Mr. Middleton’s Success Story

Glaucoma is one of the leading causes of blindness in the United States, affecting an estimated 2.7 million Americans. Because there are often no symptoms, only half of people with glaucoma know they have it. Once glaucoma is detected, appropriate management can slow the disease’s progression and prevent vision loss. However, vision that has already been lost cannot be restored, making early detection and appropriate treatment essential steps to managing the disease.

Difficulty in reaching high-risk populations and the lack of simple, cost-effective screening programs often hinder glaucoma detection and management efforts. In 2014, CDC’s Vision Health Initiative funded the Wilmer Eye Clinic at Johns Hopkins University Hospital to develop an innovative glaucoma detection and follow-up approach for high-risk populations in Baltimore.

The Hopkins team has implemented Screening to Prevent (SToP) Glaucomaexternal icon —a mobile eye care strategy. Because research shows that glaucoma disproportionately affects African Americans, Latinos, people older than 60 years of age, people with diabetes, and people with a family history of glaucoma, the program has specifically targeted African American and Latino men and women aged 50 years and older in Baltimore.

The SToP Glaucoma team partners with local senior centers and faith and community-based organizations to offer free eye examinations to local residents. Vision screenings and surgeries are provided by a small group of trained students and a glaucoma specialist funded as part of the program. The team also leads educational workshops to raise glaucoma awareness and participates in local health fairs and public health clinics to further extend the program’s reach. Eyeglasses are also provided at no cost to patients who need them, and screened participants are offered financial counseling to help obtain insurance and the ongoing care that they need.

It was at one of these community screenings in May 2015 that James Middleton* walked into his local church in Baltimore with one request—to see well again. Uninsured and unable to afford treatment, Middleton’s glaucoma had been poorly managed for years. When his vision decreased over a short period of time, he knew that something was wrong. Fortunately, he heard that free eye screenings were being offered at his church.

The screening results showed high intraocular eye pressure (IOP), and Middleton was referred to the Wilmer Eye Clinic at Johns Hopkins University Hospital for a free and more detailed follow-up. The follow-up appointment confirmed the initial findings, and Middleton was offered free prescription eye drops to help lower his IOP. To support ongoing care, program staff worked with Middleton to schedule additional appointments, determine his insurance eligibility, and help him enroll in an insurance plan. They also helped him connect with community partners who could help him find programs to support long-term treatment.

Although Middleton’s IOP showed some improvement, his care team recommended a trabeculectomy, a surgical treatment proven to consistently lower IOP in patients with glaucoma. In November 2015, Middleton received the surgery at no cost—the result of a generous donation low-income patients.

Middleton continues to visit Wilmer Eye Clinic for ongoing treatment and care. When asked about his experience, he said he was “extremely grateful and fortunate that everything went right.” Had it not been for his church’s screening event, he may have lost his remaining vision.

Patients like Middleton, who desperately need care but lack the ability to access it, are common in the communities targeted by the SToP Glaucoma program. The community-based initiative regularly encounters patients who enter the program with little or no insurance. They are often in difficult financial and social situations, many reporting that they have never seen an eye doctor before.

Today, the SToP Glaucoma program continues to meet residents at churches, nursing homes, and senior centers, providing an efficient approach to identifying people in need of additional eye care. The staff not only helps identify patients with glaucoma, but they also screen for other eye diseases like cataracts, macular degeneration, and diabetic retinopathy and provide effective follow-up care.

To date, more than 5,000 people have been screened and 2,000 referred for additional care.

* This name has been changed to protect the privacy of the individual.

For more information on CDC’s Glaucoma Initiatives, please visit: https://www.cdc.gov/visionhealth/research/projects/ongoing/glaucoma.htm.