Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program: Impact on Vision, Follow-up, and Costs

Abstract

Purpose: To evaluate the impact of the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program on visual acuity (VA), vision-related quality of life (VRQOL), satisfaction, follow-up visit attendance, and costs among medically underserved participants receiving primary care at community health centers.

Design: Prospective cohort study with an embedded randomized controlled trial.

Participants: Adults ≥ age 18.

Methods: The MI-SIGHT participants underwent an eye disease screening examination with a trained ophthalmic technician, received assistance ordering low-cost glasses, and completed surveys. Participants could return for repeat screening after 1 year. The prevalence of disease identified was compared with national rates using z tests. Visual acuity and VRQOL were compared between initial and repeat visits with paired t tests and Wilcoxon signed-rank tests. Satisfaction was summarized with descriptive statistics. Attendance at recommended follow-up was assessed overall and compared by arm (chi squared tests) for those screening positive for glaucoma who were randomized to care navigation plus personalized education and health coaching (treatment) or care navigation plus written education (control).

Main outcomes measures: Eye disease prevalence, change in VA and VRQOL, program satisfaction, follow-up attendance, and costs.

Results: Three thousand seven hundred fourteen participants were analyzed; 11.5% were visually impaired, 9.3% had uncorrected or undercorrected refractive error causing visual impairment, 22.4% had glaucoma or suspected glaucoma, 4.7% had diabetic retinopathy (all rates higher than national averages at P < 0.0001), 99% were satisfied or very satisfied, and 68% attended recommended follow-up. Nine hundred forty-three participants completed repeat screening where worse-eye presenting VA improved (from 0.25 ± 0.59 logarithm of the minimum angle of resolution [logMAR] to 0.21 ± 0.52 logMAR; P = 0.0012), as did VRQOL (9-item National Eye Institute Visual Function Questionnaire composite score of 81.1 ± 14.1 to 86.4 ± 12.0; P < 0.0001). Of the 490 participants who screened positive for glaucoma or suspected glaucoma who were randomized (n = 247 treatment group, n = 243 control group), follow-up attendance did not differ (61% vs. 59%; P = 0.74). The program cost $110.99 per participant served, and $206.72 per case of eye disease detected.

Conclusions: Expanding glaucoma and eye disease screening and treatment of refractive error to community health centers with care navigation support could improve vision and eye health outcomes.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Attendance at follow-up; Costs; Eye disease screening; Glaucoma screening; Vision-related quality of life.