Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations

青光眼是一种慢性视神经病变，导致视野缺陷、进行性视力丧失和失明。 在美国，青光眼是导致非裔美国人失明的主要原因。非洲裔美国人 患青光眼的年龄更小，进展更快，失明的可能性几乎是 非西班牙裔白人。到2020年，青光眼发病率预计将增加50%，达到336万人。这个 青光眼患病率的增加预计会造成巨大的经济和生活质量负担， 因此，我们设计了曼哈顿视力筛查和对VULNERABLE的随访研究 Popular，一项整群随机对照试验，以确定和实施创新战略，以参与 最危险、最脆弱和最不可能获得眼部护理的人群。研究人群为 由不同种族/民族(主要是非洲人)的40岁的弱势男女组成≥ 美国人和西班牙裔/拉丁裔)，眼睛护理不足的比率很高，住在经济适用房大楼里 纽约市。参与者随机接受使用患者导航器ARM 1(7栋建筑)的强化干预 未能通过筛查并需要矫正视力的人将获得免费眼镜。如果将它们提交给 眼科医生，他们将在两年内得到患者导航员的加强支持，以帮助所有 后续眼科护理方面，特别是预约时间安排和安排眼科检查的交通 还有白内障手术。参与者被随机分配到普通护理手臂2(3栋建筑)，他们没有通过筛查和 需要矫正视力的人只会得到一张眼镜处方和一份眼镜店名单。所有参与者 通过和/或不通过双臂视力筛查的人将被邀请参加12个月和24个月的视力检查 筛选，这将在相同的住宅楼举行。我们将前瞻性地跟踪参与者2 评估干预对呈现视力和健康相关生活质量的影响的年份 (主要结果)，坚持后续眼部护理和白内障手术(次要结果)，跌倒风险和 跌倒的比率(安全结果)，以及参与者在筛查后的满意度。研究的目的是： 1)开发和实施以社区为基础的创新视力筛查和后续研究， 提高对青光眼、视力障碍、白内障和其他疾病的参与度、检测和管理 居住在纽约市保障性住房建筑中的弱势人群的眼病；2)评估 使用患者导航器增强干预的有效性，以提高视力，坚持 居住在纽约市的弱势人群的后续眼部护理和白内障手术以及生活质量 经济适用房建设；3)对拟议的成本和收益进行经济分析 检查筛查和干预成本的方法、检测到的每个病例的成本以及 干预与常规护理武器的有效性；以及4)复制、扩大和传播方案， 材料和手稿。

Glaucoma is a chronic optic neuropathy resulting in visual field defects, progressive vision loss, and blindness. In the United States, glaucoma is the leading cause of blindness in African Americans. African Americans develop glaucoma at a younger age, progress more rapidly, and are almost 7 times more likely to go blind than non-Hispanic Whites. Rates of glaucoma are projected to increase by 50% to 3.36 million people by 2020. The increasing prevalence of glaucoma is expected to cause a significant economic and quality-of-life burden, therefore, we have designed the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, a cluster randomized controlled trial, to identify and implement innovative strategies to engage populations most at risk, most vulnerable, and least likely to have access to eye care. The study population is comprised of disadvantaged men and women ≥40 years old of diverse race/ethnicity (primarily African American and Hispanic/Latino), with high rates of inadequate eye care, living in affordable housing buildings in New York City. Participants randomized to Enhanced Intervention Using Patient Navigators Arm 1 (7 buildings) who fail the screening and need vision correction will receive free eye glasses. If they are referred to an ophthalmologist, they will receive enhanced support with patient navigators over 2 years to assist with all aspects of follow-up eye care, specifically appointment scheduling and arranging transportation to eye exams and cataract surgery. Participants randomized to the Usual Care Arm 2 (3 buildings) who fail the screening and need vision correction will be given an eye glasses prescription only and a list of optical shops. All participants who pass and/or fail the vision screening in both arms will be invited to the 12-month and 24-month vision screening, which will take place at the same housing buildings. We will follow participants prospectively for 2 years to evaluate the effects of the intervention on presenting visual acuity and health-related quality-of-life (primary outcome), adherence to follow-up eye care and cataract surgery (secondary outcome), falls risk and rates of falls (safety outcomes), and participants’ satisfaction following screenings. The aims of the study are: 1) Develop and implement an innovative, community-based vision screening and follow-up study where people live to increase engagement, detection and management of glaucoma, vision impairment, cataracts, and other eye diseases in vulnerable populations living in New York City affordable housing buildings; 2) Evaluate the effectiveness of an enhanced intervention using patient navigators to improve visual acuity, adherence to follow-up eye care and cataract surgery, and quality-of-life in vulnerable populations living in New York City affordable housing buildings; 3) Conduct an economic analysis of the costs and benefits of the proposed approaches to examine the cost of the screening and intervention, cost per case detected, and the cost- effectiveness of the Intervention vs. Usual Care Arms; and 4) Replicate, scale, and disseminate protocols, materials, and manuscripts.