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Sapru S, Price SM, Hark LA, Rhodes LA, Newman-Casey PA. Recruiting Populations at Higher Risk for Glaucoma and Other Eye Diseases Experiencing Eye Health Disparities. Ophthalmic Epidemiol 2024; 31:220-228. [PMID: 37408319 DOI: 10.1080/09286586.2023.2232038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE We compared recruitment of participants at high risk for glaucoma and other eye diseases in three community-based studies designed to improve access to eye care in underserved populations in New York City, Alabama, and Michigan. METHODS We used (1) participant data collected at enrollment (e.g. demographic, medical conditions, healthcare access, and method of hearing about study) and (2) interviews with study staff to assess effective recruitment strategies in enrolling people at high risk for eye disease. We analyzed participant data using descriptive statistics and interview data using content analysis to categorize responses to questions. RESULTS In these community-based studies, all sites recruited greater proportions of populations with increased risk of eye disease compared to their estimates in the US population. High-risk characteristics varied based on the setting (i.e. Federally Qualified Health Centers or affordable housing buildings). Older adults represented 35% to 57%; 43% to 56% identified as Black; 1% to 40% as Hispanic/Latino; 20% to 42% reported a family history of glaucoma; 32% to 61% reported diabetes; and 50% to 67% reported high blood pressure. Social risk factors for under-utilization of eye care due to poverty included that 43% to 70% of participants had high school or lower education; 16% to 40% were employed; and 7% and 31% had no health insurance. From a qualitative perspective, active, personalized, culturally sensitive methods were most effective in recruiting participants. CONCLUSION Implementing eye disease detection interventions in community-based settings facilitated recruiting individuals at high risk for glaucoma and other eye diseases.
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Affiliation(s)
- Saloni Sapru
- Public Health Practice, Westat, Inc, Rockville, MD, USA
| | | | - Lisa A Hark
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Lindsay A Rhodes
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Diamond DF, Hirji S, Xing SX, Gorroochurn P, Horowitz JD, Wang Q, Park L, Harizman N, Maruri SC, Henriquez DR, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services. Graefes Arch Clin Exp Ophthalmol 2024; 262:1619-1631. [PMID: 38189973 DOI: 10.1007/s00417-023-06344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To describe the benefits of optometric evaluation for detection of vision-affecting conditions in the context of community-based eye health screenings and identify factors associated with having a recent dilated eye exam. METHODS Enrolled participants were age 40 and older, living independently in affordable housing developments in New York City. Eye health screening failure and criteria for seeing the on-site study optometrist were defined as visual acuity 20/40 or worse in either eye, intraocular pressure 23-29 mmHg, or an unreadable fundus image. The optometrist conducted a manifest refraction using loose lenses and used a portable slit lamp and ophthalmoscope to perform a non-dilated anterior and posterior segment ocular health evaluation. Demographics, social determinants of health, eye health screening results, and rates of suspected ophthalmic conditions were recorded. To determine factors associated with having a recent dilated eye exam, which was the main outcome for this statistical analysis, a stepwise multivariate logistic regression was performed. RESULTS A total of 708 participants were screened, 308 attended the optometric exam; mean age 70.7 ± 11.7 [standard deviation (SD)] years. Among this subgroup, 70.1% identified as female, 54.9% self-identified as African American, 39% as Hispanic/Latino, and 26.6% Dominican ethnicity; 78.2% (241/308) had not undergone a dilated eye exam within the last year, 71.4% reported they did not have an eye care provider. Stepwise multivariate logistic regression analysis indicated that participants who self-reported having cataracts (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.03-4.47; p = 0.041), self-reported having glaucoma/glaucoma suspect (OR 5.60; 95% CI 2.02-15.43; p = 0.001), or spoke Spanish as their primary language (OR 3.25; 95% CI 1.48-7.11; p = 0.003) had higher odds of having a recent dilated eye exam. CONCLUSIONS This community-based screening initiative demonstrated the effectiveness of optometric exams in detecting vision-affecting conditions and identified factors associated with having a recent dilated eye exam. Optometrists play a vital role in increasing access to eye care for high-risk, underserved populations. TRIAL REGISTRATION ClinicalTrials.gov (NCT04271709).
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Affiliation(s)
- Daniel F Diamond
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sitara Hirji
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Samantha X Xing
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa A Hark
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
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Hark LA, Wang Y, Gorroochurn P, Simon PR, Maruri SC, Henriquez DR, Diamond DF, Horowitz JD, Park L, Wang Q, Auran JD, Carrion J, Friedman DS, Liebmann JL, Cioffi GA, Harizman N. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): a nested cross-sectional assessment of falls risk within a cluster randomised trial. Br J Ophthalmol 2024:bjo-2022-323052. [PMID: 38609163 DOI: 10.1136/bjo-2022-323052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To investigate the feasibility of using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) Falls Risk Tool Kit during community-based eye health screenings to assess falls risk of participants enrolled in the Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT). METHODS Cross-sectional analysis of data from a 5-year prospective, cluster-randomised clinical trial conducted in affordable housing developments in New York City in adults age 40 years and older. Prescreening questions determined whether participants were at risk of falling. STEADI tests classified participants at low, moderate or high risk of falling. Multivariate logistic regression determined odds of falls risk of all enrolled participants. RESULTS 708 participants completed the eye health screening; 351 (49.6%) performed STEADI tests; mean age: 71.0 years (SD±11.3); 72.1% female; 53.6% Black, non-Hispanic, 37.6% Hispanic/Latino. Level of falls risk: 32 (9.1%) low, 188 (53.6%) moderate and 131 (37.3%) high. Individuals age >80 (OR 5.921, 95% CI (2.383 to 14.708), p=0.000), had blurry vision (OR 1.978, 95% CI (1.186 to 3.300), p=0.009), high blood pressure (OR 2.131, 95% CI (1.252 to 3.628), p=0.005), arthritis (OR 2.29876, 95% CI (1.362 to 3.875), p=0.002) or foot problems (OR 5.239, 95% CI (2.947 to 9.314), p=0.000) had significantly higher odds of falling, emergency department visits or hospitalisation due to falling. CONCLUSION This study detected a significant amount of falls risk in an underserved population. The STEADI Falls Risk screening questions were easy for eye care providers to ask, were highly predictive of falls risk and may be adequate for referral to occupational health and/or physical therapy.
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Affiliation(s)
- Lisa A Hark
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Yujia Wang
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Prakash Gorroochurn
- Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Phyllis R Simon
- Occupational Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Daniel F Diamond
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Jason D Horowitz
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Lisa Park
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Qing Wang
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - James D Auran
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | | | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jeffrey L Liebmann
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - George A Cioffi
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
| | - Noga Harizman
- Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S Harkness Eye Institute, New York, NY, USA
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Diamond DF, Kresch YS, Gorroochurn P, Park L, Horowitz JD, Wang Q, Maruri SC, Henriquez DR, Harizman N, Carrion J, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Vision and refractive error results. Clin Exp Optom 2024:1-8. [PMID: 38452798 DOI: 10.1080/08164622.2024.2322523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
CLINICAL RELEVANCE Optometrists can play a key role in providing access to eye care in underserved populations by organising community-based eye health screenings that include optometric exams to detect vision impairment and uncorrected refractive error. BACKGROUND Community-based eye health screenings and optometric exams were conducted in the NYC-SIGHT Study. METHODS A sub-analysis of vision impairment and refractive error results within a 5-year prospective, cluster-randomised clinical trial. Eligible individuals (age ≥40 years) were recruited from 10 affordable housing developments in Upper Manhattan. Developments were randomised into usual care (received glasses prescription only) and intervention (free glasses) groups. Participants with 6/12 visual acuity or worse, intraocular pressure 23-29 mmHg, or an unreadable fundus image were scheduled with the study optometrist for refraction and a non-dilated exam. Visual improvement data were obtained by comparing the presenting acuity at screening compared to the best corrected acuity after refraction by the optometrist. Chi-square, two-sample t-tests, and a stepwise multivariate logistic regression model were used to determined factors associated with improvable visual impairment. RESULTS Seven hundred and eight participants completed screening, 308 received an optometric exam. Those with improvable vision impairment (n = 251), mean age: 69.8 years, 70.5% female, 53% African American, 39.8% Hispanic, >95% had health insurance. Refractive error diagnosed in 87.8% of the participants; lines of improvement: 2 lines (n = 59), 3 to 5 lines (n = 120), and ≥6 lines (n = 72). Stepwise multivariate logistic regression analysis showed that participants with visual acuity 6/12 or worse (odds ratio 16.041, 95% confidence interval 6.009 to 42.822, p = 0.000) or a normal fundus image (odds ratio 2.783, 95% confidence interval 1.001 to 7.740, p = 0.05) had significantly higher odds of improvable vision impairment. CONCLUSION This innovative, targeted community-based study included an optometrist who detected high rates of refractive error and improvable vision impairment in an underserved population living in New York City.
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Affiliation(s)
- Daniel F Diamond
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Yocheved S Kresch
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Michigan Contact Lens Specialists, Oak Park, MI, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jailine Carrion
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa A Hark
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
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Horowitz JD, Adeghate JO, Karani R, Henriquez DR, Gorroochurn P, Sharma T, Park L, Wang Q, Diamond DF, Harizman N, Auran JD, Maruri SC, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study: (NYC-SIGHT)Tele-Retinal Image Findings and Importance of Photography. Telemed J E Health 2024; 30:664-676. [PMID: 37651209 DOI: 10.1089/tmj.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Purpose: To describe tele-retinal abnormality image findings from the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT), which aims to investigate whether community-based eye health outreach strategies using telemedicine can improve visual outcomes among at-risk populations in Upper Manhattan. Methods: A 5-year prospective, cluster-randomized clinical trial was conducted. Eligible individuals aged 40 years and older were recruited from affordable housing developments and senior centers in New York City. Participants underwent on-site eye health screening (best-corrected visual acuity, intraocular pressure [IOP] measurements, and fundus photography). Fundus images were graded via telemedicine by a retina specialist. Multivariate logistic regression modeling was used to assess the factors associated with abnormal retinal findings requiring referral to ophthalmology. Results: Participants with a retinal abnormality on fundus photography (n = 157) were predominantly older adults, with a mean age of 68.4 ± 11.1 years, female (63.7%), African American (50.3%), and Hispanic (43.3%). A total of 32 participants in our study passed the vision and IOP screening but had an abnormal retinal image and ocular pathology that would have been missed without fundus photography. Individuals who self-identified as having preexisting glaucoma (odds ratio [OR] = 3.749, 95% confidence interval [CI] = 1.741-8.074, p = 0.0001) and had severe vision impairment (OR = 4.1034, 95% CI = 2.0740-8.1186, p = 0.000) at the screening had significantly higher odds of having an abnormal retinal image. Conclusion: This community-based study targeted populations at-risk for eye disease, improved access to eye care, detected a significant number of retinal image abnormalities requiring follow-up by using telemedicine, and provided evidence of the importance of fundus photography during eye health screenings. CTR number: NCT04271709.
