Telehealth Initiative May Identify Ocular Pathology in Underserved Communities

A telehealth initiative designed to identify individuals at risk for ocular pathology is able to determine eye disease prevalence and visual function while providing a satisfactory experience for individuals in an underserved community, according to research published in the American Journal of Ophthalmology.

The Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program is 1 of 3 demonstration projects funded by the Centers for Disease Control and Prevention to assess whether novel approaches to eye disease detection may be effective. At 2 clinics serving low-income communities in Michigan, the telehealth initiative recruited 1171 patients (mean age, 55 years; 38% men; 54% Black; 33% Hispanic; 70% income <30k/year) between 2020 and 2022.

During clinical visits, patients underwent visual function, visual acuity, refraction, intraocular pressure (IOP), mydriatic fundus photography, and optical coherence tomography (OCT) assessment. An ophthalmologist remotely evaluated all data of participants in the telehealth initiative. Patients were provided with treatment recommendations and low-cost spectacles when necessary. The main outcome measures included the detection rate of eye diseases, patient satisfaction, and program costs.

A total of 24.6% of patients in the telehealth initiative has visual impairment (worse than 20/40) in either eye, 18.7% had uncorrected or under-corrected refractive error in either eye, 24.4% had glaucoma, 21.5% had cataracts, 7.3% had diabetic retinopathy, 2.0% had macular degeneration, and 14.5% had other eye conditions. The prevalence of each condition exceeded national averages, according to the report.

Glasses were ordered for most participants (71.0%) and 41% were recommended for follow-up with an ophthalmologist within 1 year.

Overall, most patients were very satisfied (90.7%) or satisfied (8.3%) with the telehealth initiative, were very likely (92.0%) or likely (6.6%) to recommend the program to others, and stated the program was very convenient (86.7%) or convenient (11.6%). No significant differences in satisfaction outcomes were observed between clinics.

The telehealth initiative had a start-up cost of $206,369.27 and yearly cost of $496,206.09, according to the report.

“[P]lacing the MI-SIGHT program in trusted primary care clinics in easy-to-access locations in the community enabled a successful community outreach strategy to engage participants in the program,” according to the researchers. “This approach–placing eye disease detection programs in trusted primary care clinics in communities, such as [federally qualified health centers], that serve persons with high levels of poverty–could present a targeted national screening strategy that is more cost effective than campaigns that encourage people to visit an eye doctor for screening. Leveraging telehealth to provide high quality eye disease detection in [federally qualified health centers] could potentially be a cost-effective strategy for large-scale public eye health programs.”

Study limitations include the use of convenience sampling and the lack of an in-person control group for comparison.