This project will develop and evaluate a glaucoma screening program for high-risk African American and Latino men and women 50 years of age and older, and will provide a refined screening algorithm with acceptable positive and negative predictive values that can be generalized to other high-risk populations. We are collaborating with highly successful local community organizations with extensive experience in screening for disease and obtaining care for these at-risk populations. Our partners work closely with others in the community including churches, community health centers, and community clinics. Our approach is innovating in ways that will overcome obstacles to screening, referral and retention that have limited previous community- based glaucoma screening programs. Specifically, we will achieve our objectives in two phases. In the first phase (up to 18 months involving 1,000 participants), we will adapt our planned streamlined diagnostic algorithm to maximize positive and negative predictive values for glaucoma. Additionally, we will seek out low-cost approaches and will leverage technology to reduce the overall cost of the process so that the program used can be brought to scale in other regions of the United States. Throughout the program we will use multiple structural and functional visual tests (tests of visual acuity, fundus photographs, intraocular pressure measurements, and visual field testing) with on- site and centralized reading and interpretation of images. Data from the initial screening efforts will be used to improve our screening algorithm. In the second phase, we will apply the final simplified algorithm to a series of high-yield screening venues for African American and Latino adults 50 years of age and older via participation in events organized by local community associations (N = 9,000 participants). While glaucoma will be the primary aim of screening, other eye conditions (refractive error, cataract and diabetic retinopathy) will also be identified and referred. Given high rates of glaucoma in first-degree relatives, we will embed a program to pursue relatives of identified cases. We will also leverage internet and cell-phone based technologies to develop, implement, and evaluate strategies for monitoring follow-up care of screened participants. In summary, this program will not only screen a large number of individuals without access to eye care and at risk of blindness, it will also, through ongoing data collection at every stage of the process, create a scalable model for reaching these individuals across the country.
This work will result in a streamlined algorithm with appropriate sensitivity and specificity to provide glaucoma screening in high risk populations and to ensure appropriate referral and follow-up decisions. Additionally, those with other major eye diseases will be identified and referred. The project will inform policy makers on how to overcome key barriers for screening among high-risk minorities in the US, and will lead to novel public health approaches to reduce glaucoma burden and related vision loss in high-risk populations.