Randomized controlled trial evaluating a novel community eye care programme for elderly individuals with visual impairment

Abstract

Importance: The novel intervention was effective at improving compliance to appropriate tertiary eye care after community eye screening.

Background: Elderly individuals from low socio-economic background with visual impairment (VI) often do not attend tertiary care, even if significant eye diseases are detected while in the community. We evaluate a novel incentive care scheme (ICS) to improve compliance to appropriate follow-up after community eye screening.

Design: Randomized controlled trial in a population-based setting was conducted.

Participants: A total of 140 elderly individuals with VI (visual acuity <6/12, mean age ± SD = 66.6 ± 8.9 years, 46.4% female) were included.

Methods: Participants were randomized to either ICS (N = 72) or usual care (UC; N = 68). ICS incorporated patient education, social support and financial assistance to assist individuals in attending tertiary eye care. UC comprised of a standard referral letter and advice.

Main outcome measure: Primary outcome included compliance to eye care referral. Secondary outcomes included best-corrected visual acuity and vision-related quality of life assessed at baseline and 3 months.

Results: Participants receiving the ICS intervention had higher rates of compliance to tertiary eye care attendance compared to UC (31.9% vs. 16.2%, respectively, P = 0.027). While we observed an overall significant improvement in best-corrected visual acuity at 3 months in both groups (P < 0.05), we found no significant differences in Rasch-transformed vision-related quality of life scores between groups (all P > 0.05). Identified barriers for tertiary healthcare access included patient attitudes and financial- and health-related barriers.

Conclusion and relevance: Our pilot RCT found that ICS improved adherence to appropriate tertiary eye care referrals after community eye screening in elderly people with VI.

Keywords: eye screening; incentive care scheme; referrals; tertiary eye care.