Improving Follow-up and Reducing Barriers for Eye Screenings in Communities: The SToP Glaucoma Study

Abstract

To evaluate factors associated with attendance to follow-up ophthalmic care, and to assess the impact of strategies to improve follow-up. Cross-sectional study. This is an ongoing study to develop an eye screening paradigm, focusing on African Americans ≥50 years of age at multiple urban community sites in Baltimore, Maryland. Several strategies were employed aiming to increase follow-up attendance rates. Multivariable logistic regression was used to evaluate the associations between demographic, medical, and ocular factors with follow-up rate. The total number of referred patients presenting for a free eye examination (attendance rate) during the first phase, during the second phase, and overall was 686 (55.0%), 199 (63.8%), and 885 (57.0%), respectively. In fully adjusted models, the odds ratio (95% confidence intervals) for attending the follow-up visit was 1.82 (1.19, 2.79) for screening in second phase vs first phase, 0.62 (0.39, 0.99) for screening sites that were 3 to <5 miles vs <1 mile from the hospital, 1.70 (1.12, 2.59) in patients with body mass index ≥30 vs < 25kg/m2, 2.03 (1.28, 3.21) in patients with presenting visual acuity < 20/40 vs ≥ 20/40, and 2.32 (1.24, 4.34) for patients with an abnormal vs normal macula. Obesity, short distance between screening sites and hospital, poor presenting visual acuity in the better eye, and an abnormal macula on fundus photography were associated with increased follow-up rate. Implementation of a combination of strategies effectively increased the follow-up rate. Wideradoption of these strategies in other screening programs has the potential to reduce the burden of visual impairment.