Optimizing approaches to identifying glaucoma among at-risk African Americans and Hispanics

描述(申请人提供)：该项目将为50岁及以上的高危非裔美国人和拉丁裔男女开发和评估青光眼筛查计划，并将提供具有可接受的阳性预测值和阴性预测值的改进筛查算法，可推广到其他高危人群。我们正在与非常成功的当地社区组织合作，这些组织在筛查疾病和获得这些高危人群的护理方面具有丰富的经验。我们的合作伙伴与社区中的其他人密切合作，包括教堂、社区健康中心和社区诊所。我们的方法正在创新，将克服筛查、转诊和保留方面的障碍，这些障碍限制了以前基于社区的青光眼筛查计划。具体地说，我们将分两个阶段实现目标。在第一阶段(长达18个月，涉及1000名参与者)，我们将调整我们计划的简化诊断算法，以最大限度地提高青光眼的阳性和阴性预测值。此外，我们将寻求低成本的方法，并将利用技术来降低这一过程的总体成本，以便所使用的计划能够在美国其他地区规模化。在整个计划中，我们将使用多种结构和功能视觉测试(视力测试、眼底照片测试、眼压测量和视野测试)，并现场集中阅读和解释图像。来自初始筛选工作的数据将用于改进我们的筛选算法。在第二阶段，我们将通过参加当地社区协会组织的活动(N=9000人)，将最终的简化算法应用于一系列针对50岁及以上的非裔美国人和拉丁裔成年人的高收益筛选场所。虽然青光眼将是筛查的主要目标，但其他眼部疾病(屈光不正、白内障和糖尿病视网膜病变)也将被识别和参考。鉴于青光眼在一级亲属中的高发病率，我们将嵌入一项计划，以追踪确诊病例的亲属。我们还将利用基于互联网和手机的技术来制定、实施和评估监测筛查参与者后续护理的战略。总而言之，该计划不仅将对大量无法获得眼科护理和有失明风险的人进行筛查，还将通过在这一过程的每个阶段不断收集数据，在全国范围内为这些人创造一个可扩展的模式。

DESCRIPTION (provided by applicant): This project will develop and evaluate a glaucoma screening program for high-risk African American and Latino men and women 50 years of age and older, and will provide a refined screening algorithm with acceptable positive and negative predictive values that can be generalized to other high-risk populations. We are collaborating with highly successful local community organizations with extensive experience in screening for disease and obtaining care for these at-risk populations. Our partners work closely with others in the community including churches, community health centers, and community clinics. Our approach is innovating in ways that will overcome obstacles to screening, referral and retention that have limited previous community- based glaucoma screening programs. Specifically, we will achieve our objectives in two phases. In the first phase (up to 18 months involving 1,000 participants), we will adapt our planned streamlined diagnostic algorithm to maximize positive and negative predictive values for glaucoma. Additionally, we will seek out low-cost approaches and will leverage technology to reduce the overall cost of the process so that the program used can be brought to scale in other regions of the United States. Throughout the program we will use multiple structural and functional visual tests (tests of visual acuity, fundus photographs, intraocular pressure measurements, and visual field testing) with on- site and centralized reading and interpretation of images. Data from the initial screening efforts will be used to improve our screening algorithm. In the second phase, we will apply the final simplified algorithm to a series of high-yield screening venues for African American and Latino adults 50 years of age and older via participation in events organized by local community associations (N = 9,000 participants). While glaucoma will be the primary aim of screening, other eye conditions (refractive error, cataract and diabetic retinopathy) will also be identified and referred. Given high rates of glaucoma in first-degree relatives, we will embed a program to pursue relatives of identified cases. We will also leverage internet and cell-phone based technologies to develop, implement, and evaluate strategies for monitoring follow-up care of screened participants. In summary, this program will not only screen a large number of individuals without access to eye care and at risk of blindness, it will also, through ongoing data collection at every stage of the process, create a scalable model for reaching these individuals across the country.