1. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Year 1 Results
Lisa A. Hark, PhD, RD; Michael Waisbourd, MD; Kamran Rahmatnejad, MD; Jonathan S. Myers, MD
Scott J. Fudemberg, MD; Anand Mantravadi, MD; Jeffrey Henderer, MD; Julia Haller, MD, and L. Jay Katz, MD  
Wills Eye Hospital Glaucoma Research Center and Thomas Jefferson University, Philadelphia, PA
Purpose
Results
Results
To conduct a RCT to test an innovative, community-based intervention using optic nerve and fundus photography to improve access and utilization of eye care to detect, treat, and manage at-risk patients with previously undiagnosed glaucoma and other eye diseases.
A total of 644 patients attended the study between April 1, 2015 and March 31, 2016 (Table1). .
Table 1: Baseline Demographic and Clinical Characteristics of Philadelphia Telemedicine Glaucoma Detection Study Subjects
Variable
Data (n=644)
Age, mean (SD), y
58.8 (10.4)
Gender, Male, n (%)
274 (42.5)
Race, n (%)
African American
393 (61.0)
White
122 (18.9)
Unknown
92 (14.3)
Asian
33 (5.1)
Other
4 (0.7)
Visual Acuity
Right Eye, mean (SD), logMAR
0.20 (0.2)
Left Eye, mean (SD), logMAR
0.24 (0.2)
IOP > 21 mmHg, n (%)
120 (18.6)
Right Eye, n (%), mmHg
83 (12.9)
Left Eye, n (%), mmHg
84 (13.0 )
Diabetes, n (%)
35 (55.4)
HgbA1C, mean (SD), %
7.3 (2.1)
HTN, n (%)
429 (66.6)
SBP, mean (SD), mmHg
130.2 (17.0)
DBP, mean (SD), mmHg
78.7 (9.8)
IOP: Intraocular pressure; DM: Diabetes mellitus; HTN: Hypertension; SBP: Systolic blood pressure; DBP: Diastolic blood pressure
Methods
Subjects (African Americans, Hispanic, or Asian individuals age >45; Caucasian age >65; and those age >40 with diabetes or a family history of glaucoma) are offered eye screenings (Visit 1) in PCP offices and Federally Qualified Health Centers (Figure 1).
Visit 1 consists of an ocular, medical, and family history; fundus photographs using a non-mydriatic, auto-focus, hand-held fundus camera (Volk, Ohio, USA); IOP (icare, Helsinki, Finland); and visual acuity.
Subjects with abnormal images and unreadable photos are invited for a complete eye exam in the same community location (Visit 2) (Figure 1).
Satisfaction surveys are administered to all subjects at Visit 1 and analyzed independently by Westat, Inc.
42% of the telemedicine screening results were normal, 37% were abnormal, 16% were unreadable, and 5% had OHTN (Figure 2).
Of the abnormal results, 32.7% were glaucoma-suspect, 7.7% had diabetic retinopathy, and 7.6% had other retina pathology (Figure 3).
Satisfaction survey results showed that 99.7% (n=642/644) of the individuals screened were satisfied or very satisfied with Visit 1.
98.1% (n=632/644) said they were likely or very likely to recommend the eye screening program to a family member.
Conclusion
This project clearly demonstrates how a community-based telemedicine screening can improve access, detection, and follow-up eye care of individuals at high-risk for glaucoma and other eye diseases.
Conducting eye screenings and complete eye examinations in primary care offices and federally qualified health centers holds promise in improving follow-up eye care and delaying vision loss in high-risk populations.
Visit 2 (PCP)
Eye exam
n=600
Visit 1 (PCP) Fundus photos
n=2500
Visit 3-7: Intervention
n=150
Visit 3-7 Usual Care
Figure 1: Patient Visits 1-7
Funded by the Centers for Disease Control and Prevention
Cooperative Agreement:U01 DP005127
Contact: Lisa Hark, PhD, RD Wills Eye Hospital