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Affiliation(s)
- Jason D Horowitz
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Jennifer O Adeghate
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Rabia Karani
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Tarun Sharma
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Qing Wang
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Daniel F Diamond
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Noga Harizman
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
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Morse AR, Hark LA, Gorroochurn P, Rojas R, Seiple WH, Shukla AG, Wang Y, Maruri SC, Henriquez DR, Harizman N, Wang Q, Liebmann JM, Cioffi GA. Association of Psychosocial Factors with Activation Among Patients with Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00027-9. [PMID: 38320666 DOI: 10.1016/j.ogla.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with primary open-angle glaucoma (POAG). DESIGN Prospective cross-sectional cohort study. PARTICIPANTS Patients (n = 202) with mild, moderate, or advanced bilateral POAG. METHODS Patients (N = 1164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a social determinants of health questionnaire were administered by phone to 202 study participants. MAIN OUTCOME MEASURES The National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4, the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), a health literacy question, and a social determinants of health questionnaire. RESULTS For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (P < 0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (R2 = 5.3%; P = 0.001; 95% confidence interval [CI], 0.077-0.276). For each unit increase in "Internal" on the MHLC, mean PAM score increased (R2 = 19.3%; 95% CI, 0.649-1.166; P < 0.001). For each unit increase in "Doctors" on the MHLC, mean PAM score increased (R2 = 11.0%; 95% CI, 1.555-3.606; P < 0.001). For each unit increase in "Chance" on the MHLC, mean PAM score decreased (R2 = 2.6%; 95% CI, -0.664 to -0.051; P = 0.023). On multivariate analysis, adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI, 0.061-1.35; P = 0.032); for each unit increase in MHLC "Doctors", mean PAM score increased (95% CI, -1.448 to 3.453; P < 0.001); for each unit increase in MHLC "Internal", mean PAM score increased (95% CI, 0.639-1.137; P < 0.001); for each unit increase in MHLC "Chance", mean PAM score decreased (95% CI, -0.685 to -0.098; P = 0.009). CONCLUSIONS We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes, and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alan R Morse
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York.
| | - Lisa A Hark
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Rebecca Rojas
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - William H Seiple
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York; Lighthouse Guild, New York, New York
| | - Aakriti G Shukla
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Yujia Wang
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Noga Harizman
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Qing Wang
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jeffrey M Liebmann
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
| | - George A Cioffi
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York; Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
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Hark LA, Lin WV, Hirji S, Gorroochurn P, Horowitz JD, Diamond DF, Park L, Wang Q, Auran JD, Maruri SC, Henriquez DR, Sharma T, Valenzuela I, Liebmann JM, Cioffi GA, Friedman DS, Harizman N. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): Subanalysis of Referral to Ophthalmology. Curr Eye Res 2024; 49:197-206. [PMID: 37812506 DOI: 10.1080/02713683.2023.2269614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/08/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE 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.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Weijie Violet Lin
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sitara Hirji
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel F Diamond
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - James D Auran
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Ives Valenzuela
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - David S Friedman
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, MA, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
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8
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Newman-Casey PA, Hark LA, Rhodes LA. It Is Time to Rethink Adult Glaucoma Screening Recommendations. J Glaucoma 2023; 32:69-71. [PMID: 36696354 PMCID: PMC10108578 DOI: 10.1097/ijg.0000000000002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/20/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center University of Michigan, Ann Arbor, MI
| | - Lisa A Hark
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY
| | - Lindsay A Rhodes
- Department of Ophthalmology and Visual Sciences University of Alabama at Birmingham, Birmingham, AL
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Hark LA, Horowitz JD, Gorroochurn P, Park L, Wang Q, Diamond DF, Harizman N, Auran JD, Maruri SC, Henriquez DR, Carrion J, Muhire RSM, Kresch YS, Pizzi LT, Jutkowitz E, Sapru S, Sharma T, De Moraes CG, Friedman DS, Liebmann JM, Cioffi GA. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Baseline Results and Costs of a Cluster-Randomized Trial. Am J Ophthalmol 2023; 251:12-23. [PMID: 36690289 DOI: 10.1016/j.ajo.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe the 15-month baseline results and costs of the Manhattan Vision Screening and Follow-up Study, which aims to investigate whether innovative community-based eye health screening can improve early detection and management of glaucoma and other eye diseases among high-risk populations. DESIGN 5-year prospective, cluster-randomized controlled trial. METHODS Individuals age 40+ were recruited from public housing buildings in New York City for an eye health screening (visual acuity (VA) with correction, intraocular pressure measurements (IOP), and fundus photography). Participants with VA 20/40 or worse, IOP 23-29 mmHg, or an unreadable fundus image failed the screening and were scheduled for an optometric exam at the same location; those with an abnormal image were referred to ophthalmology. A cost analysis was conducted alongside the study. RESULTS 708 participants were screened; mean age 68.6±11.9 years, female (65.1%), African American (51.8%) and Hispanic (42%). 78.4% (n = 555) failed the eye health screening; 35% (n= 250) had an abnormal image and were also referred to ophthalmology. 308 participants attended the optometric exam; 218 were referred to ophthalmology. Overall, 66.1% were referred to ophthalmology. The cost per participant to deliver the eye health screening and optometric exam was $180.88. The cost per case of eye disease detected was $273.64. CONCLUSIONS This innovative study in public housing developments targeted high-risk populations, provided access to eye-care, and improved early detection of ocular diseases in New York City. The study has identified strategies to overcoming barriers to eye care to reduce eye health disparities.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York.
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168(th) Street, New York, NY 10032
| | - Lisa Park
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Qing Wang
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Daniel F Diamond
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Noga Harizman
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - James D Auran
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Jailine Carrion
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Remy S Manzi Muhire
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Yocheved S Kresch
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York; Kresge Eye Institute, Wayne State University School of Medicine, 4717 St Antoine, Detroit, MI 48201
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 21 S. Main Street, Providence, RI 02903
| | - Saloni Sapru
- Westat Public Health and Epidemiology Practice, 1600 Research Blvd., Rockville, MD 20850
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Glaucoma Service, 243 Charles Street, Boston, MA 02114
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - George A Cioffi
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
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10
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Tran E, Sanvicente C, Hark LA, Myers JS, Zhang Q, Shiuey EJ, Tran J, Bonafede L, Hamershock RA, Withers C, Katz LJ. Educational intervention to adopt selective laser trabeculoplasty as first-line glaucoma treatment: Randomized controlled trial: Educational intervention on selective laser trabeculoplasty. Eur J Ophthalmol 2021; 32:1538-1546. [PMID: 34041935 DOI: 10.1177/11206721211018365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the efficacy of an educational intervention on patient adoption and attitudes toward selective laser trabeculoplasty (SLT) as first-line treatment for glaucoma. METHODS This study is a randomized controlled trial. Subjects include 33 patients within 1-year diagnosis of either primary open-angle glaucoma, ocular hypertension, or pseudoexfoliation syndrome. After informed consent, subjects were randomly assigned to a Usual Care or Educational Intervention group. All subjects completed a pre-intervention questionnaire. The Educational Intervention group was shown a slideshow presentation and a 3-min video and given a post-intervention questionnaire. Follow-up examinations were reviewed for 6 months to determine subject completion of SLT, the primary outcome. Secondary outcomes include assessment of attitude toward SLT before and after intervention. RESULTS Age, gender, and baseline characteristics between the groups did not differ. The Usual Care group had a higher proportion of African Americans (77% vs 31%, p = 0.04). At 6 months following the intervention, 63% of subjects underwent SLT compared to 35% of Usual Care subjects (p = 0.12). Older age was associated with decreased SLT uptake (OR 0.90, 95% CI 0.82-0.99, p = 0.03). Prior to the intervention, there were no differences in attitudes of both groups regarding SLT therapy. Nineteen percent of Educational Intervention subjects changed positively toward SLT (p = 0.08) and 50% scheduled an SLT appointment after intervention (p = 0.005). CONCLUSIONS A slideshow and video-based educational intervention may positively enhance patient adoption of SLT.Clinical trial registration name, number, URL: Educational Intervention to Adopt SLT as First-Line Glaucoma Treatment, NCT03365778, https://clinicaltrials.gov/ct2/show/NCT03365778.
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Affiliation(s)
- Evelyn Tran
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan S Myers
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Qiang Zhang
- Vickie and Jack Farber Vision Research Center, Biostatistics Consulting Core, Wills Eye Hospital, Philadelphia, PA, USA
| | - Eric J Shiuey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Judie Tran
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Lucas Bonafede
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Rose A Hamershock
- Vickie and Jack Farber Vision Research Center, Biostatistics Consulting Core, Wills Eye Hospital, Philadelphia, PA, USA
| | - Colleen Withers
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - L Jay Katz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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11
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Leiby BE, Hegarty SE, Zhan T, Myers JS, Katz LJ, Haller JA, Waisbourd M, Burns C, Divers M, Molineaux J, Henderer J, Brodowski C, Hark LA. A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma. Prev Chronic Dis 2021; 18:E52. [PMID: 34014814 PMCID: PMC8139485 DOI: 10.5888/pcd18.200567] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appointments. Methods A randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then randomized to enhanced intervention (EI) or usual care (UC). Data on participants’ visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely attendance at the first visit with the local ophthalmologist and adherence to recommended follow-up visits. Results Timely attendance at the first visit was higher for EI than UC (74.4% vs 39.0%; average relative risk [aRR] = 1.85; 95% CI, 1.51–2.28; P < .001). Rates of adherence to recommended annual follow-up during year 1 were 18.6% in the EI group and 8.1% in the usual care group (aRR = 2.08; 95% CI, 1.14–3.76; P = .02). The aRR across years 2 and 3 was 3.92 (95% CI, 1.24–12.43; P = .02). Conclusion An intervention using patient navigators and social workers doubled the rate of adherence to annual recommended follow-up eye care compared with usual care in community settings, and was effective at increasing connections with local ophthalmologists. Interventions to further improve long-term adherence are needed.
