The focus of this cooperative agreement is to assess and evaluate system level and individual level factors that impact access to eye care; and to identify barriers and enablers to the delivery of eye care conforming to best practices that prevent vision loss and promote eye health. The Johns Hopkins Translational Research Center (TRC) will analyze multiple existing databases to develop a knowledge base for a public health interventions aimed at reducing healthcare disparities and improving the eye health of underserved populations in the United States. Specifically, we will focus on focus on cataract, glaucoma, and diabetic retinopathy. Finally, we propose a collaborative study that uses this knowledge for implementation at the city level. The first set of analyses will focus on personal and perceived system barriers associated with the uptake of eyecare services in three previously studied populations: African Americans and Caucasians from the Salisbury Eye Evaluation (SEE) study and Latinos living in Arizona (studied as part of Proyecto Ver) and Latinos living in Baltimore (evaluated in the ProVision study funded by the NIH). The barriers and enablers of obtaining cataract surgical services will be assessed in all three racial/ethnic groups, whereas factors related to screening for diabetic retinopathy will be addressed using the two Latino populations, supplemented with analyses of the National Health and Nutrition Examination Surveys (NHANES). Finally, the rates of glaucoma screening provided using the Medicare screening benefit as well as the rates and patterns of treatment of glaucoma will be assessed using data from Medicare. Additionally, NHANES has both visual field and optic nerve imaging and these data will be used to determine associations with having been diagnosed with glaucoma when it is present in order to identify groups at high risk for underdiagnosis. The proposed TRC network combined project will consist of establishing diabetic retinopathy (DR) screening surveillance systems in collaboration with city governments to be able to monitor patterns of care, especially among at risk underserved populations. An intervention will be tested to increase DR screening rates based on the findings of the analyses described above. Finally, a pre/post assessment will be made to see if the intervention might be expanded nationally.
This study is highly relevant to the public health. Findings from this research will inform policy planners and insurance administrators of key barriers and enablers associated with the major blinding eye conditions faced by minority populations in the United States. Furthermore, the high risk but high impact network project may lead to novel public health approaches at the city level to improving eyecare for persons with diabetes.
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