Community screening for eye disease by laypersons: the Hoffberger program

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Abstract

PURPOSE : To describe the results of a community-based eye screening program in Baltimore.

DESIGN : Cross-sectional study.

METHODS : This was a retrospective study of the results of screening both eyes of 5352 persons who presented at multiple community sites. The screening examination had eight risk factor questions, visual acuity measurement, and a screening field test and was carried out by technicians and lay volunteers. Screened persons (screenees) received a definitive eye examination at no out-of-pocket cost, transportation was offered, and inexpensive eyeglasses were provided if needed. The main outcome measures were the rate of appointment keeping and the eye diseases identified. Telephone interviews were used to assess reasons for missing appointments and satisfaction with visits.

RESULTS : Screenees had a median age of 45 years, were 71% black, 59% female, and had estimated median annual family income of $24,000. Among 1331 screenees who scheduled a definitive examination appointment, 552 (41%) completed the visit. Data on definitive diagnosis was available in 480 out of 552 persons (87%). Reasons given for failing to come for definitive examination were: no appointment given (26%), forgot (20%), lack of transportation (9%), and lack of insurance coverage (6%). Of those who accepted a second visit date after defaulting, only 25% (41/167) appeared. Of 17 persons identified with glaucoma at screening, 4 had previously been diagnosed, but had ceased active care.

CONCLUSION : After community screening for eye disease, efforts to provide definitive ophthalmic examination were only modestly effective. Failure of screenees to come for examination and loss to follow up were identified as serious problems.

Section snippets

Methods

The Hoffberger Program for the Prevention of Blindness is a community-based vision screening program begun in Baltimore, Maryland, in 1996 and is funded by three charitable foundations. In this report, a retrospective review of cross-sectional data are presented to evaluate specific program outcomes. In particular, the outcomes of greatest interest were the proportion of screened persons (screenees) who came for definitive examination and what eye diseases they exhibited. Among nearly 13,000

Results

From 1996 to 2000, data for 5352 screenees in the East Baltimore program were available for analysis, representing 97.7% of the total of 5473 screenees. Of these, 3155 met one or more of the referral criteria. Our staff found that 2000 of these were not receiving regular eye care and were offered an examination within the program. A total of 1331 persons agreed to be scheduled for a definitive examination at the Wilmer Institute (25% of all screenees, 42% of those who met one or more screening

Discussion

In the United States, higher rates of visual impairment and blindness are associated with lower socioeconomic status, minority ethnic status, and older age.7, 8, 9 While genetic makeup may explain some differences in disease prevalence,10, 11 the higher rates of eye disease among economically disadvantaged persons may be related to barriers to eye care access. Black Americans have lower rates of eye care visits and surgery for glaucoma than would be estimated from the age-specific prevalence of

Acknowledgements

The authors thank Adrian Mosley, Lane Cameron, Laura McKiernan, Ondra Walker, Patrice Tucker, Yvonne Blake, Yana Rachinskaya, Felicia Keel, Eve Higginbotham, MD, Nancy Ellish, PhD, and the other members of the Hoffberger Program staff, Irvin Fuss, OD, the clergy of East Baltimore, the Maryland Society for Sight, and our many volunteers for their hard work and devotion to their community and to this program.

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Supported in part by grants from the Aaron Straus and Lillie Straus Foundation, Baltimore, MD, the Hoffberger Foundation, Baltimore, MD, and the Local Initiatives Program of the Robert Wood Johnson Foundation, Princeton, NJ.

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