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Affiliation(s)
- Benjamin E Leiby
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Sarah E Hegarty
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania.,Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Ste 1110, Philadelphia PA 19107.
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Julia A Haller
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania.,Wills Eye Hospital, Office of the Ophthalmologist-in-Chief, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Department of Ophthalmology, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Christine Burns
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Meskerem Divers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jeanne Molineaux
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jeffrey Henderer
- Temple University School of Medicine, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Charles Brodowski
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Columbia University Irving Medical Center, Department of Ophthalmology, New York, New York
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12
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Hark LA, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Stidham EM, Banks AZ, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology. J Glaucoma 2021; 30:388-394. [PMID: 33492894 DOI: 10.1097/ijg.0000000000001795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
PRCIS The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. PURPOSE To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. MATERIALS AND METHODS This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. CONCLUSION This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Yocheved S Kresch
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Carlos Gustavo De Moraes
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jason D Horowitz
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Lisa Park
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - James D Auran
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | | | - Aisha Z Banks
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | | | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ
| | - Saloni Sapru
- Westat, Public Health and Epidemiology Practice, Rockville, MD
| | - Simani Price
- Westat, Public Health and Epidemiology Practice, Rockville, MD
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, Columbia University
| | - George A Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
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13
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Affiliation(s)
- Carlos Gustavo De Moraes
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Jinan Saaddine
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Vision Health Initiative, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
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14
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Hark LA, Tan CS, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Besagar S, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results. Curr Eye Res 2021; 46:1597-1604. [PMID: 33726583 DOI: 10.1080/02713683.2021.1905000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care.Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers.Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses.Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Camille S Tan
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Yocheved S Kresch
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Sonya Besagar
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Bianca C Lambert
- Department of General Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, New Brunswick, New Jersey, USA
| | - Saloni Sapru
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Simani Price
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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15
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Mayro EL, Murchison AP, Hark LA, Silverstein M, Wang OY, Gilligan JP, Leiby BE, Pizzi LT, Casten RJ, Rovner BW, Haller JA. Prevalence of depressive symptoms and associated factors in an urban, ophthalmic population. Eur J Ophthalmol 2020; 31:740-747. [PMID: 31983234 DOI: 10.1177/1120672120901701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of depressive symptoms in an adult ophthalmic patient population and to delineate correlates. DESIGN Cross-sectional study. PARTICIPANTS Adult patients (⩾18 years) were approached in general and sub-specialty cornea, retina, and glaucoma ophthalmic clinics. A total of 367 patients from the four clinics were enrolled. METHODS Depressive symptoms were assessed using the Patient Health Questionnaire-9. A cut-off score of ⩾10 was used to indicate clinically significant depressive symptoms. Patient Health Questionnaire-9 scores were used to evaluate bivariate relationships between depressive symptoms and distance visual acuity, ocular diagnosis, diabetes status, smoking status, demographic information, and medications. RESULTS The majority of patients were female (52.9%) and Caucasian (48.6%). The mean age was 52.0 years (standard deviation: 16.7). Clinically significant depressive symptoms were present in 19.9% of patients overall; this rate varied slightly by clinic. Patients with low vision and blindness (visual acuity worse than 20/60) were more likely to have depressive symptoms (odds ratio = 2.82; 95% confidence interval: 1.90-4.21). Smoking and diabetes were also associated with depressive symptoms (odds ratio = 3.11 (2.66-3.64) and 3.42 (1.90-6.16), respectively). CONCLUSION In a sample of urban ophthalmic adult patients, depressive symptoms were highly associated with low vision, smoking, and diabetes. This information can be used to target interventions to those at greatest risk of depressive symptoms.
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Affiliation(s)
- Eileen L Mayro
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA.,Vagelos College of Physicians and Surgeons and Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Marlee Silverstein
- Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Olivia Y Wang
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - John P Gilligan
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ, USA
| | - Robin J Casten
- Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
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16
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Hark LA, Adeghate J, Katz LJ, Ulas M, Waisbourd M, Maity A, Zhan T, Hegarty S, Leiby BE, Pasquale LR, Leite S, Saaddine JB, Haller JA, Myers JS. Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract Classifications Following Eye Screening. Telemed J E Health 2019; 26:992-1000. [PMID: 31721654 DOI: 10.1089/tmj.2019.0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life.
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Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Columbia University Vagelos College of Physicians and Surgeons, Edward S. Harkness Eye Institute, New York, New York, USA
| | - Jennifer Adeghate
- University of Pittsburgh, Department of Ophthalmology, Pittsburgh, Pennsylvania, USA
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mikdat Ulas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Waisbourd
- Division of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Alisha Maity
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Louis R Pasquale
- Icahn School of Medicine at Mount Sinai, Department of Ophthalmology, New York, New York, USA
| | - Stela Leite
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes and Translational Research, Vision Health Initiative, Atlanta, Georgia, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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17
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Hark LA, Radakrishnan A, Madhava M, Anderson-Quiñones C, Fudemberg S, Robinson D, Myers JS, Zhan T, Adeghate J, Hegarty S, Leite S, Leiby BE, Stempel S, Katz LJ. Awareness of ocular diagnosis, transportation means, and barriers to ophthalmology follow-up in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. Soc Work Health Care 2019; 58:651-664. [PMID: 31120381 DOI: 10.1080/00981389.2019.1614711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/15/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The purpose of this study was to assess factors affecting follow-up eye care in participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, such as awareness of ocular diagnosis, availability of transportation methods, and reasons for missing eye care appointments. Methods: The sample included 172 participants who were randomized to the intervention group and contacted by the social worker. Results: A total of 155 participants completed the assessment form, which was used as an instrument to assess factors affecting adherence to follow-up eye care. The main reasons for missing eye exam appointments were feeling ill (38.1%, n = 59) and forgetting the appointment (34.2%, n = 53). In addition, 45 (29.2%) participants were unaware of or did not comprehend the severity of their ocular diagnosis. Common methods of transportation included public transportation (31.6%, n = 49), driving (29.7%, n = 46), and being driven (27.7%, n = 43) to their appointment. Conclusion: These results suggest that individuals in need of eye care may benefit from additional assistance of a social worker regarding ongoing eye exam appointment reminders and in-depth explanation of their ocular diagnosis.
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Affiliation(s)
- Lisa A Hark
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- b Department of Ophthalmology , Columbia University Irving Medical Center , New York , NY , USA
| | - Anjithaa Radakrishnan
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Malika Madhava
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Catherine Anderson-Quiñones
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Scott Fudemberg
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Debra Robinson
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
| | - Jonathan S Myers
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Tingting Zhan
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Jennifer Adeghate
- e Department of Ophthalmology , Weill Cornell Medical College , New York , NY , USA
| | - Sarah Hegarty
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Stela Leite
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
| | - Benjamin E Leiby
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Stella Stempel
- b Department of Ophthalmology , Columbia University Irving Medical Center , New York , NY , USA
| | - L Jay Katz
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
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18
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Cui QN, Gogt P, Lam JM, Siraj S, Hark LA, Myers JS, Katz LJ, Waisbourd M. Validation and reproducibility of the Heidelberg Edge Perimeter in the detection of glaucomatous visual field defects. Int J Ophthalmol 2019; 12:577-581. [PMID: 31024809 DOI: 10.18240/ijo.2019.04.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/29/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To validate the ability of the Heidelberg Edge Perimeter (HEP) in detecting glaucomatous visual field (VF) defects compared to the Octopus Visual Field (OVF) Analyzer and to determine the test-retest repeatability of both modalities. METHODS This prospective, cross-sectional study was conducted at Wills Eye Hospital, Philadelphia, PA. Glaucoma subjects and unaffected controls underwent VF testing using HEP standard automated perimetry (SAP) III 30-2 Adaptive Staircase Thresholding Algorithm (ASTA) FAST protocol and OVF G-TOP white-on-white strategy. Testing order was randomized. Pearson's correlation coefficient was calculated for both mean deviation (MD) and pattern standard deviation/square root of loss of variance (PSD/sLV). Receiver operating characteristic (ROC) curves were used to determine the diagnostic abilities of both modalities. Glaucoma subjects returned for repeat testing and intraclass correlation coefficients (ICCs) were calculated to assess test-retest repeatability. RESULTS Seventy-nine subjects with glaucoma and 36 unaffected controls were enrolled. HEP and OVF were significantly correlated for both MD (r=-0.84; P<0.01) and PSD/sLV (r=0.79; P<0.01). Areas under the ROC curves (AUCs) were also comparable between HEP and OVF for both MD (0.74 and 0.79, respectively; P=0.26) and PSD/sLV (0.74 and 0.82; P=0.08). ICC was high for both HEP (0.96 for MD, 0.95 for PSD/sLV) and OVF (0.82 and 0.88, respectively). Mean test duration (min) was significantly shorter for OVF (2.63) compared to HEP (5.15; P<0.01). CONCLUSION HEP and OVF show strong correlation for both MD and PSD/sLV, and have similar validity for detecting glaucoma. The test-retest repeatability is high for both HEP and OVF, however the average testing duration of HEP is significantly longer than that of OVF.
