Michigan Screening & Intervention for Glaucoma and Eye Health through Telemedicine Program: First Year Outcomes and Implementation Costs

Am J Ophthalmol. 2023 Mar 9:S0002-9394(23)00097-1. doi: 10.1016/j.ajo.2023.02.026. Online ahead of print.

ABSTRACT

PURPOSE: The Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program aims to engage people at high risk of glaucoma; we assess first year outcomes and costs.

DESIGN: Clinical cohort study.

METHODS: Participants ≥18 years were recruited from a free clinic and a federally qualified health center in Michigan. Ophthalmic technicians in the clinics collected demographic information, visual function, ocular health history, measured visual acuity, refraction, intraocular pressure, pachymetry, pupils, and took mydriatic fundus photographs and retinal nerve fiber layer optical coherence tomography. Data were interpreted by remote ophthalmologists. During a follow-up visit, technicians shared ophthalmologist recommendations, dispensed low-cost glasses and collected participant satisfaction. Main outcome measures were prevalence of eye disease, visual function, program satisfaction and costs. Observed prevalence was compared to national disease prevalence rates using z-tests of proportions.

RESULTS: Among 1171 participants enrolled, average age was 55 years (SD=14.5), 38% were male, 54% identified as Black, 34% as White, 10% as Hispanic, 33% had ≤ high school education, and 70% had income <$30k. The prevalence of visual impairment was 10.3% (national average 2.2%), glaucoma and suspected glaucoma 24% (national average 9%), macular degeneration 2.0% (national average 1.5%), and diabetic retinopathy 7.3% (national average 3.4%) (p<0.0001). 71% of participants received low-cost glasses, 41% were referred for ophthalmology follow-up, and 99% were satisfied or very satisfied with the program. Startup costs were $103,185; recurrent costs were $248,103 per clinic.

CONCLUSIONS: Telemedicine eye disease detection programs in low-income community clinics effectively identify high rates of pathology.

PMID:36906094 | DOI:10.1016/j.ajo.2023.02.026