Eye disease and vision impairment are more prevalent in the aged population, especially those in senior living communities, such as assisted or independent living. Older patients with visual impairment are more likely to have severe problems with daily activities, mobility, pain, and discomfort, anxiety, depression, and self-care. By 2030, 50% of seniors will have at least one visually significant ocular disease that could account for about 50% of the health care budget for older adults. Medicare expenses for non-vision-related medical care are 50% higher for those with vision loss than for those without. Fortunately vision loss from the majority of age-related eye conditions can be treated and/or avoided with appropriate preventive measures -- especially if detected early. Thus, there is both a quality of life and cost-advantage to early detection of eye disease among seniors. However, at best, only 60% of the insured Medicare population has regular eye exams. The purpose of this study is to determine whether providing remote diagnostic screenings for vision impairment and eye disease using retinal cameras combined with personalized patient education is feasible and acceptable for older adults in senior living settings. Feasibility of improving access to visio care in this vulnerable population is tested as well. We expect this service to be well received in older adult residential settings based on our current work in using a similar strategy to improve diabetic retinopathy screening rates in inner city primary care clinics. The proposed non-randomized feasibility study aims to develop and implement a teleophthalmology surveillance program in senior living communities (Aim 1);establish feasibility and acceptability of the teleophthalmology model at both the resident and facility level through focus groups and qualitative staff and leadership interviews about impact on facility work flow and resources (Aim 2);and obtain preliminary estimates in four major outcomes: (a) residents'knowledge about eye health assessed by a pre and post multiple choice test (b) residents'motivation to take care of their eye health, and (c) diabetic residents reported intention to see the eye doctor at least annually assessed by directly questioning the , (d) level of vision impairment and eye pathology in an elder residential setting as identified by the screening values and PI review of ocular imaging.
(Aim 3) Our Tele-I-CARE for Seniors model has the potential to 'produce patient- centered, timely and effective care that reduces the financial impact and economic burden to society caused by vision problems.'

Public Health Relevance

Eye disease and vision impairment are more prevalent in the aged population, especially those in senior living facilities and Medicare expenses for non-vision-related medical care are 50% higher for those with vision loss than for those without. Fortunately vision loss from the majority of age related eye diseases can be treated and/or avoided with appropriate preventive measures -- especially if detected early, but, at best, only 60% of the Medicare population has regular eye exams. The purpose of this study is to determine whether providing onsite screening with a retinal camera and personalized education about eye health is feasible and acceptable for older adults and will improve access to vision care and reduce medical expenses for this vulnerable population.

Agency
National Institute of Health (NIH)
Type
Small Research Grants (R03)
Project #
1R03AG048111-01
Application #
8757818
Study Section
Special Emphasis Panel (ZAG1)
Program Officer
Chen, Wen G
Project Start
Project End
Budget Start
Budget End
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Rochester
Department
Ophthalmology
Type
School of Medicine & Dentistry
DUNS #
City
Rochester
State
NY
Country
United States
Zip Code
14627