Community-Based Initiative May Improve Eye Care Access in High-Risk Populations

On-site eye health screenings can improve access among individuals at an elevated risk for ocular disease.

A community-based eye health screening program geared toward high-risk populations may improve early detection and management of ocular diseases and access to care, according to research published in the American Journal of Ophthalmology.

“Innovative eye health screening methods and early detection strategies to address the rising trend of avoidable vision loss are needed to reduce health inequity and eye health disparities in high-risk populations,” according to the study authors.   “Community-based eye health interventions that consider social determinants of health (SDOH) have the potential to identify and target those at highest risk for blindness.”

Researchers recruited individuals from public housing developments in New York City (N=708; mean age, 68.6 years; 65.1% women; 58.2% Black; 42% Hispanic) for the prospective, cluster-randomized control trial and performed visual acuity screening, fundus imaging, and intraocular pressure (IOP) assessment. Visual acuity worse than 20/40, IOP of 23 mm Hg or higher, or abnormal imaging constituted screening failure. Patients who failed the visual screening, had an IOP between 23 and 29 mm Hg, or an unreadable fundus image were referred for care with an optometrist, while those with an IOP of 30 mm Hg or higher and those with a readable abnormal image were referred to an ophthalmologist for care.

A total of 78.4% of participants failed the vision screening (n=555) and a total of 35% (n=250) were immediately referred for care with an ophthalmologist. Among these participants, 365 were scheduled for exams with the on-site optometrist, and 308 completed the exam. A cost analysis revealed a total cost of $180.88 per participant — $273.64 per patient in cases of disease detection.  

A majority of participants reported satisfaction with the convenience of the location (93%), screening time (85%), and screening team (82%), and 85% reported satisfaction with the screening program overall.

“These results provide important evidence that persons at increased risk could be identified and benefit from community-based eye health screenings,” according to the researchers. “The influences of sociocultural, environmental, economic, and demographic factors in urban settings must be considered to reduce health inequity and eye health disparities in high-risk populations.”

The use of cluster recruitment is an acknowledged limitation to the research. 

Disclosure: Some  study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Hark LA, Horowitz JD, Gorroochurn P, et al. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): baseline results and costs of a cluster-randomized trial. Am J Ophthalmol. Published online January 20, 2023. doi:10.1016/j.ajo.2023.01.019