MANHATTAN VISION SCREENING AND FOLLOW-UP STUDY IN VULNERABLE POPULATIONS

Glaucoma is a chronic optic neuropathy resulting in visual field defects, progressive vision loss, and blindness.In the United States, glaucoma is the leading cause of blindness in African Americans. African Americansdevelop glaucoma at a younger age, progress more rapidly, and are almost 7 times more likely to go blind thannon-Hispanic Whites. Rates of glaucoma are projected to increase by 50% to 3.36 million people by 2020. Theincreasing prevalence of glaucoma is expected to cause a significant economic and quality-of-life burden,therefore, we have designed the Manhattan Vision Screening and Follow-up Study in VulnerablePopulations, a cluster randomized controlled trial, to identify and implement innovative strategies to engagepopulations most at risk, most vulnerable, and least likely to have access to eye care. The study population iscomprised of disadvantaged men and women ≥40 years old of diverse race/ethnicity (primarily AfricanAmerican and Hispanic/Latino), with high rates of inadequate eye care, living in affordable housing buildings inNew York City. Participants randomized to Enhanced Intervention Using Patient Navigators Arm 1 (7 buildings)who fail the screening and need vision correction will receive free eye glasses. If they are referred to anophthalmologist, they will receive enhanced support with patient navigators over 2 years to assist with allaspects of follow-up eye care, specifically appointment scheduling and arranging transportation to eye examsand cataract surgery. Participants randomized to the Usual Care Arm 2 (3 buildings) who fail the screening andneed vision correction will be given an eye glasses prescription only and a list of optical shops. All participantswho pass and/or fail the vision screening in both arms will be invited to the 12-month and 24-month visionscreening, which will take place at the same housing buildings. We will follow participants prospectively for 2years to evaluate the effects of the intervention on presenting visual acuity and health-related quality-of-life(primary outcome), adherence to follow-up eye care and cataract surgery (secondary outcome), falls risk andrates of falls (safety outcomes), and participants’ satisfaction following screenings. The aims of the study are:1) Develop and implement an innovative, community-based vision screening and follow-up study where peoplelive to increase engagement, detection and management of glaucoma, vision impairment, cataracts, and othereye diseases in vulnerable populations living in New York City affordable housing buildings; 2) Evaluate theeffectiveness of an enhanced intervention using patient navigators to improve visual acuity, adherence tofollow-up eye care and cataract surgery, and quality-of-life in vulnerable populations living in New York Cityaffordable housing buildings; 3) Conduct an economic analysis of the costs and benefits of the proposedapproaches to examine the cost of the screening and intervention, cost per case detected, and the cost-effectiveness of the Intervention vs. Usual Care Arms; and 4) Replicate, scale, and disseminate protocols,materials, and manuscripts.