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Affiliation(s)
- Qi N Cui
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA.,Scheie Eye Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Priyanka Gogt
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Jonathan M Lam
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Safa Siraj
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA 19107, USA.,Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
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19
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Hark LA, Myers JS, Ines A, Jiang A, Rahmatnejad K, Zhan T, Leiby BE, Hegarty S, Fudemberg SJ, Mantravadi AV, Waisbourd M, Henderer JD, Burns C, Divers M, Molineaux J, Pizzi LT, Murchison AP, Saaddine J, Pasquale LR, Haller JA, Katz LJ. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses. Br J Ophthalmol 2019; 103:1820-1826. [PMID: 30770354 DOI: 10.1136/bjophthalmol-2018-313451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. RESULTS Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. CONCLUSIONS This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg. TRIAL REGISTRATION NUMBER NCT02390245.
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Affiliation(s)
- Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA .,Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Ines
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alicia Jiang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott J Fudemberg
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand V Mantravadi
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey D Henderer
- Ophthalmology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Christine Burns
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Meskerem Divers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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20
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Hark LA, Madhava M, Radakrishnan A, Anderson-Quiñones C, Robinson D, Adeghate J, Silva S, Zhan T, Adepoju T, Dave Y, Fudemberg SJ. Impact of a Social Worker in a Glaucoma Eye Care Service: A Prospective Study. Health Soc Work 2019; 44:48-56. [PMID: 30561635 DOI: 10.1093/hsw/hly038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to evaluate the effects of a six-month social worker intervention for participants with a glaucoma-related diagnosis in an urban ophthalmic setting (N = 40). The social worker assessed common barriers to eye care, helping participants with transportation, access to low-vision resources, and supportive counseling. The Distress Thermometer, Patient Health Questionnaire-9, and a satisfaction survey were administered to determine the effect of the social worker intervention and participants' overall impressions of the social worker. The most common barrier to eye care was emotional distress (77.5 percent). There was a significant decrease in the number of participants with symptoms of major and moderate depression. Fourteen participants experienced a clinically relevant decrease in depression, 37 participants felt that the social worker's support addressed their issues, and 29 participants thought it helped them in managing their glaucoma. This study provides evidence that a social work intervention may improve care coordination and management of individuals afflicted with vision impairment due to glaucoma and other ocular diseases.
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Affiliation(s)
- Lisa A Hark
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Malika Madhava
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Anjithaa Radakrishnan
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Catherine Anderson-Quiñones
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Debra Robinson
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Jennifer Adeghate
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Stephen Silva
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Tingting Zhan
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Tomilade Adepoju
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Yatee Dave
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
| | - Scott J Fudemberg
- Lisa A. Hark, PhD, RD, is professor of ophthalmic sciences, administrative director of Jonas Children's Vision Care, and director of the Clinical Trials Unit, Irving Medical Center, Columbia University, 635 West 165th Street, Mailbox 10, New York, NY 10032; e-mail: . Malika Madhava, BS; Anjithaa Radakrishnan, BS, are medical students, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Catherine Anderson-Quiñones, BM, is study coordinator, Glaucoma Research Center, Wills Eye Hospital, Philadelphia. Debra Robinson, MSS, LSW, is a medical social worker, Generations Life Care, Chadds Ford, PA. Jennifer Adeghate, MD, is resident physician, Department of Ophthalmology, Weill Cornell Medical Center, New York. Stephen Silva, MD, is orthopedic resident (surgery), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia. Tingting Zhan, PhD, is a biostatistician, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia. Tomilade Adepoju, MD, is medical doctor and ophthalmology resident, Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY. Yatee Dave, BA, is a medical student, Robert Wood Johnson Medical School, Rutgers University, Piscataway Township, NJ. Scott J. Fudemberg, MD, is ophthalmologist and glaucoma specialist, Glaucoma Research Center, Wills Eye Hospital, Philadelphia
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Mayro EL, Pizzi LT, Hark LA, Murchison AP, Wisner D, Koka A, Leiby BE, Dabbish N, Okulate A, Dessy A, Green C, Bailey R. A Proposed Intervention to Decrease Resident-Performed Cataract Surgery Cancellation in a Tertiary Eye Care Center. Am Health Drug Benefits 2018; 11:480-487. [PMID: 30746019 PMCID: PMC6322594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/15/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cataracts are the leading cause of preventable blindness globally. As a result, competence in cataract surgery is an important component of ophthalmology residency training. Residency programs must optimize the number of cataract surgery cases to train proficient physicians. However, the rate of cataract surgery cancellations is high, and some are canceled because of preventable causes. OBJECTIVE To evaluate the effect of mandatory on-site preadmission testing, including having a physical examination, on resident-performed cataract surgery cancellation rates. METHODS For this study, patients scheduled for cataract surgery at the Wills Eye Hospital resident cataract clinic between January 2015 and November 2015 were enrolled and randomized into 2 groups: usual care or intervention. The patients randomized to the usual care group were instructed to complete preadmission testing and to have a physical examination with their primary care physician. The patients randomized to the intervention group were escorted to a Wills Eye Hospital-affiliated cardiologist to complete preadmission testing and to have a physical examination. Patients in both groups received a reminder call before the cataract surgery. RESULTS A total of 441 patients were included in the study-240 patients in the usual care group and 201 patients in the intervention group. The overall cataract surgery cancellation rate was 14.5%; the rate was 12.4% in the intervention group and 16.3% in the usual care group (P = .28). The patients receiving the intervention were more likely to have preadmission testing and a physical examination than the patients in the usual care arm (P <.001). CONCLUSIONS Facilitating the completion of preadmission testing for patients decreased the rates of resident-performed cataract surgery cancellation at a Wills Eye Hospital resident clinic and has the potential to improve patient outcomes and prevent blindness.
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Affiliation(s)
- Eileen L Mayro
- Research Coordinator, Department of Research, Wills Eye Hospital, Philadelphia, PA, and Student, Sidney Kimmel Medical College, Thomas Jefferson University (TJU), Philadelphia
| | - Laura T Pizzi
- Professor and Director, Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ
| | - Lisa A Hark
- Director, Department of Research, Wills Eye Hospital, and Professor of Ophthalmic Sciences (Ophthalmology), Columbia University Vegalos College of Physicians and Surgeons, New York, NY
| | - Ann P Murchison
- Attending Surgeon and Director, Emergency Department, Wills Eye Hospital, and Associate Professor of Ophthalmology, Sidney Kimmel Medical College, TJU
| | - Douglas Wisner
- Attending Surgeon, Cataract and Primary Eye Care Service, Wills Eye Hospital
| | - Anish Koka
- Attending Physician, Koka Cardiology, TJU
| | - Benjamin E Leiby
- Associate Professor and Director, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, TJU
| | - Nooreen Dabbish
- Biostatistician, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, TJU
| | | | - Alexa Dessy
- Students, all at Sidney Kimmel Medical College, TJU
| | | | - Robert Bailey
- Attending Surgeon and Director, Cataract and Primary Eye Care Service, Wills Eye Hospital and Professor of Ophthalmology, Sidney Kimmel Medical College, TJU
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Hark LA, Shiuey E, Yu M, Tran E, Mayro EL, Zhan T, Pond M, Tran J, Siam L, Levin AV. Efficacy and outcomes of a summer-based pediatric vision screening program. J AAPOS 2018; 22:309.e1-309.e7. [PMID: 30012459 DOI: 10.1016/j.jaapos.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the prevalence of decreased visual acuity and uncorrected refractive error in school-aged children participating in summer programs. METHODS During the summers of 2014-2016, Wills Eye Hospital collaborated with summer programs in Philadelphia to provide vision screenings for underserved children. Parental consent was obtained prior to vision screening. Fail criteria included children in grades K-1 (ages 5-6) with visual acuity worse than 20/40 in either eye, children in grades 2-6 (ages 7-13) with visual acuity worse than 20/30 in either eye, or children with ≥2 lines of interocular difference. If decreased visual acuity was correctable to ≥20/30 by the onsite optometrist, two pairs of free eyeglasses were provided. Children with other ocular abnormalities were referred to pediatric ophthalmology. RESULTS Of 1,627 children screened, 360 children (22.1%) did not pass vision screening, and 64 (3.9%) were referred. The prevalence of decreased distance visual was 34.1%. Younger children were more likely to have worse visual acuity than older children (OR = 0.943; P = 0.023; 95% CI, 0.896-0.992). Myopia (73%), astigmatism (56.8%), hyperopia (15.5%), spherical anisometropia (12.5%), and cylindrical anisometropia (11.9%) presented in the 303 children who underwent a manifest refraction. Myopia increased with age (OR = 0.818; P = 0.001; 95% CI, 0.724-0.922), whereas astigmatism decreased (OR = 0.817; P < 0.001; 95% CI, 0.728-0.913) with age. Two pairs of glasses were provided to 301 children. CONCLUSIONS Partnership with summer programs and other community initiatives to provide vision screenings facilitates access to eye care ultimately aimed at improving social functioning and academic performance.
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Affiliation(s)
- Lisa A Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Columbia University Medical Center, New York
| | - Eric Shiuey
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Yu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Evelyn Tran
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eileen L Mayro
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Pond
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Judie Tran
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Linda Siam
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alex V Levin
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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23
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Thau AJ, Rohn MC, Biron ME, Rahmatnejad K, Mayro EL, Gentile PM, Waisbourd M, Zhan T, Hark LA. Depression and quality of life in a community-based glaucoma-screening project. Can J Ophthalmol 2018; 53:354-360. [DOI: 10.1016/j.jcjo.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/19/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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24
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Mayro EL, Hark LA, Shiuey E, Pond M, Siam L, Hill-Bennett T, Tran J, Khanna N, Silverstein M, Donaghy J, Zhan T, Murchison AP, Levin AV. Prevalence of uncorrected refractive errors among school-age children in the School District of Philadelphia. J AAPOS 2018; 22:214-217.e2. [PMID: 29660392 DOI: 10.1016/j.jaapos.2018.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the prevalence and severity of uncorrected refractive errors in school-age children attending Philadelphia public schools. METHODS The Wills Eye Vision Screening Program for Children is a community-based pediatric vision screening program designed to detect and correct refractive errors and refer those with nonrefractive eye diseases for examination by a pediatric ophthalmologist. Between January 2014 and June 2016 the program screened 18,974 children in grades K-5 in Philadelphia public schools. Children who failed the vision screening were further examined by an on-site ophthalmologist or optometrist; children whose decreased visual acuity was not amenable to spectacle correction were referred to a pediatric ophthalmologist. RESULTS Of the 18,974 children screened, 2,492 (13.1%) exhibited uncorrected refractive errors: 1,776 (9.4%) children had myopia, 459 (2.4%) had hyperopia, 1,484 (7.8%) had astigmatism, and 846 (4.5%) had anisometropia. Of the 2,492 with uncorrected refractive error, 368 children (14.8%) had more than one refractive error diagnosis. In stratifying refractive error diagnoses by severity, mild myopia (spherical equivalent of -0.50 D to < -3.00 D) was the most common diagnosis, present in 1,573 (8.3%) children. CONCLUSIONS In this urban population 13.1% of school-age children exhibited uncorrected refractive errors. Blurred vision may create challenges for students in the classroom; school-based vision screening programs can provide an avenue to identify and correct refractive errors.
