An estimated 2.2 million people are affected by glaucoma.1,2 The prevalence among whites is 1.8% compared with 5.2% among blacks, 4.7% among Hispanics/Latinos,3 and 6.5% among Asians.4 In addition, prevalence increases with age among all groups. A recent study estimates the number of people with glaucoma will increase to 7.3 million by 2050.2
Once glaucoma is detected, appropriate management can slow disease progression and save remaining vision although lost vision cannot be restored. Therefore, early detection and appropriate management are essential to controlling the disease. Detection and management of glaucoma are challenged by difficulties in reaching high-risk populations and by the lack of simple, cost-effective screening plans.
In 2012, CDC funded a new cooperative agreement program, Improving Access to Eye Care Among Persons at High Risk for Glaucoma, to improve glaucoma screening, referral, and treatment. The program is intended to reach those populations experiencing the greatest disparity in access to glaucoma care through an integrated collaboration among private and public organizations.
Two institutions were funded to support this initiative: the University of Alabama-Birmingham and Wills Eye Institute. In addition, CDC is supporting a contract with Westat to conduct a comprehensive evaluation of this cooperative agreement.
This project will focus on developing a community-based, cost-efficient intervention to detect glaucoma and provide long-term care, targeting at-risk African Americans aged ≥40 years. The program will improve the quality of and access to eye care. It will examine the optic nerve condition in which images of the eyes are made at one location, and then later assessed by an eye care professional. The intervention is intended to detect and manage glaucoma in two predominantly African American communities in Alabama (one urban/suburban and one rural) where there are Wal-Mart Vision Centers. Furthermore, it will employ a culturally sensitive, validated eye health education program to help manage the disease with treatment and follow-up care.
This intervention has three advantages. First, it allows an eye care professional to see eye images of a patient using remote access and offer a high-level clinical evaluation in primary eye care clinics serving people who are socioeconomically disadvantaged. These people may ordinarily experience significant barriers to receiving such a high-level evaluation. Second, it provides education on maintaining eye health that is specifically targeted to this population. Third, if this project is successful it can be carried out nationwide at Wal-Mart Vision Centers and other large retailers with vision centers.
The Wills Eye Institute’s 2-year demonstration project, entitled Improving Access to Eye Care Among High-Risk Persons for Glaucoma in Philadelphia, will use existing community partners to plan, develop, and put into action an integrated community-based intervention. The intervention will improve detection, management, treatment, and follow-up care for individuals at high risk for glaucoma, assure access to eye care, and reduce disease burden and related vision loss.
The goals of this intervention are 1) to identify and engage at least 5,000 adults (African Americans aged >50 years, adults of other races/ethnicities aged >60 years) living in underserved communities in Philadelphia, where residents are less likely than people in other communities to have their glaucoma detected and treated; 2) to provide onsite educational workshops to at least 5,000 people to increase awareness about glaucoma and its risks; 3) to perform 2,500 onsite eye examinations to detect glaucoma in these high-risk persons; and 4) to provide onsite management, treatment, follow-up examinations, and referrals for those people diagnosed with glaucoma or suspected of having glaucoma.
- The Eye Diseases Prevalence Research Group. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmology. 2004;122:532–538.
- Vajaranant S, Wu S, Torres M, Varma R. A 40-year forecast of the demographic shifts in primary open-angle glaucoma in the United States. Investigative Ophthalmology & Visual Science. 2012;53(5):2464–2466.
- Varma R, Ying-Lai M, Francis BA, Nguyen BB-T, Deneen J, Wilson MR, Azen SP. Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111:1439–1448.
- Stein JD, Kim DS, Niziol LM, Talwar N, Nan B, Musch DC, Richards JE, Differences in rates of glaucoma among Asian Americans and other racial groups, and among various Asian ethnic groups. Ophthalmology. 2011;118:1031–1037.
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