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

项目总结/摘要 世界卫生组织估计，全球80%的失明是可以避免的。但在 资源有限的环境，渐进性眼病，如青光眼，糖尿病视网膜病变（DR），和年龄- 黄斑变性（AMD），往往得不到诊断，直到为时已晚。为了解决全球负担， 可避免的失明，眼科护理系统必须确定最佳策略，以识别患有或处于风险中的人， 视力障碍的治疗方法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，如年龄相关性黄斑变性（AMD）、糖尿病视网膜病变（DR）， 和青光眼以及白内障和屈光不正等症状性疾病的病例检测。眼部护理系统 已经为这些识别方法开发了许多基于社区的方法，包括筛查 通过白内障营地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 已就这些不同方法的比较效益或成本效益进行了研究。 乡村综合眼科工作者试验II（VIEW II）是一项正在进行的随机分组试验， 尼泊尔的社区接受视力筛查，随后随机接受 基于社区的眼科疾病筛查干预，包括光学相干断层扫描（OCT）和 眼内压（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的病例-所有这些都是进行性的 如果不及时治疗，会导致不可逆转的视力丧失，并将这些病例转介到当地眼科医院进行治疗。 确诊和随访管理。四年后进行挨家挨户的人口普查， 开始筛查干预，以确定筛查对减少视力损害的有效性 相对于未接受筛查干预的社区而言。经过四年的人口普查，我们将 对视力受损的眼睛进行眼科检查。 这项研究意义重大，因为它将提供最有力的证据，以指导国家的眼睛 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，使移动的，远程医疗为基础的筛选， 大规模的最终，这项试验将有利于全世界的防盲计划， 如何进行眼疾普查。我们最大限度地提高我们的机会，发现一个影响， 在尼泊尔进行的一项研究表明，未确诊的眼疾负担很高。如果在尼泊尔取得成功， 可以评估这样一个计划的普遍性，以其他设置，如农村社区， 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种计划的普遍性 到其他环境，如工业化国家的农村社区。

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.