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Affiliation(s)
- Eileen L Mayro
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Columbia University Medical Center, New York
| | - Eric Shiuey
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Pond
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Linda Siam
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Judie Tran
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Nitasha Khanna
- Division of Ophthalmology, Brown University, Providence, Rhode Island
| | - Marlee Silverstein
- Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Donaghy
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ann P Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alex V Levin
- Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania; Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
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25
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Cui QN, Fudemberg SJ, Resende AF, Vu TA, Zhou C, Rahmatnejad K, Hark LA, Myers JS, Katz LJ, Waisbourd M. Validation of the structure–function correlation report from the heidelberg edge perimeter and spectral-domain optical coherence tomography. Int Ophthalmol 2018; 39:533-540. [DOI: 10.1007/s10792-018-0836-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
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Abstract
PURPOSE To determine what metrics might impact satisfaction survey responses. METHODS A 37-question survey was administered to 249 participants. Responses were correlated to demographics, clinical factors, weather conditions, and examination timing. RESULTS Sample consists of 55.4% female and 73.9% white, and mean age was 65.1 years. Participants were assigned to: completely satisfied (77.9%) or not completely satisfied (22.1%) groups based on their rating of glaucoma specialist on a scale of 1-10, while 10 considered "completely satisfied" and less than 10 "not completely satisfied." Complete satisfaction was associated with ability to schedule appointments early, phone calls answered/returned same day, shorter perceived wait time, and better communication skills of ophthalmologist (p < 0.05). Completely satisfied participants reported their ophthalmologist spent enough time with them, listened carefully, and communicated in an understandable way (p < 0.05). CONCLUSIONS The majority of factors found to be associated with patient satisfaction were related to characteristics of the ophthalmologists and their office.
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Affiliation(s)
- Kamran Rahmatnejad
- a Wills Eye Hospital , Glaucoma Research Center , Philadelphia , PA , USA
| | - Jonathan S Myers
- a Wills Eye Hospital , Glaucoma Research Center , Philadelphia , PA , USA.,b Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
| | - Megan E Falls
- b Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
| | - Sarah R Myers
- a Wills Eye Hospital , Glaucoma Research Center , Philadelphia , PA , USA
| | - Michael Waisbourd
- a Wills Eye Hospital , Glaucoma Research Center , Philadelphia , PA , USA.,b Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
| | - Lisa A Hark
- a Wills Eye Hospital , Glaucoma Research Center , Philadelphia , PA , USA.,b Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
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27
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Fudemberg SJ, Amarasekera DC, Silverstein MH, Linder KM, Heffner P, Hark LA, Waisbourd M. Overcoming Barriers to Eye Care: Patient Response to a Medical Social Worker in a Glaucoma Service. J Community Health 2018; 41:845-9. [PMID: 26860278 DOI: 10.1007/s10900-016-0162-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper investigates the patient response to a medical social worker in a glaucoma clinic. The literature suggests that medical social workers are effective in a variety of health care settings, yet the efficacy of a medical social worker in an adult ophthalmic setting has not been studied. We present the results of a retrospective chart review of 50 patients with glaucoma referred to a medical social worker between January 5, 2015 and June 31, 2015 in an outpatient clinic of an urban eye hospital. Clinical and demographic data, as well as the data from a quality of care questionnaire, were collected for each patient. Patients rated their interaction with the medical social worker as highly positive (mean = 4.75, 5-point Likert scale), and nearly 90 % of patients expressed interest in future contact with the social worker. Additionally, most patients reported that the social worker resolved the issues they were facing (61.1 %), supported them in seeing their ophthalmologist (70.6 %), and helped them to manage their glaucoma (69.7 %). Reported barriers to glaucoma care were emotional distress; cost of office visits and medications; lack of medical insurance; transportation; poor medication adherence; impairment of daily activities; follow-up adherence; and language. As vision loss from glaucoma is irreversible, it is important to detect and treat patients at early stages of the disease. Therefore, it is imperative for patients to regularly visit their eye care providers and adhere to treatment and follow-up recommendations. This study suggests that a medical social worker could play a pivotal role in helping patients with glaucoma overcome barriers to treatment and facilitate disease management.
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Affiliation(s)
- Scott J Fudemberg
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, 19107, USA
| | | | | | - Kathryn M Linder
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, 19107, USA
| | - Paul Heffner
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, 19107, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, 19107, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, 19107, USA.
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28
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Lin SC, Zheng CX, Waisbourd M, Molineaux J, Zeng L, Zhan T, Rahmatnejad K, Resende A, Mantravadi AV, Hark LA, Moster MR, Markoff JI, Spaeth GL, Katz LJ. Visual Field Changes in Professional Wind versus Non-wind Musical Instrument Players in the Philadelphia Orchestra. J Ophthalmic Vis Res 2018; 13:224-230. [PMID: 30090176 PMCID: PMC6058539 DOI: 10.4103/jovr.jovr_155_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: We compare the prevalence of glaucoma in professional wind versus non-wind instrument players in the Philadelphia Orchestra. Visual field changes in individuals with glaucoma and glaucoma suspects were evaluated, and the results were correlated with cumulative practice time. Methods: In this cross-sectional, observational study, fifty-one Philadelphia Orchestra musicians were enrolled and categorized as wind or non-wind instrument players. All study participants underwent screening fundus photography. Participants with optic discs suspicious for glaucoma underwent further evaluation, including standard automated visual field perimetry and a comprehensive eye examination by a glaucoma specialist. Results: Of the 51 musicians enrolled, 9 of the 21 wind instrument players (43%) and 8 of the 30 non-wind instrument players (27%) were suspected of developing glaucoma in at least one eye (P = 0.25), with examinations performed on 12 of the 17 returning musicians (71%) for further confirmation. Wind instrument players exhibited significantly higher Octopus visual field mean defect scores (1.08 ± 1.5 dB) than non-wind instrument players (−0.43 ± 0.7 dB; P < 0.001). There was a significant association between cumulative hours playing wind instruments and visual field mean defect (P < 0.001). Conclusion: Among members of the Philadelphia Orchestra, the difference in prevalence of glaucoma suspicious optic discs between wind and non-wind instrument players was not significant. The clinical significance of the greater visual field mean defect found in wind instrument players, and the association between the degree of visual field mean defect and the cumulative practice-time of playing wind instruments, needs further investigation.
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Affiliation(s)
- Shuai-Chun Lin
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Cindy X Zheng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - Jeanne Molineaux
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Lichuan Zeng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Arthur Resende
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - Lisa A Hark
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA
| | - Marlene R Moster
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Joseph I Markoff
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - George L Spaeth
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - L Jay Katz
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
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Waisbourd M, Bond EA, Sullivan T, Hu WD, Shah SB, Molineaux J, Sembhi H, Spaeth GL, Myers JS, Hark LA, Katz LJ. Evaluation of Nonmydriatic Hand-held Optic Disc Photography Grading in the Philadelphia Glaucoma Detection and Treatment Project. J Glaucoma 2017; 25:e520-5. [PMID: 26900823 DOI: 10.1097/ijg.0000000000000382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the reproducibility of optic disc photograph grading obtained by a hand-held fundus camera and to determine the diagnostic value of these photographs in detecting patients with glaucoma in a community-based glaucoma-detection program. MATERIALS AND METHODS Patients underwent slit-lamp examination by an ophthalmologist who graded each patient's optic discs using 2 methods: cup-to-disc ratio (CDR) and disc damage likelihood scale (DDLS). After a comprehensive glaucoma evaluation, patients were diagnosed as having "glaucoma," "glaucoma suspect," or "no glaucoma." Nonmydriatic, monoscopic optic disc photographs were then taken with a portable digital imaging device. On a different day, the same examiner and a second observer graded the disc photographs in a masked manner and determined a diagnostic impression based only on the disc photographs. RESULTS Of the 1649 patients examined, 119 subjects were randomly selected according to 3 groups of diagnoses: "glaucoma" (n=36), "glaucoma suspect" (n=50), and "no glaucoma" (n=33). For CDR, the intraobserver agreement was 0.71 and the interobserver agreement was 0.69. For disc DDLS, the intraobserver agreement was 0.65 and the interobserver agreement was 0.67. The area under the receiver-operating characteristic distinguishing between normal and glaucoma was 0.88 and 0.86 for CDR and disc DDLS, respectively. CONCLUSIONS Nonmydriatic, monoscopic disc photographs obtained by a hand-held camera had only moderate disc grading reproducibility. This could be due to a reduced quality of images, making interpretation more challenging, due to taking photographs through small pupils by a hand-held camera and the high percentage of patients with significant cataracts.
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Amanullah S, Okudolo J, Rahmatnejad K, Lin SC, Wizov SS, Manzi Muhire RS, Hark LA, Zheng CX, Zhan T, Spaeth GL. The relationship between contrast sensitivity and retinal nerve fiber layer thickness in patients with glaucoma. Graefes Arch Clin Exp Ophthalmol 2017; 255:2415-2422. [DOI: 10.1007/s00417-017-3789-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/13/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022] Open
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Hark LA, Katz LJ, Myers JS, Waisbourd M, Johnson D, Pizzi LT, Leiby BE, Fudemberg SJ, Mantravadi AV, Henderer JD, Zhan T, Molineaux J, Doyle V, Divers M, Burns C, Murchison AP, Reber S, Resende A, Bui TDV, Lee J, Crews JE, Saaddine JB, Lee PP, Pasquale LR, Haller JA. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results. Am J Ophthalmol 2017; 181:114-124. [PMID: 28673747 DOI: 10.1016/j.ajo.2017.06.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN Screening program results for a prospective randomized clinical trial. METHODS Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.
