Admin Supplement: Village-Integrated Eye Worker Trial II (VIEW II)

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PROJECT SUMMARY/ABSTRACT The World Health Organization estimates that 80% of blindness worldwide is avoidable. However, in resource-limited settings, progressive eye diseases such as glaucoma, diabetic retinopathy (DR), and age- related macular degeneration (AMD), often go undiagnosed until it is too late. To address the global burden of avoidable blindness, eye care systems must determine optimal strategies for identifying people with or at risk for visual impairment beyond opportunistic screening. Outreach programs can prevent blindness both by screening for asymptomatic disease like age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma and case detection of symptomatic disease like cataract and refractive error. Eye care systems have developed numerous community-based approaches to these identification methods, including screening using telemedicine and case detection via cataract camps or community health worker models, but few studies have been conducted on the comparative effectiveness or cost effectiveness of these various approaches. The Village Integrated Eye Workers Trial II (VIEW II) is an ongoing cluster-randomized trial in which communities in Nepal receive visual acuity screening and are subsequently randomized to receive either a community-based eye disease screening intervention consisting of optical coherence tomography (OCT) and intraocular pressure (IOP) assessment, or to no intervention. The goal of the screening intervention is to detect cases of glaucoma, diabetic retinopathy, and age-related macular degeneration—all of which are progressive and cause irreversible vision loss if left untreated—and refer these cases to the local eye hospital for a confirmatory diagnosis and follow-up management. A door-to-door census is performed four years after starting the screening intervention to determine the effectiveness of screening for reducing vision impairment relative to communities not receiving the screening intervention. Following the four-year census, we will conduct ophthalmologic examinations in any eyes with incident visual impairment. This research is significant because it will provide the strongest type of evidence to guide national eye health programs – results from a randomized controlled trial. The approach is also innovative in its use of recently developed portable diagnostic technology that enables mobile, telemedicine-based screening on this large scale. Ultimately, this trial will benefit blindness prevention programs worldwide in deciding whether and how to implement eye disease screening. We maximize our chances of finding an effect by conducting the study in Nepal, where the burden of undiagnosed eye diseases is high. If successful in Nepal, future studies could assess the generalizability of such a program to other settings, such as rural communities in the industrialized world. If successful in Nepal, future studies could assess the generalizability of such a program to other settings, such as rural communities in the industrialized world.