Community-based amblyopia screening using a novel device

项目总结 在世界范围内，每年有50多万儿童失明，大多数失明儿童生活在低收入家庭。 和中等收入国家(LMIC)，在这些国家，可预防的视力丧失和失明的比率显著 再高一点。弱视是全球儿童视力丧失的主要原因。弱视导致的视力丧失可能是 通过早期、有效的弱视筛查来预防，尽管目前的筛查设备具有很高的灵敏度 特异性低，导致大量的假阳性转诊。这最终限制了 弱视筛查方案，因为成本和资源利用率增加，这在#年特别令人关注 LMIC和低资源设置。这项提案将评估两种方案的疗效和成本效益 弱视筛查设备和筛查策略：当前的标准设备--自动屈光仪(AR)，它 只检测弱视的危险因素，和一种新的设备，视网膜双折射扫描仪(RBS)，它检测 直接弱视。本提案的目标1将比较AR和RBS设备的性能 在尼泊尔的诊所中检测弱视。Aim 2将比较基于社区的设备 背景设在尼泊尔。目标3将比较这两种弱视筛查策略和 设备。这些目标的可行性是通过与第二代乡村综合眼科工作者的合作而确定的 (查看II)试验，这是一项由候选人的主要导师Jeremy Keenan博士领导的整群随机试验。美景 II试验随机选择尼泊尔城市周边社区的成年人进行视力筛查干预 训练有素的社区外展工作者。这项提议包含了几项创新。首先，它独一无二 利用成熟的成人视力筛查基础设施创建和评估筛查计划 为儿童准备的。其次，这将是第一次直接比较两种弱视的性能和成本的研究 筛选策略。候选人朱利叶斯·奥茨博士是加州大学的儿科眼科医生。 加州旧金山(加州大学旧金山分校)，其长期目标是成为一名独立调查员 在诊断和监测可预防的视力损失的新技术的诊断准确性研究方面的专业知识 在国内和国际上的儿童中。为了成功完成这项研究，奥茨博士将把重点放在四个方面 相关培训领域：诊断准确性研究、临床试验设计、成本效益分析 流行病学和生物统计学。他的杰出导师团队包括他的主要导师杰里米博士 基南，普罗科特基金会国际项目主任，VIEW II试验的PI，以及 导师波士顿儿童医院眼科主任大卫·亨特医生和主任英汉医生 加州大学旧金山分校的青光眼服务。这个团队，结合普罗科特基金会和加州大学旧金山分校的环境 他将支持他发展成为一名由NIH资助的独立研究员。

PROJECT SUMMARY Worldwide, more than 500,000 children become blind each year, and the majority of blind children live in low- and middle-income countries (LMICs), where rates of preventable vision loss and blindness are significantly higher. Amblyopia is the leading cause of vision loss in children worldwide. Vision loss from amblyopia can be prevented through early, effective amblyopia screening, though current screening devices have high sensitivity and low specificity which leads to a high number of false positive referrals. This ultimately limits the success of amblyopia screening programs due to increased cost and resource utilization, which is of particular concern in LMICs and low resource settings. This proposal will evaluate the efficacy and cost-effectiveness of two amblyopia screening devices and screening strategies: a current standard device, autorefractor (AR), which only detects amblyopia risk factors, and a novel device, retinal birefringence scanner (RBS), which detects amblyopia directly. Aim 1 of this proposal will compare the performance of the AR and RBS devices for detecting amblyopia in a clinic-based setting in Nepal. Aim 2 will compare the devices in a community-based setting in Nepal. Aim 3 will compare the cost-effectiveness of these two amblyopia screening strategies and devices. The feasibility of these Aims is anchored by collaboration with the Village Integrated Eye Worker II (VIEW II) trial, a cluster-randomized trial led by the candidate’s primary mentor, Dr. Jeremy Keenan. The VIEW II trial randomizes adults in peri-urban communities in Nepal to undergo a vision screening intervention by trained community outreach workers. This proposal incorporates several innovations. First, it uniquely leverages a well-established adult vision screening infrastructure to create and evaluate a screening program for children. Second, it will be the first study to directly compare the performance and cost of two amblyopia screening strategies. The candidate, Dr. Julius Oatts is a pediatric ophthalmologist at the University of California, San Francisco (UCSF), whose long-term goal is to become an independent investigator with expertise in diagnostic accuracy studies for novel technologies to diagnose and monitor preventable vision loss in children nationally and internationally. To successfully complete this research, Dr. Oatts will focus on four relevant domains of training: diagnostic accuracy studies, clinical trial design, cost-effectiveness analysis, and epidemiology and biostatistics. His exceptional mentorship team includes his primary mentor, Dr. Jeremy Keenan, Director of International Programs at the Proctor Foundation and PI of the VIEW II trial, and co- mentors Dr. David Hunter, Chief of Ophthalmology at Boston Children’s Hospital, and Dr. Ying Han, Director of the UCSF Glaucoma service. This team, combined with the environment of the Proctor Foundation and UCSF Department of Ophthalmology, will support his development into an NIH-funded independent investigator.