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Hark LA, Deen D. Position of the Academy of Nutrition and Dietetics: Interprofessional Education in Nutrition as an Essential Component of Medical Education. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.04.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Amarasekera DC, Resende AF, Waisbourd M, Puri S, Moster MR, Hark LA, Katz LJ, Fudemberg SJ, Mantravadi AV. Steady-state pattern electroretinogram and short-duration transient visual evoked potentials in glaucomatous and healthy eyes. Clin Exp Ophthalmol 2017; 46:54-61. [PMID: 28600806 DOI: 10.1111/ceo.13006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
IMPORTANCE This study evaluates two rapid electrophysiological glaucoma diagnostic tests that may add a functional perspective to glaucoma diagnosis. BACKGROUND This study aimed to determine the ability of two office-based electrophysiological diagnostic tests, steady-state pattern electroretinogram and short-duration transient visual evoked potentials, to discern between glaucomatous and healthy eyes. DESIGN This is a cross-sectional study in a hospital setting. PARTICIPANTS Forty-one patients with glaucoma and 41 healthy volunteers participated in the study. METHODS Steady-state pattern electroretinogram and short-duration transient visual evoked potential testing was conducted in glaucomatous and healthy eyes. A 64-bar-size stimulus with both a low-contrast and high-contrast setting was used to compare steady-state pattern electroretinogram parameters in both groups. A low-contrast and high-contrast checkerboard stimulus was used to measure short-duration transient visual evoked potential parameters in both groups. MAIN OUTCOME MEASURES Steady-state pattern electroretinogram parameters compared were MagnitudeD, MagnitudeD/Magnitude ratio, and the signal-to-noise ratio. Short-duration transient visual evoked potential parameters compared were amplitude and latency. RESULTS MagnitudeD was significantly lower in glaucoma patients when using a low-contrast (P = 0.001) and high-contrast (P < 0.001) 64-bar-size steady-state pattern electroretinogram stimulus. MagnitudeD/Magnitude ratio and SNR were significantly lower in the glaucoma group when using a high-contrast 64-bar-size stimulus (P < 0.001 and P = 0.010, respectively). Short-duration transient visual evoked potential amplitude and latency were not significantly different between the two groups. CONCLUSIONS AND RELEVANCE Steady-state pattern electroretinogram was effectively able to discern between glaucomatous and healthy eyes. Steady-state pattern electroretinogram may thus have a role as a clinically useful electrophysiological diagnostic tool.
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Affiliation(s)
| | - Arthur F Resende
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Sanjeev Puri
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Hark LA, Mayro EL, Tran J, Pond M, Schneider R, Torosian J, Snitzer M, Dabbish N, Levin AV. Improving access to vision screening in urban Philadelphia elementary schools. J AAPOS 2016; 20:439-443.e1. [PMID: 27647117 DOI: 10.1016/j.jaapos.2016.07.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/16/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Wills Eye Vision Screening Program for Children is a community-based vision screening program for children in urban Philadelphia elementary schools that aims to provide vision screening, remedy refractive error by providing glasses, and refer children with suspected nonrefractive eye disease for eye care. METHODS Children in grades K-5 from 45 Philadelphia elementary schools were screened for distance and near visual acuity, stereopsis, and color vision from January 2014 to June 2015. Children who failed were assessed by an on-site optometrist. Two pairs of eyeglasses were provided at no cost. Children with suspected, nonrefractive disease were referred to Wills Eye Hospital Pediatric Ophthalmology and contacted by a social worker to schedule an appointment. RESULTS Over 84 days, 10,726 children were screened for vision problems at 45 schools. A total of 1,321 children (12%) had refractive error and 1,015 children (77%) returned the consent form and received two pairs of glasses. Of the 509 children (5%) referred to Wills Eye, 177 returned consent forms and were not being followed by an ophthalmologist. Of these, 127 children (72%) completed an eye examination at Wills. CONCLUSIONS The program described herein can provide comprehensive vision screening, with eyeglasses and/or referrals, to children within an underserved community.
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Affiliation(s)
- Lisa A Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Eileen L Mayro
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Judie Tran
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Pond
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Rachel Schneider
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Justin Torosian
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Melanie Snitzer
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Nooreen Dabbish
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alex V Levin
- Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
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Callinan CE, Kenney B, Hark LA, Murchison AP, Dai Y, Leiby BE, Mayro EL, Bilson J, Haller JA. Improving Follow-Up Adherence in a Primary Eye Care Setting. Am J Med Qual 2016; 32:73-79. [PMID: 26656245 DOI: 10.1177/1062860615616860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lack of patient adherence with eye appointments can decrease ocular outcomes. This prospective, randomized, single-blinded controlled study assessed the effectiveness of multiple interventions in improving follow-up adherence to recommended eye appointments. Patients due for follow-up appointments were randomly assigned to usual care, automated intervention, or personal intervention. Automated-intervention patients and personal-intervention patients received a call one month prior to the recommended follow-up date, and a mailed appointment reminder letter. The call was automated for automated-intervention patients and personalized for personal-intervention patients. The primary outcome was adherence to the follow-up appointment. The secondary outcome was rate of appointment scheduling. Patients in the personal-intervention group had greater adherence to follow-up recommendations (38%) than patients in the usual care group (28%) and the automated-intervention group (30%). Personal intervention significantly increased appointment scheduling (51%) over usual care (32%) and automated intervention (36%). These results support systems-level changes to improve patient follow-up adherence in urban primary eye care settings.
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Affiliation(s)
| | | | - Lisa A Hark
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Ann P Murchison
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Yang Dai
- 1 Wills Eye Hospital, Philadelphia, PA
| | | | | | | | - Julia A Haller
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
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Rovner BW, Haller JA, Casten RJ, Murchison AP, Hark LA. Cultural and Cognitive Determinants of Personal Control in Older African Americans with Diabetes. J Natl Med Assoc 2016; 107:25-31. [PMID: 27269487 DOI: 10.1016/s0027-9684(15)30021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ACKNOWLEDGEMENTS The study was funded by Pennsylvania Department of Health's Commonwealth Universal Research Enhancement (CURE) Program (SAP#4100051727). OBJECTIVE To describe the determinants of personal control over diabetes complications in older African Americans (N=123) with type 2 diabetes. METHODS We administered structured instruments to assess perceptions of personal control, time orientation, religiosity, depression, and cognition in this cross-sectional study. RESULTS More years of education (p ≤ .001), better Clock Drawing (p ≤ .001), higher levels of Religiosity (p ≤ .04), and lower Present Time Orientation (p ≤ .01 ) were independent predictors of higher levels of Personal Control. DISCUSSION Risk perceptions of control over diabetes complications vary among older African Americans according to cultural constructs, executive function, and education. This finding highlights the cultural diversity in this population and the potential impact of culturally-determined views and cognitive function on health behaviors. Cognitive screening of older persons with diabetes and interventions that incorporate perceptions of time and religion to increase rates of eye examinations are needed.
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Affiliation(s)
- Barry W Rovner
- Departments of Psychiatry and Neurology, Jefferson Hospital for Neuroscience.
| | | | - Robin J Casten
- Department of Psychiatry and Human Behavior; Jefferson Hospital for Neuroscience
| | | | - Lisa A Hark
- Department of Ophthalmology, Wills Eye Institute
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Waisbourd M, Pruzan NL, Johnson D, Ugorets A, Crews JE, Saaddine JB, Henderer JD, Hark LA, Katz LJ. The Philadelphia Glaucoma Detection and Treatment Project: Detection Rates and Initial Management. Ophthalmology 2016; 123:1667-1674. [PMID: 27221736 DOI: 10.1016/j.ophtha.2016.04.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/11/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. DESIGN Retrospective analysis. PARTICIPANTS A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. METHODS Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. MAIN OUTCOME MEASURES Detection rates of glaucoma-related diagnoses and types of treatments administered. RESULTS Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. CONCLUSIONS Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations.
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Affiliation(s)
- Michael Waisbourd
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, Pennsylvania.
