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

项目摘要/摘要 世界卫生组织估计，全球80%的失明是可以避免的。但是，在 资源有限的环境、进行性眼病，如青光眼、糖尿病视网膜病变(DR)和年龄- 相关性黄斑变性(AMD)，通常被漏诊，直到为时已晚。要解决全球范围内的 为了避免失明，眼科保健系统必须确定最佳策略，以识别有风险或有风险的人 对于机会性筛查以外的视力障碍。外展计划可以通过以下两种方式预防失明 筛查无症状疾病，如老年性黄斑变性(AMD)、糖尿病视网膜病变(DR)、 以及青光眼和白内障、屈光不正等症状性疾病的病例检测。眼部护理系统 开发了许多基于社区的方法来识别这些方法，包括筛查 通过白内障训练营或社区卫生工作者模式使用远程医疗和病例检测，但很少有研究 已经对这些不同方法的比较效果或成本效益进行了研究。 乡村综合眼科工人试验II(VIEW II)是一项正在进行的整群随机试验，在该试验中 尼泊尔的社区接受视力筛查，随后随机接受一项 以社区为基础的眼病筛查干预，包括光学相干断层扫描(OCT)和 眼压(IOP)评估，或不干预。筛查干预的目标是检测 青光眼、糖尿病视网膜病变和老年性黄斑变性--所有这些都是进行性的 如果不治疗会导致不可逆转的视力损失--并将这些病例转介到当地的眼科医院进行治疗 确诊性诊断和随访管理。四年后进行挨家挨户的普查 启动筛查干预，以确定筛查对减少视力损害的有效性 相对于没有接受筛查干预的社区。在四年的人口普查之后，我们将 对任何视力受损的眼睛进行眼科检查。 这项研究具有重要意义，因为它将提供最有力的证据来引导国民的眼睛 健康计划--来自随机对照试验的结果。该方法还创新地使用了 最近开发的便携式诊断技术使基于移动、远程医疗的筛查成为可能 规模很大。最终，这项试验将有利于全世界的失明预防计划，以决定是否和 如何实施眼病筛查。我们最大限度地通过进行 在尼泊尔进行研究，那里未确诊的眼病负担很大。如果在尼泊尔取得成功，未来的研究 可以评估这种方案对其他环境的普适性，例如 工业化世界。如果在尼泊尔取得成功，未来的研究可以评估这样一个计划的普适性 到其他环境，如工业化世界的农村社区。

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.