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Principal Investigator: Jeremy David Keenan
Organization: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Fiscal Year: 2024
Award: $695,692
Funding agency: National Center for Chronic Disease Prev and Health Promo
PROJECT SUMMARY/ABSTRACT
Most glaucoma in the United States goes undetected, and hence, untreated until late stages of disease.
Open angle glaucoma is a progressive disease that is asymptomatic in its early to moderate stages and thus
may be amenable to screening. Eye disease screening of the general population is not currently recommended
given low-cost effectiveness and insufficient evidence of improved health outcomes. However, screening in
higher-risk groups, including Black and Latino individuals, could be more cost-effective.
This randomized trial will assess the feasibility and effectiveness of telemedicine-based glaucoma
screening for high-risk populations. The specific aims of the proposal are (1) to determine the effectiveness of
a telemedicine-based glaucoma screening program for detecting glaucoma, (2) to determine if a telemedicine-
based glaucoma screening program provides ancillary benefits besides detection of glaucoma, such as
detection of cataract or refractive error, and (3) to determine the cost-effectiveness of a telemedicine-based
glaucoma screening program.
The trial will be conducted at Federally Qualified Health Centers (FQHCs) in northern California since
the burden of undiagnosed glaucoma is expected to be high in this population—both due to poor access to
care and because most patients seen at California FQHCs are Black or Latino. We will randomize patients to
one of three groups: telemedicine screening, direct mail educational brochure, or a delayed intervention. In the
screening arm, a community health worker (CHW) will call patients to schedule a screening visit. The CHW will
operate a mobile telemedicine screening unit that drives from clinic to clinic to perform screenings. The CHW
will perform all screening tests, including optical coherence tomography (OCT), virtual reality visual field
testing, and tonometry, and will upload the results to the existing telemedicine platform EyePACS. Participants
in the education arm will be mailed a brochure about the importance of glaucoma screening with a phone
number to schedule a screening visit. The delayed treatment arm will be mailed a brochure at the end of the
study. The primary outcome will be a self-reported diagnosis of glaucoma, assessed by phone at 3 months.
This research uses novel portable tests, and it has been designed to be financially sustainable in the
real world. Leveraging the existing EyePACS telemedicine platform reduces barriers for FQHCs to participate,
simplifying the administrative and logistical burden for FQHCs and improving the potential for easy scalability.
The trial focuses on detecting new cases of glaucoma, since this is the crucial first step in establishing whether
glaucoma screening of high-risk populations leads to improved health outcomes.