| | - Noelle L Pruzan
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Deiana Johnson
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Angela Ugorets
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, Pennsylvania
| | - John E Crews
- Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jinan B Saaddine
- Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffery D Henderer
- Lewis Katz School of Medicine at Temple University, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, Pennsylvania
| | - L Jay Katz
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, Pennsylvania
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Ekici F, Loh R, Waisbourd M, Sun Y, Martinez P, Nayak N, Wizov SS, Hegarty S, Hark LA, Spaeth GL. Relationships Between Measures of the Ability to Perform Vision-Related Activities, Vision-Related Quality of Life, and Clinical Findings in Patients With Glaucoma. JAMA Ophthalmol 2016; 133:1377-85. [PMID: 26425961 DOI: 10.1001/jamaophthalmol.2015.3426] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To our knowledge, few studies have combined an objective measure of vision-related performance (VRP) and subjective measures of vision-related quality of life (VRQoL) with clinically related visual parameters, particularly in a large, prospective, cohort study setting. OBJECTIVE To examine the relationships between clinical visual assessments and both a VRP and 2 self-reported VRQoL measurements. DESIGN, SETTING, AND PARTICIPANTS Patients (N = 161) with moderate-stage glaucoma recruited from the Glaucoma Service at Wills Eye Hospital, Philadelphia, Pennsylvania, were enrolled from May 2012 to May 2014 in an ongoing prospective, 4-year longitudinal observational study. This report includes cross-sectional results from the baseline visit. Patients received a complete ocular examination, automated visual field (VF) test and Cirrus optical coherence tomographic scan. Contrast sensitivity was measured with the Pelli-Robson and the Spaeth-Richman Contrast Sensitivity (SPARCS) tests. Vision-related performance was assessed by the Compressed Assessment of Ability Related to Vision (CAARV) test. Vision-related QoL was assessed by the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and a modified Glaucoma Symptom Scale (MGSS). MAIN OUTCOMES AND MEASURES Correlations between clinical measures and CAARV, NEI-VFQ-25, and MGSS scores. RESULTS A total of 161 patients were enrolled in the study. The strongest correlation was found between SPARCS score in the better eye and total CAARV score (r = 0.398; 95% CI, 0.235-0.537; P < .001). The CAARV score also correlated with the Pelli-Robson score (r = 0.353; 95% CI, 0.186-0.499; P = .001), VF mean deviation (r = 0.366; 95% CI, 0.200-0.510; P < .001), and VA (r = -0.326, 95% CI = -0.476 to -0.157; P = .003) in the better eye. There were more statistically significant correlations between contrast sensitivity tests and VF mean deviation with VRQoL measurements than with other clinical measures (visual acuity, intraocular pressure, Disc Damage Likelihood Scale, and mean retinal nerve fiber layer thickness). The MGSS scores were lower (worse) in women compared with men (P = .03 for binocular, P = .01 for better eye, and P = .05 for the worse eye). Structural measures (eg, Disc Damage Likelihood Scale, and retinal nerve fiber layer thickness) were generally not informative with respect to VRP or VRQoL. CONCLUSIONS AND RELEVANCE Contrast sensitivity tests and VF mean deviation were associated with both objective measures of the ability to act and subjective measurements of VRQoL. The strongest correlation was between SPARCS score (contrast sensitivity) in the better eye and total CAARV score. Therefore, measurement of contrast sensitivity should be considered when evaluating patients' VRQoL. The results of this study were limited by the patient population and apply only within the bounds of the tested cohort.
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Affiliation(s)
- Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Rebecca Loh
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Yi Sun
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Patricia Martinez
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Natasha Nayak
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sheryl S Wizov
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
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Johnson DM, Stratford S, Shyu AP, Sembhi H, Molineaux J, Reamer C, Spaeth GL, Myers JS, Hark LA, Katz LJ, Waisbourd M. The impact of educational workshops on individuals at risk for glaucoma in the Philadelphia Glaucoma Detection and Treatment Project. Patient Educ Couns 2016; 99:659-664. [PMID: 26686991 DOI: 10.1016/j.pec.2015.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/19/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the impact of educational workshops, led by community health educators, on the level of knowledge, perceived risk of glaucoma, and rate of attendance in a subsequent glaucoma detection examination. METHODS Participants attended an educational workshop about glaucoma and completed an 8-question pre- and post-test to assess knowledge. A paired samples t-test assessed mean differences in composite pre- and post-test scores, correct responses for each question, and perceived risk of glaucoma after the workshop. RESULTS Seven hundred and seven (707) pre- and post-test surveys were completed. There was a significant increase in the level of knowledge about glaucoma as reflected in the pre- and post-test composite scores (M=3.86, SD=1.95 vs. M=4.97, SD=1.82, P<0.001). In the 5 largest community sites, 44% (n=221/480) of the participants who attended an educational workshop scheduled a glaucoma detection examination appointment and 76% (n=160/211) of these participants completed this eye examination in the community setting. CONCLUSIONS Educational workshops increased knowledge and awareness about glaucoma and were helpful in recruiting patients for community-based glaucoma detection examinations. PRACTICE IMPLICATIONS We recommend including educational workshops when conducting community-based outreach programs.
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Affiliation(s)
- Deiana M Johnson
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Shayla Stratford
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Andrew P Shyu
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Harjeet Sembhi
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Courtney Reamer
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, USA.
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Sun Y, Lin C, Waisbourd M, Ekici F, Erdem E, Wizov SS, Hark LA, Spaeth GL. The Impact of Visual Field Clusters on Performance-based Measures and Vision-Related Quality of Life in Patients With Glaucoma. Am J Ophthalmol 2016; 163:45-52. [PMID: 26701273 DOI: 10.1016/j.ajo.2015.12.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/05/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate how visual field (VF) clusters affect performance-based measures of the ability to perform activities of daily living and subjective measures of vision-related quality of life (QoL) in patients with glaucoma. DESIGN Prospective, cross-sectional study. METHODS setting: Institutional - Wills Eye Hospital. STUDY POPULATION 322 eyes of 161 patients with moderate-stage glaucoma. OBSERVATION VF tests were conducted using the Humphrey 24-2 Swedish Interactive Thresholding Algorithm standard perimeter. The VFs of each patient were divided into 5 clusters: nasal, temporal, central, paracentral, and peripheral. The score for each cluster was the averaged total deviation scores of all tested points within the cluster. Each cluster score was correlated with performance-based measures of visual function and subjective assessment of vision-related QoL. MAIN OUTCOME MEASURES The Compressed Assessment of Ability Related to Vision, the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25), and the Modified Glaucoma Symptom Scale. RESULTS The central VF cluster in the better eye was positively correlated with all Compressed Assessment of Ability Related to Vision (performance-based measure) subscales. The strongest correlation for the better eye was between the central VF cluster and total Compressed Assessment of Ability Related to Vision score (0.39, P < .001). The inferior VF hemisphere in both eyes was positively correlated with most Compressed Assessment of Ability Related to Vision subscales. Central VF clusters in the better eye were positively correlated with a majority of the NEI VFQ-25 subscales. There were no significant correlations between VF clusters and Modified Glaucoma Symptom Scale subscales. CONCLUSIONS Scores of central VF defects in the better eye and inferior hemisphere defects in both eyes were positively correlated with performance-based measures of the ability to perform activities of daily living. Glaucoma patients with central defects in the better eye were more likely to have reduced scores on assessments of vision-related QoL.
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Affiliation(s)
- Yi Sun
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Clarissa Lin
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Elif Erdem
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sheryl S Wizov
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania.
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Myers JS, Fudemberg SJ, Fintelmann RE, Hark LA, Khanna N, Leiby BE, Waisbourd M. Impossibility to eliminate observer effect in the assessment of adherence in clinical trials. Patient Prefer Adherence 2016; 10:2145-2150. [PMID: 27822015 PMCID: PMC5087773 DOI: 10.2147/ppa.s114746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To utilize the Travoprost Dosing Aid (DA) in the assessment of patient medication adherence, while also determining whether or not altering the functionality of the DA in three randomized subject groups can reduce observer effect. METHODS Forty-five subjects were randomized into three groups: two with monitored DAs and one without monitoring. One group of subjects was given a DA that both monitored drop usage and had visual and audible alarms, while the other monitored group included subjects given a DA that had no alarms but continued to monitor drop usage. The third group was given a DA that had no alarm reminders or dose usage monitoring. Subjects were informed that some monitors would not be functional, in an attempt to reduce observer effect, or the effect of being monitored on subject behavior and adherence. A six-item questionnaire was also utilized to assess how the subjects felt about their adherence and DA use. RESULTS The overall adherence rates were found to be 78% in the fully functional group (95% confidence interval: 70-88) and 76% in the no alarms group (95% confidence interval: 65-89). No association was seen between questionnaire response and medication adherence. The patients in the DA group without alarms had a significantly higher odds ratio of medication adherence if they reported on the questionnaire that using the DA did affect how much they used their drops. CONCLUSION Though the use of DA was expected to reveal different rates of adherence depending on the functionality of the DA between groups, patients with a nonfunctioning DA did not have a significant difference in medication adherence compared to those given a fully functional DA. This supports that an observer effect was not reduced despite these interventions, and that the subjects adhered to taking their medications as if they had a functioning DA and were being monitored.
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Affiliation(s)
| | | | | | - Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA
- Correspondence: Lisa A Hark, Wills Eye Hospital, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA, Tel +1 215 928 3045, Email
| | - Nitasha Khanna
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, PA
| | - Benjamin E Leiby
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA
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Hark LA, Johnson DM, Berardi G, Patel NS, Zeng L, Dai Y, Mayro EL, Waisbourd M, Katz LJ. A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence. Patient Prefer Adherence 2016; 10:1739-48. [PMID: 27660423 PMCID: PMC5019463 DOI: 10.2147/ppa.s108391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Patients with glaucoma who do not keep their follow-up eye care appointments are at risk for developing more severe ocular disease. The primary aim of the current study was to evaluate whether the use of a patient navigator altered adherence to follow-up eye care appointments in community-versus office-based settings. PATIENTS AND METHODS Patients diagnosed with a glaucoma-related condition following a comprehensive eye examination at 43 community sites in Philadelphia, PA, USA, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community-based setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; and Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05. RESULTS A total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±standard deviation) was 71.2 (±10.0) years. Patients were predominantly female (65.8%, n=102/155) and African-American (71.6%, n=111/155). The mean (±standard deviation) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Appointment adherence, defined as attendance of ≥1 follow-up visit, was 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=33/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended ≥2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11). CONCLUSION Help from a patient navigator did not increase the likelihood of keeping ≥1 follow-up appointment in an office-based setting. Adherence rates for follow-up appointments reached close to 70% or above in a self-selected patient population.
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Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
- Correspondence: Lisa A Hark, Department of Research, Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA, Tel +1 215 928 3045, Fax +1 215 928 9085, Email
| | - Deiana M Johnson
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Giuliana Berardi
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Neal S Patel
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Lichuan Zeng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - L Jay Katz
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
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Fudemberg SJ, Lee B, Waisbourd M, Murphy RA, Dai Y, Leiby BE, Hark LA. Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic. Patient Prefer Adherence 2016; 10:19-25. [PMID: 26811672 PMCID: PMC4712968 DOI: 10.2147/ppa.s89336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the rate of adherence to follow-up appointment recommendations in a resident glaucoma clinic with no mechanism for reminders, compared to a resident cataract and primary eye care (CPEC) clinic in which telephone reminders were used, and to identify factors that contribute to adherence in each patient group. METHODS This retrospective cohort study included subjects in the CPEC clinic who received telephone reminders and those in the glaucoma clinic who did not. Each sample was selected to have a similar proportion of follow-up recommendations for 1, 3, and 6 months. Subjects were considered adherent if they returned within a specified timeframe. RESULTS A total of 144 subjects from the glaucoma clinic and 151 subjects from the CPEC clinic were included. There was no significant difference between follow-up adherence rates of patients who received telephone reminders and those who did not (odds ratio [OR] =1.35, 95% confidence interval [CI] 0.79-2.32, P=0.28). Patients who were on more than two ocular medications were more likely to return for follow-up (OR=3.11, 95% CI 1.53-6.35, P=0.0018). Subjects between the ages 50 and 80 years were more likely to be adherent compared to their younger and older peers (P=0.02). CONCLUSION The follow-up adherence of patients in a CPEC clinic who received telephone reminders was similar to patients in a glaucoma clinic who did not receive any intervention to increase their adherence. Younger (⩽50 years old) and elderly (⩾80 years old) subjects, as well as patients using less than two glaucoma medications, were less likely to adhere to their follow-up appointments.
