Wills Eye Community Intervention to Improve Glaucoma Detection and Follow-up Care

Wills Eye 社区干预改善青光眼检测和后续护理

• 批准号: 9316335
• 负责人: JULIA A HALLER
• 金额: $ 60万
• 依托单位: WILLS EYE HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2019-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9316335
• 关键词: Wills; Eye; Community; Intervention; Improve

DESCRIPTION (provided by applicant): Glaucoma is a chronic optic neuropathy resulting in visual field defects and progressive, irreversible vision loss. Glaucoma is the second leading cause of blindness in the United States. Primary open-angle glaucoma is the most common form. Rates of glaucoma are projected to increase by 50% to 3.36 million people by 2020, causing a significant economic and quality of life burden. Risk factors for glaucoma include advanced age (65+ years), family history of glaucoma, race (African American, Asian), and ethnicity (Hispanic/Latino). Diabetes is also an independent risk factor for glaucoma. African Americans develop glaucoma at a younger age, progress more rapidly, and are almost 7 times more likely to go blind than non-Hispanic Caucasians. Despite the advanced technology and available diagnostic testing, 50% of people with glaucoma remain undiagnosed. When glaucoma is diagnosed in its early stages, appropriate treatment and management can almost always prevent blindness. Under the leadership of L. Jay Katz, MD; Julia A. Haller, MD; and Lisa Hark, PhD, RD, the Wills Eye Glaucoma Research Center will conduct a 5-year prospective, randomized controlled trial to test an innovative community intervention using fundus photography of the optic nerve and macula (telemedicine) to detect, treat, and manage high-risk patients with previously undiagnosed glaucoma and other eye diseases. Our diverse, targeted at-risk population includes African Americans, Hispanics and Asian over age 40; older adults (aged 65+); and those over age 40 with a family history of glaucoma and/or diabetes. Phase 1 will consist of recruiting approximately 2,000 patients from 14 primary care offices and 10 federally qualified health centers across Philadelphia and Chester counties with our community partners. Using telemedicine, we will detect eye disease using telemedicine (Visit 1) followed by a comprehensive eye exam by a glaucoma specialist to confirm the diagnosis (Visit 2). Based on preliminary data, 30% of patients (approximately 600) will have abnormal optic nerve and/or macula images. The predictive accuracy of the optic nerve images to detect glaucoma and glaucoma suspect as confirmed by the comprehensive eye exam will be evaluated. Phase 2 will involve consenting, enrolling, and randomizing 300 patients to either the usual care group (n=150) or the enhanced intervention group (n=150) and scheduling follow-up eye exams with local, general ophthalmologists (Visit 3). The enhanced intervention will consist of using patient navigators and a social worker to reduce barriers to follow-up eye care. Phase 3 will consist of following patients proximally (6 months) and distally (3 years) while they attend ophthalmology appointments (Visits 4-8). Adherence to follow-up recommendations for eye care will be the primary outcome measure. A comprehensive cost study to estimate the intervention costs and cost-effectiveness of detecting eye diseases and vision impairment in a high-risk population will also be conducted. Protocols, materials, and results will be disseminated to other communities in order to expand detection of glaucoma, other eye diseases, and visual impairment, and to further refine these approaches.

描述(申请人提供)：青光眼是一种慢性视神经病变，导致视野缺陷和进行性的、不可逆转的视力丧失。青光眼是美国第二大致盲原因。原发性开角型青光眼是最常见的形式。到2020年，青光眼发病率预计将增加50%，达到336万人，造成巨大的经济和生活质量负担。青光眼的危险因素包括高龄(65岁以上)、青光眼家族史、种族(非裔美国人、亚洲人)和种族(西班牙裔/拉丁裔)。糖尿病也是青光眼的独立危险因素。非裔美国人患青光眼的年龄更小，进展更快，失明的可能性几乎是非西班牙裔高加索人的7倍。尽管有先进的技术和可用的诊断测试，50%的青光眼患者仍然没有得到诊断。当青光眼在早期被诊断出来时，适当的治疗和管理几乎总是可以防止失明。在医学博士L.Jay Katz、医学博士Julia A.Haller和医学博士Lisa Hark的领导下，威尔斯眼科青光眼研究中心将进行一项为期5年的前瞻性随机对照试验，以测试一种使用视神经和黄斑(远程医疗)眼底照相术的创新社区干预措施，以发现、治疗和管理患有以前未确诊的青光眼和其他眼病的高危患者。我们多样化的高危人群包括40岁以上的非洲裔美国人、西班牙裔美国人和亚洲人；老年人(65岁以上)；以及40岁以上有青光眼和/或糖尿病家族史的人。第一阶段将包括与我们的社区合作伙伴从费城和切斯特县的14个初级保健办公室和10个具有联邦资格的卫生中心招募大约2000名患者。使用远程医疗，我们将使用远程医疗检测眼部疾病(访问1)，然后由青光眼专家进行全面的眼睛检查以确认诊断(访问2)。根据初步数据，30%的患者(约600人)会有异常的视神经和/或黄斑图像。将评估视神经图像对青光眼和青光眼可疑患者的预测准确性，这是通过全面的眼科检查证实的。第二阶段将包括同意、登记和随机将300名患者分为常规护理组(n=150)或强化干预组(n=150)，并安排当地普通眼科医生的后续眼科检查(访视3)。加强的干预措施将包括使用患者导航器和一名社会工作者来减少后续眼睛护理的障碍。第三阶段将包括近端(6个月)和远端(3年)的患者，同时他们参加眼科预约(访问4-8次)。对眼睛护理的后续建议的遵守将是主要的结果衡量标准。还将进行一项全面的成本研究，以估计在高危人群中检测眼病和视力损害的干预成本和成本效益。将向其他社区传播方案、材料和结果，以扩大对青光眼、其他眼病和视力损害的检测，并进一步完善这些方法。