOP ≥30 mmHg were referred directly to ophthalmology. Main outcome was factors associated with referral to ophthalmology.Results A total of 708 individuals completed the eye health screening over 15 months. A total of 468 participants were referred to ophthalmology (250 had an abnormal image and 218 were referred by the optometrist). Those referred were predominantly older adults (mean age 70.0 ± 11.4 years), female (66.7%), African American (55.1%) and Hispanic (39.5%). Seventy percent of participants had not had a recent eye exam. Stepwise multivariate logistic regression analysis showed that participants with pre-existing glaucoma (OR 3.14, 95% CI 1.62 to 6.08, p = 0.001), an IOP ≥23 mmHg (OR 5.04, 95% 1.91 to 13.28, p = 0.001), or vision impairment (mild) (OR 2.51, 95% CI 1.68 to 3.77, p = 0.001) had significantly higher odds of being referred to ophthalmology.Conclusion This targeted community-based study in Upper Manhattan provided access to eye care and detected a significant amount of ocular pathology requiring referral to ophthalmology in this high-risk population.Keywords: Community-basedeye health screeningunderserved populationsNew York Cityglaucoma screening AcknowledgmentsWe thank the CDC for funding the Manhattan Vision Screening and Follow-up Study and our project officer, Jinan Saaddine, MD, MPH for her guidance and support for the SIGHTSTUDIES. We thank our Columbia University advisors from the Department of Government and Community Affairs (Ross Frommer, Esq.), Wellness Center (Olajide Williams, MD), School of Nursing (Steven Ferrara, DNP, FNP-BC), Mailman School of Public Health (Linda Fried, MD, MPH), Internal Medicine (Rafael Lantigua, MD), and Occupational Therapy (Phyllis Simon, OTD, OTR/L); New York City community partners: New York City Housing Authority (NYCHA) (Marina Oteiza), NYC Department for the Aging (Lorraine Cortés-Vázquez and Edgar Yu) and Senior Center Directors, NYC Department of Health and Mental Hygiene Falls Prevention Coalition, New York Academy of Medicine, Lighthouse Guild, and Vision Services for the Blind and Visually Impaired and Volk Optical, Inc. We thank Warby Parker for providing eyeglasses. We also thank our Data and Safety Monitoring Board: David S. Friedman, MD, PhD, MPH (Harvard Medical School), Cynthia Owsley, PhD, MPH (University of Alabama Birmingham), Jonathan S. Myers, MD (Wills Eye Hospital), Benjamin E. Leiby, PhD (Jefferson Medical College), David Weiss, PhD (Psychology Specialists of Maine), and Tarun Sharma, MD (Columbia University) for advising us on the study design, clinical decision making, and evaluation of outcomes. We thank our community health workers (Jaqueline Wright and Rachel Wint) for conducting visual acuity tests as well as Alexa M. Kaminsky (Columbia Research Assistant) for assistance with the manuscript preparation and submission.Authors contributionJ.D.H.: Member Medical Policy Council of Superior Vision.D.S.F: Research support- Genentech, Inc.; Speaking honorarium- Thea Pharmaceuticals. Chair- Data Safety Monitoring Board for Manhattan Vision Screening and Follow-Up Study.J.M.L.: Research support- NIH/NEI, Heidelberg Engineering, Novartis, Inc.; Consultant- Allergan, Inc., Genentech, Inc., Thea Pharmaceuticals, Inc., Janssen Pharma, Inc.Disclosure statementNo conflicting relationship exists for any author.Data availability statementAll deidentified participant data, study protocol, statistical plan, and informed consent will be made available by the corresponding author upon email request. The data will be made available with investigator support after approval of a proposal and a signed data access agreement is fully executed. Study materials are available at SIGHTSTUDIES.org.Additional informationFundingThis work was supported by the United States Centers for Disease Control and Prevention, Vision Health Initiative Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia under Grant U01DP006435 and U01DP006436 and an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. The sponsor or funding organization had no role in the design or conduct of this research.