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Affiliation(s)
- Scott J Fudemberg
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
- Correspondence: Scott J Fudemberg, Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 1140, Philadelphia, PA 19107, USA, Tel +1 215 928 3197, Fax +1 215 928 3285, Email
| | - Brian Lee
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Rachel A Murphy
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Yang Dai
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Weiss DM, Casten RJ, Leiby BE, Hark LA, Murchison AP, Johnson D, Stratford S, Henderer J, Rovner BW, Haller JA. Effect of Behavioral Intervention on Dilated Fundus Examination Rates in Older African American Individuals With Diabetes Mellitus. JAMA Ophthalmol 2015; 133:1005-12. [DOI: 10.1001/jamaophthalmol.2015.1760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David M. Weiss
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Robin J. Casten
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin E. Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa A. Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania4Department of Ophthalmology, Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Ann P. Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania4Department of Ophthalmology, Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Deiana Johnson
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Shayla Stratford
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jeffrey Henderer
- Department of Ophthalmology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Barry W. Rovner
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julia A. Haller
- Department of Ophthalmology, Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
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Waisbourd M, Parker S, Ekici F, Martinez P, Murphy R, Scully K, Wizov SS, Hark LA, Spaeth GL. A prospective, longitudinal, observational cohort study examining how glaucoma affects quality of life and visually-related function over 4 years: design and methodology. BMC Ophthalmol 2015; 15:91. [PMID: 26231376 PMCID: PMC4522094 DOI: 10.1186/s12886-015-0088-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/23/2015] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study is to summarize the design and methodology of a prospective, longitudinal, observational cohort study to investigate how glaucoma affects patients’ quality of life and visually-related function over a 4-year period. Methods/Design One hundred sixty-one (161) subjects were enrolled in this ongoing study. Patients between the ages of 21–85 years with a minimum 2-year diagnosis of primary open-angle glaucoma, chronic primary angle-closure glaucoma or pseudoexfoliation glaucoma were included. Each patient visited Wills Eye Hospital for a baseline visit. Follow-up is planned for a minimum of 4 years, with annual visits. Each visit includes (1) Clinical evaluation: a slit lamp examination, fundoscopy, intraocular pressure measurement, visual field examination, spectral domain optical coherence tomography, Pelli-Robson Contrast Sensitivity test and the Spaeth-Richman Contrast Sensitivity test; (2) a performance based measure: the Compressed Assessment of Ability Related to Vision; and (3) Subjective measures of vision-related quality of life (the National Eye Institute Visual Functioning Questionnaire 25 and the Modified Glaucoma Symptom Scale). Discussion The results of this ongoing, prospective, longitudinal study are expected to shed light on the relationships between clinical measures, performance-based measures and subjective measures of well-being, in order to assess changes in the quality of life and the ability to function of patients with glaucoma over time.
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Affiliation(s)
- Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Samantha Parker
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Patricia Martinez
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Rachel Murphy
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Katie Scully
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Sheryl S Wizov
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
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Aleo CL, Murchison AP, Dai Y, Hark LA, Mayro EL, Collymore B, Haller JA. Improving eye care follow-up adherence in diabetic patients with ocular abnormalities: the effectiveness of patient contracts in a free, pharmacy-based eye screening. Public Health 2015; 129:996-9. [PMID: 26119987 DOI: 10.1016/j.puhe.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 03/04/2015] [Accepted: 05/13/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Patient contracts are increasingly utilized in medical practice and have the potential to improve health outcomes in high-risk populations. However, as a relatively new tool, there has been limited research regarding the efficacy of patient contracts. Diabetic retinopathy (DR) is one of the leading causes of vision impairment in adults in the US and only 50-60% of adults with diabetes adhere to annual dilated fundus exam recommendations. This study aimed to evaluate the impact of patient contracts on follow-up adherence in diabetic patients with ocular abnormalities after a free, pharmacy-based eye screening. STUDY DESIGN This prospective study implemented a non-invasive, non-mydriatic fundus camera in an urban, community-based pharmacy setting to screen for ocular diseases in patients with diabetes. Patients were assigned to the contract or non-contract group. Patients who signed a contract agreed to: 1) review their results with their primary care doctor, 2) follow-up with an ophthalmologist if their results were abnormal, and 3) inform research staff if/when they completed an eye care appointment. All study participants and their primary care doctors were notified of their results via mail. Follow-up questionnaires were administered to all patients by telephone three months after the screening results. RESULTS 500 patients were screened and 113 (22.6%) had abnormal results. Of the patients who had abnormal results, 83 (74.3%) were able to be contacted. Of the 83 patients who were able to be contacted, the majority of patients were African American (73.5%) and female (56.6%). The mean age was 54.7 years. Of those, 34 (41.0%) adhered to follow-up recommendations. There was no significant difference in follow-up adherence between the contract (38.1%) and non-contract group (43.9%) (P = 0.59). In addition, 70.4% of patients did not comply with at least one measure of the contract agreement. CONCLUSION Contracts did not increase follow-up adherence to eye appointments in diabetic patients with ocular abnormalities. The majority of patients did not comply with their contract and follow-up adherence was low in both groups. Most research has yielded mixed results regarding the efficacy of contracts in improving health outcomes. Therefore, different types of contracts or other patient-centered tools should be evaluated in order to increase follow-up adherence in patients at high risk for DR.
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Affiliation(s)
- C L Aleo
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA.
| | - A P Murchison
- Wills Eye Hospital, Emergency Department, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - Y Dai
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - L A Hark
- Research Department and Glaucoma, Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - E L Mayro
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - B Collymore
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - J A Haller
- Wills Eye Hospital, 840 Walnut Street 1510, Philadelphia, PA 19107, USA
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Owsley C, McGwin G, Lee DJ, Lam BL, Friedman DS, Gower EW, Haller JA, Hark LA, Saaddine J. Diabetes eye screening in urban settings serving minority populations: detection of diabetic retinopathy and other ocular findings using telemedicine. JAMA Ophthalmol 2015; 133:174-81. [PMID: 25393129 DOI: 10.1001/jamaophthalmol.2014.4652] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes mellitus from ethnic/racial minority populations with low utilization of eye care. OBJECTIVE To examine the rate and types of DR identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study (Innovative Network for Sight [INSIGHT]) was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. Participants included persons aged 18 years or older who had type 1 or 2 diabetes mellitus and presented to the community-based settings. MAIN OUTCOMES AND MEASURES The percentage of DR detection, including type of DR, and the percentage of detection of other ocular findings. RESULTS A total of 1894 persons participated in the INSIGHT screening program across sites, with 21.7% having DR in at least 1 eye. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR; 30.7% of the other ocular findings were cataract. CONCLUSIONS AND RELEVANCE In a DR telemedicine screening program in urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority populations, DR was identified on screening in approximately 1 in 5 persons with diabetes. The vast majority of DR was background, indicating high public health potential for intervention in the earliest phases of DR when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be underappreciated.
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Affiliation(s)
- Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - David J Lee
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Byron L Lam
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - David S Friedman
- Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily W Gower
- Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine, Baltimore, Maryland6Department of Epidemiology, Wake Forest School of Medicine, Winston-Salem, North Carolina7Department of Ophthalmology, Wake Forest Sc
| | - Julia A Haller
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jinan Saaddine
- Vision Health Initiative, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zangalli CS, Murchison AP, Hale N, Hark LA, Pizzi LT, Dai Y, Leiby BE, Haller JA. An Education- and Telephone-Based Intervention to Improve Follow-up to Vision Care in Patients With Diabetes. Am J Med Qual 2014; 31:156-61. [DOI: 10.1177/1062860614552670] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | | | - Yang Dai
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Benjamin E. Leiby
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Abstract
Objective. The purpose of this study is to describe the impact of depression on perceptions of risks to health, diabetes self-management practices, and glycemic control in older African Americans with type 2 diabetes. Methods. The authors analyzed data on depression, risk perceptions, diabetes self-management, and A1C in African Americans with type 2 diabetes. T-tests, χ(2), and multivariate regression were used to analyze the data. Results. The sample included 177 African Americans (68% women) whose average age was 72.8 years. Thirty-four participants (19.2%) met criteria for depression. Compared to nondepressed participants, depressed participants scored significantly higher on Personal Disease Risk (the perception of being at increased risk for various medical problems), Environmental Risk (i.e., increased risk for environmental hazards), and Composite Risk Perception (i.e., overall perceptions of increased risk); adhered less to diabetes self-management practices; and had marginally worse glycemic control. Depression and fewer years of education were independent predictors of overall perception of increased health risks. Conclusion. Almost 20% of older African Americans with type 2 diabetes in this study were depressed. Compared to nondepressed participants, they tended to have fewer years of education, perceived themselves to be at higher risk for multiple health problems, and adhered less to diabetes self-management practices. It is important for diabetes educators to recognize the impact of low education and the fatalistic perceptions that depression engenders in this population.
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Casten RJ, Brawer R, Haller JA, Hark LA, Henderer J, Leiby B, Murchison AP, Plumb J, Rovner BW, Weiss DM. Trial of a behavioral intervention to increase dilated fundus examinations in African–Americans aged over 65 years with diabetes. Expert Review of Ophthalmology 2014. [DOI: 10.1586/eop.11.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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