February 28, 2023

Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Baseline Results and Costs of a Cluster-Randomized Trial

Author(s): Lisa A Hark (1), Jason D Horowitz (2), Prakash Gorroochurn (3), Lisa Park (2), Qing Wang (2), Daniel F Diamond (2), Noga Harizman (2), James D Auran (2), Stefania C Maruri (4), Desiree R Henriquez (4), Jailine Carrion (4), Remy S Manzi Muhire (4), Yocheved S Kresch (5), Laura T Pizzi (6), Eric Jutkowitz (7), Saloni Sapru (8), Tarun Sharma (2), C Gustavo De Moraes (2), David S Friedman (9), Jeffrey M Liebmann (2), George A Cioffi (2)

1 Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York. Electronic address: lah112@cumc.columbia.edu. 2 Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York. 3 Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168(th) Street, New York, NY 10032. 4 Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York. 5 Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York; Kresge Eye Institute, Wayne State University School of Medicine, 4717 St Antoine, Detroit, MI 48201. 6 Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854. 7 Department of Health Services, Policy & Practice, Brown University School of Public Health, 21 S. Main Street, Providence, RI 02903. 8 Westat Public Health and Epidemiology Practice, 1600 Research Blvd., Rockville, MD 20850. 9 Massachusetts Eye and Ear Infirmary, Harvard Medical School, Glaucoma Service, 243 Charles Street, Boston, MA 02114.

PURPOSE: To describe the 15-month baseline results and costs of the Manhattan Vision Screening and Follow-up Study, which aims to investigate whether innovative community-based eye health screening can improve early detection and management of glaucoma and other eye diseases among high-risk populations.

DESIGN: 5-year prospective, cluster-randomized controlled trial.

METHODS: Individuals age 40+ were recruited from public housing buildings in New York City for an eye health screening (visual acuity (VA) with correction, intraocular pressure measurements (IOP), and fundus photography). Participants with VA 20/40 or worse, IOP 23-29 mmHg, or an unreadable fundus image failed the screening and were scheduled for an optometric exam at the same location; those with an abnormal image were referred to ophthalmology. A cost analysis was conducted alongside the study.

RESULTS: 708 participants were screened; mean age 68.6±11.9 years, female (65.1%), African American (51.8%) and Hispanic (42%). 78.4% (n = 555) failed the eye health screening; 35% (n= 250) had an abnormal image and were also referred to ophthalmology. 308 participants attended the optometric exam; 218 were referred to ophthalmology. Overall, 66.1% were referred to ophthalmology. The cost per participant to deliver the eye health screening and optometric exam was $180.88. The cost per case of eye disease detected was $273.64.

CONCLUSIONS: This innovative study in public housing developments targeted high-risk populations, provided access to eye-care, and improved early detection of ocular diseases in New York City. The study has identified strategies to overcoming barriers to eye care to reduce eye health disparities.

PMID: 36690289 DOI: 10.1016/j.ajo.2023.01.019

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